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Jennifer0512 6,367 Views

Joined: Jan 16, '09; Posts: 217 (16% Liked) ; Likes: 47
Pediatric Nurse Practitioner; from US
Specialty: 2 year(s) of experience in Pediatrics

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  • Nov 16 '12

    Sorry, all advance practice nurses are created equally. None of them is superior to any other, and I don't know anyone who thinks otherwise except students who don't know any better. We think of ourselves, along with our PA brethren, as well as MDs and DOs, as colleagues. We have different specialties and backgrounds, but we are all peers. This constant need to "rank" people is jejune, and only diffident people feel the need to play that game. Everyone brings something unique to the table. When you are working within a group, you quickly learn how to work together toward everyone's strengths and all that ego nonsense falls away.

    Grown ups do not discuss their salaries, how gauche.

    I've got news, the coding police, practice managers and risk mangers ultimately out "rank" us all.

  • Jul 18 '12

    People tell me I'm an easygoing guy. I can handle 3 exams in a week, or a multiple page paper that's length rivals something from Tolkien. However, we all have our breaking points, our moments when we enter a crossroad. We can either snap, or bite our lip. This was that kind of week.

    It was the week that I had one of the most high maintenance patients in the history of creation. He seriously called for me every 10 minutes, on the minute. I started to question whether he had an alarm or stopwatch set to the exact time.

    "Is Adam there? He's needed in room 21"

    I let out a sigh that could of bristled leaves off of the trees outside. It's a hush of white noise that disquiets the static.

    The nurses around me float a grimaced hemi-lipped smirk in my direction. Our eyes lock as I peer upward from my downturned gaze of disbelief.


    Of course, again.

    Have you ever sat down to start a project, and the very second you get started, you get disrupted? It's like putting down the baby to sleep, after she's been crying for an hour, and the moment that silence darkens the room, the postman shows up and rings the doorbell.

    Chaos ensues.

    That's the kind of day I've been having. I haven't been able to chart, or finish looking up my medications, or work on my plan of care, or come up to answers to the dozen questions I've been assigned to today.

    Now I'm not one that really gets stressed, but I'd like to attempt to finish ONE thing today. If for nothing else, then just to say I started AND finished something.

    Let me go see what he wants this time.

    I stop at the door, use the hand sanitizer, and get my mind right. I clear my head, and with my melting thoughts, my face becomes blank. I can't show him that I'm irritated; I have to be comforting and strong. He's the one that could be hurting.

    Mr. Lewis, all 240 pounds of him, is tossed on his side in his bed. His gown is disheveled, his sheets and blanket thrown on the ground. He looks up at me, and says that he has to go to the bathroom.

    I knew that's what he wanted before I came in. This is probably attempt number 17 in the past 2 hours.

    I really do feel bad for the guy though. I've never really had any problems with my GI system. Sure, we've all be constipated or suffered from diarrhea, but this is different. He hasn't had a bowel movement in 4-5 days. I'm hoping it happens for him pretty soon.
    He needs to get up slowly, because due to his condition and some of the medications he's on, his blood pressure can drop if he rises too fast. He can get dizzy, or light headed, or nauseous.

    I don't want any of those things to happen, because they all require some part of him to fall, and probably fall on top of me. He's a much bigger guy than me. Big crushes not as big. That's just science.

    I help him stand, remind him to steady himself for a second, and let it all settle in. It's like embarking on some new foreign land, it's better to take in the scenery, plan your next move. We move in tandem over to the toilet where he semi-plants himself.
    Whew. Now I partly close the door and wait.


    I debate in my mind whether it's better to leave the room for a while and have him call when he's ready to get up. I've done that before, it's not that big of a deal. He's safe and fine on the toilet.

    But, I know that every time I've done that, he calls for me the minute I step out of the room. It's weird how that happens, but that's just the way life works sometimes. It's like the kid that spills orange juice all over the place right after you've cleaned the floor.
    I hear a grunt, a gurgle, and a semi-scream. Ok, now I'm a little intrigued and worried at the same time. It's important not to overexert yourself in situations like this. Some people 'over push' on the toilet.

    TMI, right? Well, it's true.

    I knock on the door and enter.

    The man looks enthusiastic and relieved. There's a glisten of sweat on his bald head.
    I think he did it.

    "How do you feel? Did you do it?"

    He nods up and down slowly, a mouth full of smiling teeth.


    I jump up and down inside my head. I want to high five him, but I know I can't. That whole feces and bare hands thing... not a fan.

    I tell him I'm really happy for him, and we sort of bond there, while in the bathroom. The look on his face almost says "Thank God that's over. I feel so bad for making you come in here every 5 minutes to help me".

    I know that sounds like a complicated look, but that's really the feeling that his stare gave me.

    I respond with a look that says "It's ok, I've never been in your spot, but I understand that it must have been really hard, and basically sucked".

    He finishes up, and we travel back over the bed together. He flops himself onto the mattress, a look of triumph and reward still radiates through.

    And within a minute and a half, the man is passed out sleeping. He's silent except for the rushing sounds of air in and out of his lungs.

    The chip on my shoulder broke off and fell onto the ground right at that moment. This man changed me. He helped me work on my patience for patients. He made me appreciate the little abilities we have that we take for granted. He made me learn to work hard.

    I tilt my head to the side and let out an inside laugh.

    It's the little things that make your day.

    I think we both had a good day today.

  • Jul 16 '12

    Quote from Jennifer0512

    And in my opinion, I think that RN experience doesn't hurt, but I do NOT think it's necessary--especially in the primary care route, it may be more helpful if you wanted to be an acute care PNP.
    I completely agree with this. I wouldn't want to do acute care without hospital peds experience, but it does almost nothing to help you in a primary care setting. Aside from just extra experience listening to breath sounds and maybe some familiarity with asthma medications, etc. The two worlds are SO different.

  • Jul 11 '12

    The moment you look at the pregnancy test and see that the result is a positive, you're entire world automatically changes whether it is your first pregnancy or your tenth. You have 40 weeks, maybe less depending how far along you were when you found out, to prepare for this new bundle of joy. Most parents are hoping for either a girl or a boy, while some just merely pray for a healthy baby. I was one who was hoping for a boy seeing as though we already had our little girl.

    At 12 weeks on a Friday, a doctor told me that I was having an inevitable miscarriage and to go home and rest because there was nothing they could do. I was instructed to make an appointment with my OB for Monday and I did as I was told. The OB ordered an ultrasound STAT and performed it himself. There on the screen was our precious baby still alive and swimming around inside me

    After that mishap my perspective changed and all I could hope for was that my baby was healthy. The pregnancy continued well after that with the exception that I was huge rather quickly for no apparent reason considering nausea was occurring 24/7.

    At 29 weeks I went in for an unplanned visit due to some irregular pains, only to find out I was dilated and in premature labor and had very high amniotic fluid levels. It took over a week to keep my labor at bay well enough to move me out of the labor room and into a regular room. It took another two weeks of bed-rest in the hospital before i was able to leave and be with my 2 year old daughter; unfortunately I wasn't able to go home because I would be too far away from the hospital so we stay at one of the hospitality houses with me on strict bed-rest.

    Almost a week went by, putting me at 33 weeks, and I woke abruptly in the middle of the night because my water broke. Within 4 1/2 hours my beautiful son had entered the world and was being whisked away to the ICU. He was found to have a condition known as Tracheal Esophageal Fistula (TEF) & Esophageal Atresia (EA). Automatically I knew he would need to be transferred to a different hospital to receive the proper medical attention he would need.

    At two days old my son received a major surgery to repair the TEF & EA, and within a couple of hours, he was back in the OR having emergency surgery to repair a hole in the back of his trachea caused by his ET Tube. Part way through the surgery my son went into complete cardiac arrest and died on the table, the doctor said they were trying everything they could, and managed to save him, but if it had been a matter of seconds more, then he wouldn't have made it.

    My son continued to have many problems and still does to this day. He was on a ventilator for over two month, coded twice, stopped breathing multiple times, required oxygen, has chronic lung disease, had a tracheostomy and requires a feeding tube. I was unable to hold him until he was 6 weeks old and unable to touch him for the first 3 weeks of his life in which he was kept paralyzed. He was in the NICU for the first 5 months of his life and has been in and out many times ever since. He is a year and a half now and has had more than 14 surgeries.

    Due to all these events in my life, I met some amazing people, but what helped keep me strong through everything was his nurses. They made such an impact on our lives, and it made me reconsider what I wanted to do with my life. Watching them every day through the ups and downs made me realize that I have the strength I never thought possible and that I want to make a difference in other people's lives just as they did for me.

    My son is doing much better now, still has a lot going on but we have adjusted accordingly, and it became clear to me that it was time to start college for nursing. I will be starting in Fall of 2012 and I'm pretty excited. I have my son & his nurses to thank for the path I am taking.

  • Jul 2 '12

    I had been working with medically fragile kids for over 10 years and while all of my patients were special to me, this one was different. I had been hearing about this "walkie-talkie" five-year-old boy for months, we'll call him Joseph. I was intrigued by the stories of Joseph and itching to get the chance to work with him, when finally my day came. I walked into a room full of sponge bob, spider man and every kind of video game, puzzle and book you could ever think of. Sitting smack dab in the middle of all these toys was a small, chubby cheeked, cutie pie with a trach in his neck and a ventilator attached. He immediately looked up at me, and with an Alvin the chipmunk voice, gave me a squeaky and cheery "Hi! Are you my new nurse?" I was amazed by him in that instant.

    I obtained report from the day nurse and a quick orientation and was left alone with this special little man. As I was starting my notes and talking with him, I nonchalantly asked him his trach type and size. He immediately replied, "Bivona 4.5 uncuffed." Wow! This was a smart kiddo I had on my hands that knew his stuff! He even knew all of his meds by the color and amount in the syringes! By the end of my first shift, even after he whooped my butt at memory, I was hooked. I called my agency and begged to be his full time nurse.

    I quickly learned all of the words to Sonic Underground and how to play a mean air guitar. After all what good would a nurse be to this little guy if she couldn't play air guitar in his band? He loved pinching my nose in his tiny hands and tossing it into his mouth right after screeching, "Got your nose!" Water gun fights were a daily occurrence and it seemed to be the end of the world if the internet wasn't working and he couldn't play his Scooby Doo Mystery Game. He went back and forth on whether he thought he was a baby or a big boy. One day he might be dressing himself, brushing his own teeth and even holding his trach in place while I changed the ties. The next day he may be in baby mode and want every little thing done for him, including his blanket moved to the perfect position. You never knew what mood he was going to be in. He could be the sweetest kid that ever lived telling you he loves you, you are beautiful and giving you hugs and kisses left and right. Within five minutes without anything seeming to change, he could hate your guts while giving you a mean dirty look and sticking strongly to the silent treatment. He knew what he wanted and he knew how to work the nurses to get it. And of course, we gave in every time.

    Several days into working with Joseph, I realized just how sick he was. His trach secretions could go from white to boogery brown within hours. His poor little body shook with pain when he'd have a coughing fit. We kept him on 2-5 lpms to maintain his oxygen above 94%, but this often wasn't enough. We had to wake him every 2 hours to put him through IPV treatments that were extremely painful for his frail body. He'd beg us to skip the treatment saying, "No Manda, just hold me." My heart ached for what he was feeling. He'd spent his entire life going in and out of the hospital every couple of months. He had two families that loved him dearly, one at home and one in the hospital.

    He'd wake up many nights asking to be held. I'd pull him onto my lap and he'd swing his tiny arms around my neck, snuggling his face into my neck. Those are the moments I lived for. He needed me and I needed him.

    At a time of my life when I was feeling alone and lost, Joseph kept me going. I had moved halfway across the country, away from my family and friends for a relationship that was now failing. Joseph was my light in this dark time. He was the reason for me being away from everything and everyone that I knew and loved. I was with him 48-60 hours a week. I'd drop plans in a heartbeat and drive the hour to his house if he needed a nurse. He was my baby. My heart was consumed with love for this tiny child and he was all I could seem to talk about. My family and friends back home asked about him every time they called and my mom and sister even had the chance to speak to him on the phone several times. He was a ham that loved the attention.

    The first time I received a middle of the night call, I was in disbelief. iI had just gone to bed when my phone rang. It was Joseph's mom. Joseph had been in the hospital for a couple weeks with a lung infection. As soon as I answered the phone, I immediately knew something was wrong. His mom had received a call from the hospital saying they didn't think he would make it through the night and she was on her way to be by his side. She needed me there also. Within minutes I was in my truck and flying down the freeway to get to my little man. I called my mom on the way crying hysterically, saying that I wasn't ready to lose him yet. I parked my truck in the first spot I saw and ran through the hospital to the 3rd floor. I slowed down before entering his room, afraid of what I'd find. It was odd, I heard laughing. I walked in and saw a drugged up looking Joseph sitting up on his bed smiling.

    "Hi Manda!" Confused but relieved, I swooped him up in a tight hug, snuggled my nose into his neck and breathed deeply his sweet smell. After a few happy tears I walked out to the nurses' station to get a report of what happened. Apparently he'd became very lethargic in the early hours of the night and they thought they were losing him. After a trach change and an IPV treatment he was back to good. Phew! That was one of several scares. I was amazed at the resilience of this boy.

    Christmas came and Joseph was home. Santa came to his house and Joseph sat on his lap and belted out his long list of toys he didn't yet have. Christmas day was filled with toys and wrapping paper but he soon tired and needed to return to his room for a nap.

    The months went on and Joseph continued to be in and out of the hospital with either pneumonia or pseudomonas. He signed up for his make-a-wish and Morgan's Wonderland was all he could talk about for weeks. He rarely was able to go outdoors, unless to head to a doctors appointment or a trip to the ER. Joseph was elated at the thoughts of trains and merry go rounds. When the weekend came for his trip, he wasn't feeling too well. He was taken to the doctor and told he'd have to miss his trip. he was just too fragile. We were all bummed for him. He deserved to go. In an attempt to cheer him up, I decided to paint his room from the boring white that it was to a bright sponge bob blue.

    It was Joseph's 6th birthday and it was his first birthday home. We celebrated with cake and candles --not the smartest idea considering her was on oxygen-- and lots of presents. I finished painting his room the next week and we planned on moving him from his temporary spot in the living room, to his new blue room the next day.

    It was 10am and the physical therapist was at the house helping Joseph walk across the room. After she left he was exhausted and just wanted to rest. By 11am I realized something wasn't right. He was whining and crying, which wasn't typical. He wouldn't let me out of his sight and he just kept saying how tired he was. As soon as I left the room to retrieve his meds, he lost it. He started crying hysterically and his oxygen immediately began dropping.

    I first tried calming him, but he automatically started calling out orders between sobs. "Suction me Manda!" Done. "Change my trach!" Done. "My vent isn't working!" I had his mom ambu bag him to help him breathe while I tried trouble shooting the vent, which was working correctly. By now we were up to 10lpms and his oxygen saturation's were in the 70's.

    There is only one thing left to do when nothing else is working to sustain your patients vitals. I picked up the phone and dialed 911 for the first time in my life. "I have a baby here on a ventilator and I cannot keep his oxygen saturation's up. Please send someone now."

    [font=&amp]joseph looked up at me with anger in his eyes and though gasping for air he managed to yell out, "i'm a big boy!" i quickly corrected myself to the 911 operator and hung up the phone. thankfully, within mere seconds the paramedics arrived.

    The 30 minute ride to the emergency room seemed to take forever. The paramedic knew Joseph and knew that the situation wasn't a good one. My little baby kept his big, scared eyes focused on me through gasps, trying to get oxygen into his lungs.

    "A home is a home, home is wherever Im with you. Apples, peaches, pumpkin pie, you're the apple of my eye. I ain't nothin without you."

    I kept singing our song as I clutched his hands and tried to keep myself together. Soon his beautiful eyes turned red and he slipped into an unconscious state. My baby, my silly pants, sponge bob loving little man was limp in front of me. "home is wherever I'm with you.... don't leave me baby."

    Even with sirens blaring and the ambulance driver flying down the freeway, I felt like we'd never get to the hospital. Upon pulling up to the ER there was a crowd of medical staff waiting for us. Joseph was somewhat of a celebrity in the pediatric medical community. He was a light in all of our lives and everyone seemed to be available in that moment to help him. Once in the trauma room I stayed by his side.

    "A home is a home. Home is wherever I'm with you. Please don't leave me little man. I need you."

    The doctors, nurses, and respiratory therapists all worked around me. His mom was not at the hospital yet and the doctor kept asking for his DNR (do not resuscitate) order.

    "Everything but compressions. Do everything you can but compressions."

    I kept trying to tell them what the DNR said and that his mom would be there with it soon. His little body was so limp on the gurney. His eyes no longer bright, happy and alive. My heart was breaking. "Home is wherever I'm with you."

    Soon his mom arrived and stood in the hallway looking in with disbelief. I ran to her and we wrapped our arms around each other.

    "What did I do to our baby?? I don't know what happened. He was fine this morning. What did I do to him??", I asked through sobs.

    With a loving and stern look she grabbed my shoulders, gave me a gentle shake and said, "You didn't do this. Joesph is a sick little boy and it wasn't anything you did or didn't do to bring us here."

    At that moment I swore off nursing. I can't do this the rest of my life. Too much responsibility. Too much sadness.

    We went back to Joseph's side and each took a hand in our own as the doctors worked around us.

    "A home is a home. Home is wherever I'm with you. Don't leave us baby boy."

    Within approximately 15 minutes after arriving in the ER, the chest x-ray results were available. It was a collapsed lung. The doctor inserted a chest tube and we waited as his O2 saturation's began to slowly climb and his heart rate stabilized. We were transferred up to the pediatric intensive care unit and were still in shock from the happenings of the previous hour.

    I was standing in the hallway with his mom as the nurses and doctors got his ventilator, suction machine, 02 and all other tubes and monitors situated on his tiny, limp body. I remember telling the nurse the meds he was on as I kept my eyes trained on Joseph lying in the bed.

    Then it happened,I saw his hand move. Thinking it was a reflex, I didn't get my hopes up. Then he moved his head and opened his eyes. I ran to his side, threw my arms around him and cried tears of joy and sweet relief.

    He looked from me to his mom and all over the room. He couldn't talk due to being on a different ventilator than his normal home vent. Being the amazing, resilient kid that he is, he immediately pointed to the tv and mouthed the words "Sponge Bob." Although turning on the TV wasn't a priority for any of us at the moment, we did as Joseph said and turned on Sponge Bob for him right away. Next thing i know, he was grabbing at my nose and tossing it in his mouth. "Got your nose!" he mouthed! Always finding a way to make everyone around him feel better, this little boy melted my heart for the millionth time in that moment.

    We left the hospital that night knowing that Joseph was in good hands and feeling as though we dodged yet another bullet. I was scheduled to leave for California to see my family that next day and was feeling unsure about whether I should still go. Since first starting work with Joseph, I knew that I wanted to be a constant in his life. I wanted to be a nurse that he could depend on. I also wanted to be with him when he passed away. Up until the moment my plane took off the ground, I was on edge about whether I should go or not.

    The morning of my flight I spent in the hospital with him in my arms. He slept on me for several hours, clutching tighter to me with every little move I made to try to readjust my body in the awkward position it was in on his hospital bed. Still being unable to talk due to the vent, I did the talking. Ever since months prior when we thought we were going to lose him, Joseph had been seeing "monsters." He said they would be near him in his bed and came around every time he had a coughing fit or didn't feel well. For months we hadn't known how to calm his fears of these monsters or what to tell him to make him feel safe.

    In this moment in the hospital with him in my arms, recalling the terrible, scary ambulance ride to the ER the day before, it came to me. I moved Joseph into a position where I could see his face and had him look in my eyes.

    "Last night an angel came to me Joseph. Angels are special people with big, beautiful wings that protect other people. These angels told me that they are looking over you. They wanted me to tell you that you have nothing to be afraid of. The angels come around to help you when you are scared and hurting. When you are ready and feel comfortable with these angels, you can go with them. The angels can take you to a place where you won't be sick anymore. A place where you can run, and laugh and play without coughing and without hurting. One day we will all go with the angels. Me, mommy, all the other nurses and everyone you love will meet you in heaven one day.

    "The angels will take you to heaven when you are ready and you can be a happy, healthy big boy and wait for the rest of us to come see you. Joseph, you weren't seeing monsters all those times, baby. You were seeing angels. Don't be afraid of them. Go with them when you are ready, be a free and happy big boy. We will all see you there one day."

    I don't know how much he understood, but I saw his eyes soften. He looked at me, kissed my cheek, nodded his head as if to say "OK" and wrapped his tiny arms back around my neck. We sat that way snuggling for another hour, until the very last second when I had to leave and catch my flight. I gave him big kisses and told him several hundred times how much I loved him and how proud I was of him for being so brave.

    "A home is a home. Home is wherever I'm with you." Then I left.

    I was in San Diego for 4 days, calling the hospital and Joseph's mom several times a day for updates. Things were touch and go, but he was a strong kid, a fighter, a resilient boy with the heart of gold that was loved by every person that ever came into contact with him.

    He was also a tired boy. On july 11, 2011 at two o'clock in the morning, Joseph went with the angels. I received the call from his mom. Waking up, I looked at my phone, realized who was calling and answered it without saying anything. I didn't have to say a word, and neither did she. I knew my baby was gone.

    Within hours I was on a flight back to Texas. I had to be there, I had to be near Joseph and see his mom. Words cannot explain the grief I felt for the following weeks. Joseph, a foster child, was a member of Native American tribe that required his body be taken from the hospital soon after his passing. He was laid to rest in sacred ground , and we were not permitted to attend his burial. I still don't know where his precious body lies.

    As nurse I open my heart to fragile lives. I do my job and try my best to keep my patients as happy, healthy and comfortable as possible. I am constantly losing patients either from them getting better and moving forward in their lives or by them passing away. Each patient leaves a mark on my tender heart and I hope that I have also touched their lives. Being a pediatric nurse is the most important thing in my life. I am honored to be able to care for these precious angels in waiting.

    Although I have seen many of my tiny patients pass away, Joseph has been the one that left the largest impression on my heart. It's been a year since he left this world, but there isn't a second of any day that goes by that I do not think of him and feel him near me. He taught me how to have fun, love, be patient, have hope and most importantly, he showed me that even the tiniest, weakest bodies can have super human strength. I will forever hold him in my heart and be eternally grateful for the year that I was able to spend with him.

    "Apples, peaches, pumpkin pie, you're the apple of my eye. I ain't nothin without you. A home is a home. Home is where ever I'm with you."

    I love you precious boy. Forever in my heart.

    *The patient's name has been changed keep confidential.

  • May 6 '12

    Imagine, if you will, emerging from the best sleep of your life and finding yourself in a strange land, surrounded by light and peace. Realizing that you have arrived at the gates of Heaven, you look around and note that there are other people here with you.......hmm, must've been a bad day on Earth for so many folks to be moving in at the same time. But there is also overwhelming relief in knowing that you've worked your last double, and you wait patiently at St. Peter's desk while he searches for your records, anticipating joyful reunions with long-departed loved ones.

    After a couple of minutes, he pulls up the file, briefly clicks through the pages, then pauses. "So, you were a nurse," he chuckles knowingly. He beckons to you as he smiles and says, "Come with me.....I have a few people for you to meet before I take you up to the Big House."

    Curious, you follow as you're told, marveling that your feet no longer hurt and your back has stopped its ceaseless groaning. St. Peter then calls to a shadowy figure in the distance: "Mrs. Perkins, look who's come to join us." Suddenly she materializes right in front of you and greets you warmly; you instantly recognize the sweet elderly woman you cared for as a new nurse. She was dying of metastatic ovarian cancer then, in tremendous pain despite a morphine drip, yet she had treated everyone with kindness and never even complained when you came in every two hours to reposition her. You'd had to excuse yourself and cry in the bathroom when she finally passed; it's good to learn that her prayers to "go home" were answered.

    The next person you meet is the 42-year-old tele patient---a husband and father of two little girls---who coded on a sunny Tuesday morning as you were admitting him. You've never forgotten his pleading eyes, nor how he went from pink and freckled to grey, then blue, then almost purple within minutes. He had clutched your hand and begged you not to let him die just before he lost consciousness. So you never quite got over feeling as though you'd failed him somehow, despite knowing that the battle was lost before it began. Now he stands before you, pink and freckled again, and he reaches for your hand once more, as he did that fateful morning. "I know you did everything you could," he says. "Thank you for trying---as you can see, it all worked out for the best."

    You can practically feel the old wound heal instantaneously as you are guided to the third patient, a 60-year-old Vietnam War veteran who had spent his last years in the nursing home, lying in bed listening to his TV (he was nearly blind) and dealing with phantom pain in the limbs he'd lost to diabetes.....when he wasn't at dialysis, that is. A man of few words and even fewer complaints, he had won your admiration with his positive outlook despite having such poor quality of life, and the day you attended his military funeral, and heard the lonely bugle playing "Taps" at the end, was one of the worst in your entire life as a nurse. Yet here he is, happy and whole like you've never seen him before, and his voice is strong now as he says "Thank you, babe" like he used to whenever you did something for him.

    The fourth patient you meet is something of a surprise: she's the patient you thought was from the Bad Place. She'd come to your assisted living facility under protest, and to make her anger known, she berated nurses and aides for any reason and no reason, refused meds and then complained that she felt bad, and reported everyone for even the smallest infraction of what she thought should be the rules. In fact, she was generally so rude and nasty that half the staff refused to go into her room, and the other half usually came out of it in tears. But somehow you managed to slay the dragon with a combination of skill, active listening, and old-fashioned emotional intelligence.....and while she never warmed up to the facility (let alone made any friends), she now kisses your cheek and expresses her appreciation. "No matter how badly I behaved, I always knew you cared about me," she says with the first smile you've ever seen on her face. "You made me feel safe."

    But it's the sight of the fifth patient that blows your Sunday-school concept of Heaven to smithereens and makes you question, just for a moment, where you've landed......for this one is the alcoholic, meth-addicted, HIV-positive frequent flyer who bit you and drew blood while you were admitting him for something like his eighth detox in the two years you'd worked at that hospital. What a nightmare THAT had been.......the frequent blood tests, the waiting, the sheer fear that you might come down with that dread disease. And for what? So this loser could go out, drink and drug himself nearly to death, and come back in (on the public dime, no less) for treatment he didn't want and threaten the staff with exposure to a deadly illness?

    Strangely, he too looks amazingly well for someone who'd been such a shambles the last time you saw him on earth. He is clean-shaven and sober; his shoes and socks are no longer one; and you notice that he's actually quite handsome.

    Still, you can't help reacting, and the words "What are YOU doing here?" fly out of your mouth before you have the chance to stifle them. He grins shyly, ducks his head and blushes a little, and then begins his narrative.

    "Well, it's a long story, Ma'am," he says. "When I was in the hospital that last time---when I bit your arm---I hit bottom. My mom came in to see me after I got detoxed and told me she was done with everyone else in my life. She said that she couldn't deal with a son who'd try to give HIV to someone who was helping him---it was like attempted murder, she said. So I guess God or somebody---maybe it was you? told me to let the social worker get me into a rehab. And I did."

    He pauses briefly while you stand there, astounded at what you're hearing. "Long story short, Ma'am, that changed my life. I cleaned up, went back to school, found a job. I even got married and had a couple of kids before I went into full-blown AIDS. Those were some tough times, but I never drank or used again......thanks to you."

    "Me?!" you sputter, nonplussed. "You gave me the scare of my life! I took care of you because it was my job, not because I wanted to. In fact, I used to curse whenever I saw your name on the report sheet, or heard you were coming up from the ER. I couldn't let YOU know it, but....."

    "And that's just it," he interrupts, softly but firmly. "You treated me like a person, even after I bit you. You never stood over me and judged never came in with a bunch of other staff and talked about me when I was passed out and nobody thought I could hear them. I figured if someone like you could show me respect, even with everything I'd done, then I should at least respect myself that much. That's the only reason I made it."

    His words fill you with gratitude as you shake hands, and the thought occurs that maybe, just maybe, you DID do something right as a nurse.....and as a human being. And as St. Peter guides you toward your ultimate destination, you finally come to understand what it really means to make a difference. Not just in the Johnson & Johnson commercial way, but in real life, for real people. And for that, you can rest easy knowing you've truly earned those angel wings.

  • Feb 29 '12

    Here's some tips from the other side:

    - There are about 20 bazillion schools in my area. If you aren't from the school I attended, telling me what semester or rotation you're on tells me nothing (unless you tell me you're on your first or last one). Tell me what you're allowed to do or what your goals are. "I can give any medication except blood or chemo." "I want to work on my IV skills." "I need my instructor to supervise any Foley insertions."

    - I work in the ER, where there is NO privacy. If I'm really encouraging you to do something boring with me, there's probably a reason behind it that I don't want to say in front of the patient. Yesterday I had a patient with really cool wounds that were in various stages of healing from newly formed to eschar covered. I asked one nursing student if she wanted to learn how to do wound cultures because I didn't want to say "Hey, check out this dude's funky arms! Aren't they awesome?" She was smart and caught on to what I was saying.

    - Don't be afraid to say "Can I watch?" In the ER, there are overhead announcements whenever a critical patient comes in. We teach students what they mean so they can say "Hey, since we aren't doing anything right this second, I'm going to go check out that Code 3 GSW to the head." Be the awesome friend and if someone is pulling you in to watch a procedure, grab your classmate on the other side of the floor if time permits.

    - Get my attention so I know you're there and looking to learn. If you're with the nurse next to me but really interested in one of my patients, don't be afraid to talk to me. Some of the EMT students spend the whole day taking histories from patients and when they ask me about my patients, I'll tell them who has an interesting story, who is cranky, and who doesn't speak English.

    - Doing "scut work" for me gives you good karma, and makes me more likely to find you when something interesting is going on. Also, don't discount the skills you're learning when you're cleaning a patient who is taking lactulose, from log rolling to breathing through your mouth.

    - Let me cheer you on. I had two patients who needed IVs yesterday. An EMT student missed twice on the first patient and he really didn't want to try on the second patient. After a little cheerleading from me and his instructor, he got the next patient on the first try and I hopefully will have some awesome IVs from the patients he brings me in the future.

    - A lot of RNs have cool stuff on their unit that you don't think is cool. That just means you are probably not an ortho/dialysis/oncology nurse. I think the OR is deadly boring (sorry OR nurses!). Some students come to the ER and turn green at the really cool stuff we have. That's ok. Be nice and learn what you can.

  • Feb 29 '12

    Good luck in school. I would be sure that if you are feeling treated poorly that you are unconsciously wearing a chip on your shoulder from being defensive. Some people are just haters and they always will be, mostly because they don't understand and are jealous. Be gracious and move on.

  • Feb 27 '12

    Phew - took the GREs this morning and got a 158 verbal/156 quant. From what I have seen, that equates to approximately a 1300 with the old scoring! YAY!! And that is without the essays. Now I just have my interview and will wait with fingers crossed.

  • Feb 24 '12

    I've got an awesome NP. And I'm an annoyingly non-compliant patient. She talks me into what she thinks is really important. Let's me be stubborn when it can pass for now. LOVE her.
    And an amazing ED NP did some sutures on my little sis's face. You have to know where to look to see the scar. And discovered a fracture that nobody expected was there. (Huge pain tolerance and decreased sensation made for hidden broken bone.)

    There's room for everyone. And anyone new to their position should look to the people that have been there a while for guidance, even if their "rank" is "lower."

    Give me someone competent. I don't care what the letters after their name happen to be. If you can get me better, that's what I care most about.

    I'm lucky to work with some really great mid-levels. PA and NP. They make my job easier. Love them!!

  • Jan 18 '12

    Have you never seen this before?

  • Dec 30 '11

    I don't believe this is going to go under business expenses unless you are part of a business. If you are a student, things can get deducted but you have to be very careful. See a tax adviser and let us know!

  • Dec 30 '11

    If I'm not mistaken, business deductions must also meet a certain percentage of your salary. If you do not reach that monetary amount, then you cannot deduct it. I'd check it out though.

  • Dec 30 '11

    I believe so. Consult with a tax advisor or look it up in an IRS pub. IRS Publication 17 covers everything the normal person would ask. This would probably come under "business expenses". Check if there is a recorded message line at the IRS that you can listen to on the subject. I think my state used to have one for state taxes and I believe there might be one for the feds.

  • Dec 14 '11

    A Nurses Christmas
    Author Unknown

    T'was the night before Christmas
    & all through the floor,
    The Lasix was filling the foley's galore.
    Stockings were worn, to prevent emboli,
    They came in two sizes: knee, and thigh-high.

    The patients were nestled half-assed in their beds,
    While visions of stool softeners danced in their heads.
    We in our scrubs, and they in their gowns,
    Fashions created to hide extra pounds.

    When down in E.R. it became such a zoo,
    They called with admissions, for me and for you.
    They're coming, they're going, they're looking the same,
    My patience for patients is starting to wane.

    Another call light is ringing, the patient expounds,
    "I have not had my peri-care, please send someone down."
    About now delegation seems a good plan,
    We pass onto others, the needs of this man.

    When what to my wondering eyes should appear,
    But Santa himself, and 8 tiny reindeer.
    He states that he came from Central Supply,
    To bring us LR, NS, and D5.

    The doctor then scribbles what no one could read,
    Orders instruct us to measure their pee.
    As we try to decipher illegible words,
    We find a new order to guaiac their turds.

    The next shift arrives; our day is now through,
    Only to discover emesis inside of our shoe!
    We give them report and pass on the facts,
    And tell them of duoderm lining the cracks.

    And the Nurses exclaimed as they drove out of site,
    Let there be Ambien for all, and to all a good night!