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Sarah Matacale

Sarah Matacale

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Sarah Matacale has 20 years experience.

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  1. Halloween can be a nightmare for kids with food-based allergies and the parents who have to monitor for them. This seemingly simple holiday is not as easy for some as a knock on the door and getting a treat; it can mean life-threatening anaphylaxis and a trip to the ER. I have been unlucky enough to be on both sides of Halloween hypervigilance. As a child, I was very allergic to chocolate and peanuts. I know...right??!!! Can there be worse on Halloween than the build-up and excitement of waiting to see what sweet treasure gets dropped in your treat bag only to unload the majority into "the parent's stash" later that night? I was stuck with candy apples, popcorn balls and some sweet tarts. No full sized Snickers or 2 pack Reese's peanut butter cups here! When all was said and done, I had a handful of candies and my parents' bucket overflowed. Fast-forward a few decades to our oldest son.....allergy laden from birth thanks to the wonders of genetics. He was allergy tested before he was 2 years old...as I prayed that the massive hive on his scratch test site was not a chicken nugget allergy (as that was all he lived on back then), we were somewhat surprised to hear "He is allergic to peanuts...here is a booklet with instructions and an EpiPen...." He had not even eaten peanuts at that point in his life, so we really did not know what his reaction would be. He is our firstborn, and very type A, so he grew to be very aware of what his food was cooked in, manufactured in a factory with, or possibly containing. Even with the best efforts, he has had a few exposures. Each exposure has brought much worse symptoms than the last. Halloween is now his watchful holiday; I was lucky enough to outgrow my food allergy and the "parent stash" has come full circle for me...Snickers and Reese's for me and my hubby and sweet tarts and Epipen on hand for my son!! As I was writing this article, I reached out to Dr. Purvi Parikh, MD. She is an adult and pediatric allergist and immunologist with The Allergy & Asthma Network. Many children are diagnosed after they have been exposed and have a reaction to a known or unknown substance and receive further testing. Testing is routinely done by an allergist/ immunologist in the office by either scratch test or blood draw and serum markers. A diagnosed food allergy can obviously benefit the health and welfare of your child, however, even with known allergy, the presentation may worsen or change with repeat exposure. Parents, caregivers should be aware of risks and signs and symptoms of food allergies even if the child is not known to have an allergy at present. One risk factor for developing a food allergy is, "having just one parent with any allergies. This can increase risk in a child by 50 percent", according to Dr. Parikh. Some of the biggest food allergy culprits in Halloween candy are milk, eggs, wheat, tree nuts, peanuts and soy. The most common allergic responses noted by Dr. Parikh are, "Rash or swelling which is isolated or can be accompanied by trouble breathing, vomiting, diarrhea, stomach cramps or loss of consciousness. Anything more than a rash can be a sign of a dangerous allergic reaction called anaphylaxis." Dr. Parikh encourages, " all parents: allergies can be life-threatening, please take them seriously even if your own child does not have them, their friends may. If your child or another appears to be suffering from any of the above symptoms, Dr. Parikh recommends, "using an epinephrine autoinjector if your child has one and seek medical attention to be a sure reaction not progressing. If you do not have one seek medical attention so that you can be treated asap in case the reaction is progressing." Keep in mind while trick-or- treating or during holiday parties that "the only food or candy you have control over is what you prepare yourself. The safest thing for food allergic kids is to not eat the candy they obtain. They can still participate and dress up but don't eat it. Parents - have safe candy or toys for your food allergic child as a substitute. Educate kids who have food allergies to not consume food given to them by outsiders." Also keep in mind, "often even candy that may seem safe could be packaged in an area near allergens and cross-contamination can occur". With a few modifications, your child with a food allergy can still have as much fun as all other children. Being alert and aware of potential hazards and having safety precautions and techniques on hand, can be life-saving for a known or even unknown allergy exposure. Talk to your child, your children's teachers and friend's parents regarding your child's restrictions. Remind them all of how serious food allergies can be, and when possible find alternatives to known allergy foods. Some safe options and revisions can make Halloween a fun and Emergency free holiday!! And parents...keep the "parent-of-an-allergic-kid" yummy stash out of reach or hidden from your kids to avoid any temptations, while you make sure not to waste their hard-earned procurements...wink, wink! Dr. Purvi Parikh is an adult and pediatric allergist and immunologist with The Allergy & Asthma Network She completed her fellowship training in allergy and immunology at Albert Einstein College of Medicine's Montefiore medical center. Prior to that, she completed her residency at The Cleveland Clinic Foundation in Cleveland, OH and she is board certified by the American Board of Internal Medicine as well as the American Board of Allergy and Immunology. She completed her B.A. in political science at Emory University and received her M.D. from St. George's University.
  2. For many of us who know of Kati Kleber, it's as a nurse on a cardiac med-surg step-down unit, the author of several books including Becoming Nursey, or as a speaker, blogger and podcaster specializing in educating and supporting brand new nurses. As if this is not enough, there is way more to learn about this super nurse that fuels and strengthens her passion within the profession of nursing. Born and raised in Illinois, Kati declares herself "a midwestern girl at heart". Kati started her nursing journey after graduating from Parkland College in 2007 with an Associates Degree in Applied Science. (She also played basketball while studying nursing at Parkland). By 2010, she obtained her Bachelors of Science in Nursing at Iowa Wesleyan University. For the next 2 years, Kati worked as a nurse on a Cardiovascular med-surg unit in Champaign, Illinois. 2012 was the year that took her out of the Midwest, planting Kati in Charlotte, North Carolina working as a nurse on a Neurocritical Care Unit. Within a few months, the world would become familiar with Kati Kleber RN! This article is featured in the Fall 2018 issue of our allnurses Magazine... Download allnurses Magazine Kati had always enjoyed writing but had no outlet until 2013 when she figured out how to blog on Tumblr and Twitter under the anonymous nurse persona named Nurse Eye Roll. Her passion was supporting and educating new nurses. As her social following began to grow through the blog, one of Kati's friend recommended that she create her own website and begin maintaining social platforms to support it.....NurseEyeRoll.com was formed! Kati remained anonymous through her Nurse Eye Roll persona, adding humor to everyday experiences in bedside nursing. She began writing short but funny posts on time management, delegation and prioritizing. She gained even more popularity. Kati found that she was receiving many of the same questions from supporters and was spending countless hours tending to the blog and followers while still working a full-time job in a busy neurocritical care unit. While searching for a way to be compensated for her work and hours blogging and also a way to provide answers and guidance to new nurses, Kati's friend suggested she write a book. She did just that. In 2014, Kati wrote Becoming Nursey. The biggest struggle at that time was her decision to become public with her real self, no more anonymity. She was encouraged by many trusted friends and colleagues to take credit for her work and revisit all of her prior writings to be sure no violations both personally and professionally had occurred. In November 2014 Becoming Nursey was published and Kati Kleber was no longer hidden from the world. Since its release, it has sold over 20 thousand copies, has been re-published by the American Nurses Association (ANA), and is used by nursing schools and residency programs all over the country. When collaborating with the ANA, Kati made some changes to the first edition and added the title Becoming Nursey, Anatomy of a Super Nurse. Amazon's book description states: "Armed with tons of information- and lots of laughs-anatomy of a Super Nurse shines light onto the dark spots in a nurse's first year, equipping you with everything you need to become a successful bedside nurse". As the book started to generate income, the blog started to gain sponsors, and Kati was asked to do some public speaking. She started to hear from healthcare professionals, potential sponsors and collaborators that they were having a bit of difficulty with the Nurse Eye Roll name. They understood the humor in it, but found it a bit hard to market, and possibly offensive to some. So after much soul-searching, Kati found herself at another crossroads....an opportunity to reinvent herself so-to-speak. If her passion for supporting and educating new nurses was going to be her focus, Kati felt that Nurse Eye Roll may not be the best way to obtain that goal. The name did not convey what she desired most and it began to require explanation...not what Kati wanted to be her focus. During this time of change in 2015, Kati was awarded Nurse of the Year by the Charlotte Business Journal and received the Great 100 Nurses of North Carolina Award and was a guest on the Dr. Oz show! Looking back, this is the time that Kati really feels was a turning point in her career. Kati spent much time in 2015 and money rebranding her entire platform to FreshRN. This allowed her to focus her strategy, which she is so glad she did. Freshrn.com currently contains a blog and podcasts hosting a wide variety of topics for new and experienced nurses alike. It provides both practical information and encouragement for those beginning their bedside nursing career. The website also offers courses designed to educate and provide CE hours. Lastly, there are links to books that can offer more to beginning nurses, those new to the healthcare system, mentoring and precepting, as well as blogging advice. The past two years have been a whirlwind of writing, blogging, public speaking and family growing! Katie and her husband welcomed their first child in 2016 and in December of this year are adding baby#2. Kati has partnered with the American Nurses Association again, publishing two more books. What's Next is written for the nurse who is no longer new, but is not the most experienced nurse on the unit. A nurse in this stage is starting to be asked to mentor and precept as well as take the charge nurse role. This book is designed for this time in a nurses career when the role starts to change and options open up for advanced practice and education. What's Next addresses these and other topics. Admit One was written for patients or those entering the healthcare field and want to learn more about the flow and culture of the hospital. " I go into things like a nurse vs. nurse manager vs. CNA vs. NP vs. physician, the difference between consulting and attending physicians, what to expect from different levels of care, code status and more". Her next book focuses on another area close to her heart. Having found her voice in blogging, Kati encourages nurses to blog as well. "I encourage nurses who have a specific passion to dive deep into that and think about how they can innovatively serve that niche." She motivates fellow nurses to be smart and productive with blogging. "We all see and hear enough complaining, and while writing may be a therapeutic way to deal with some of the challenging aspects of our field, publically publishing a blog simply to complain isn't going to go far." With this in mind, Kati and her friend Brittany Wilson BSN, RN independently published The Nurses Guide to Blogging which has been a huge success. "It lays out how to build a platform on a blog and a community around it". These days, Kati is very focused on completing her Master Degree in Nursing Education. She and her family moved back to the Midwest in 2017 and she states she is very happy to be back to her roots in Illinois. She is still working PRN at the bedside in a cardiac med-surg/step-down unit. Kati feels it is important to keep her foot in the door of practice. "It is really hard to write about/ for an audience when you are physically removed from it. I find a lot of value in providing direct patient care". She works 12 hours a week at the bedside and spends the rest of her week working on her Master's practicum in hopes to complete it before baby #2 arrives. She has also recently released an online crash course for new nurses in neurosciences and is soon to release a cardiac course as well (available at freshrn.com/courses). Kati is very present in the challenges of balancing her time with grad school, clinical roles, social media, and family. Speaking to these challenges, Kati says the key is "proactive communication with my husband (with whom she just celebrated 8 years of marriage with) and family. Intentionally disconnecting from the business/ platform and not being constantly accessible is a really important boundary to have and maintain. I also try to be keenly aware of balancing what I personally enjoy and what brings me joy and not stress/ anxiety, what challenges me, and what brings in income. She enjoys free time (watching Harry Potter, the Simpsons and The Office) and spending time with her family and two adopted dogs (coincidentally named Mac and Tosh...not adopted at the same time or named together..) The field of nursing has been blessed that Kati Kleber found her public and professional voice years ago. She has continued to offer much to both new nurses and seasoned as well. Her career and path thus far speaks volumes to finding your passion and running with it... the number of nurses and patients/ families, and healthcare workers affected by Kati's passion in insurmountable! The power of one voice........
  3. About 5 days after our daughter was born, she stopped breathing during a bath. I had been a cardiac critical care nurse for a number of years at that time. You would think that I would know exactly what to do. I will tell you exactly what I did...I ran around crying in a very tight circle while my husband who is a doctor did CPR. After what seemed like forever, EMS and Paramedics came with a NICU team to take her to our local hospital (where both my husband and I worked). As a nurse, I have always been awestruck by what Emergency Nurses do each day, but I will say that I have never been more so than I was that day. I rode with our baby girl and her NICU nurse in the ambulance. I found myself waiting on the nurses every word for reassurance. Watching her care for my sweet girl was a surreal experience as I knew exactly what she was doing and why, yet I was helpless and trusted her literally with my everything. We arrived in the Emergency room where we were greeted by familiar faces of friends and colleges. I needed them to cry with, to calm me, to help me think clearly as my husband was finding someone to watch our 17 month old son. Pediatrics is not my thing, so heart rate monitors alarming with rates outside of adult parameters sent me into a panic. I had dealt with these nurses with adult critical care patients and knew their skill set. I was thankful to know those skills did not depend on the age of their patients. We were transferred to a tertiary care hospital by another NICU transfer team. Exhausted both emotionally and physically (I was just 5 days postpartum), I was able to sleep in the ambulance...another testament to the confidence I felt with the transport team. We spent a few more days at the hospital for what was thankfully just reflux. I have never been able to forget all of the "feels" that went along with that day. Each Emergency nurse that worked with my daughter also worked with me as a mom, a patient, and a nurse. Our family will forever be grateful. Fast forward several years to my new routine of picking up my oldest from kindergarten. As I was driving to get him, I witness a head on, high speed collision. I see the car fly at least 50 feet in the air and watch the driver eject from the car and land a few feet in front of my van. I slam on the brakes and get out to help. The young man is not breathing. I am in shock and trying to sort out what I am supposed to do. I have my kids in the van, the man is not breathing and bleeding from everywhere, and there is drug paraphernalia that flew from his car all over the road. (This makes me think harder on what to do...what if he has infections related to IV drug use). As I go back to my car to get gloves and CPR barrier, I hear voices start to approach the scene. Like a golden angelic glow...I see 3 faces of Emergency room nurses that I work with coming to help! It just so happened that at that very moment 3 nurses who were all ER trained were in that exact spot! They were calm and collected. They surveyed the scene, gave instructions, worked together, told me how to help...all until EMS arrived. That man lived despite so many life-threatening injuries thanks to those nurses. When you come upon an accident, you don't have to stop to help. You are either a person who jumps in head first or shys back knowing someone trained is on the way. Emergency nurses are the engrained to stop and help no matter the situation, lifestyle of the person in need, race, color, religious preference, age etc. Emergency nurses have one of the broadest and all-encompassing roles in nursing. They care for newborns, temperamental toddlers, children, teens, adults and elderly. They educate and nurture pregnant mothers, the frightened parents of children, and concerned loved ones. They provide end of life support to the patient and family members who sometimes anticipated this time and others who are thrust into it by life circumstances. They provide critical care at a moments notice for however long is needed to get the patient to the next level or care. During any given shift, Emergency nurses may be responsible for an inmate with an armed guard at bedside, a gang member who has been shot or stabbed in a street fight, a teen in a car wreck with parents on the way, a toddler having seizures with a fever over 104F, a 50 something year old man with new onset rapid afib and rising troponins with EKG changes, an intoxicated addict, a kid with a broken arm during a football game, and on top of that, a stream of people who visit the ER for ear aches, stomach bugs and pink eye. They are cursed at by families wanting quicker care. They take the attitude of those of us ICU and floor nurses whose units are already full to capacity as they are trying to transfer their care. They have to remember that radiology has not yet picked up the patient for their CXR to rule out pneumonia and that the lab needs the second set of blood cultures. They need to read cardiac monitors, bandage wounds, start IVs, monitor chest tubes, airways, run a code, and monitor sedated patients. Without even a thought, Emergency nurses seamlessly navigate from patient to patient, family to family and room to room, working with different doctors and orders along the way. They have one of the toughest, most exhausting yet rewarding and heroic roles in our community and healthcare today. Thank you so much from this fellow nurse, mom, wife, family member and friend. You are appreciated!
  4. Sarah Matacale

    Well Kiss My Grits Flo!

    Well Kiss My Grits Flo! Hurricane Florence: A Tale from a nurse in Eastern NC I stole this title from a boarded-up restaurant window that I saw today in our small town in Eastern North Carolina. If any of y'all (see how I did that..y'all) have ever read my articles, you know that I am a nurse and my husband is a doctor. We have 3 young kids and are transplants (over 20 years ago) from the northeast. Yankee's as we are lovingly and no-so-lovingly (at times) referred to down here. Growing up, we both had snow and ice to contend with....lots of it. We are experts at getting to work, school etc in winter conditions. We know how to prepare for such...when to prepare and with what. We both practiced medicine there and know how emergency personnel will get you to work if you can't get yourself there. When you get to the hospital, you better plan on staying...indefinitely. That being said, we have weathered through some serious hurricanes and tornadoes here in North Carolina, however, nothing compares to this baby named Florence. She has set our state and several others in a widespread panic. We have been watching Florence casually for about 10 days, I am guessing, to see what she might amount to. Hurricanes are not unfamiliar here. Anytime you have a "season", such as hurricane season, and the storms get a name, you know it's a pretty regular thing. People down here know their storms. They can track a storm, know the wind patterns, surges and flood zones with more accuracy than the IV team placing an 18 gauge. They know their local weather person by name (good ones and bad). They will smack talk about another person's trusted forecaster like they are college basketball players, and each "storm-watch" day facebook lights up with memes of the local weather celebrities. So, when the locals tell you it's time to worry as they compare the storm statistics of Florence to a catastrophic storm tale from the 1950's, you know you know it's time to get serious. As serious as a post-op patient with decreasing urine output! Oh, and we got the National weather celebrities setting up camp at our coast...cue the memes. Thursday was the day we were told she would hit land as a category 4. We were projected to be hit by the eye of this massive storm bringing catastrophic conditions such as 30 to 40 inches of rain, severe flooding, crazy high wind and storm surges. So, Monday morning we started preparing. The grocery stores were already sold out of bread and much of their canned and boxed food. Water was sparse so I grabbed all that I could. Got batteries, food for pets, and other necessities. We just built a new house in the country that has well water. The power goes out easily here, and we are one of the last to get turned back on as we are the furthest out from the city. No power equals no water...no water also equals no toilets flushing! Yikes. Got as much water as we could by Monday night. Got all medicines refilled and emergency medications on hand for what could potentially be a week or more without power. My in-laws at the coast were on high alert on Monday. They expected to evacuate to us on Wednesday or Thursday. I bought wine....... Tuesday morning was when things got real. We started getting messages from our hospital's Emergency Response Command Center. At this point, they were offering optional time for staff to volunteer to work during the storm. They were offering to pay minimum wage for essential personnel to just stay at the hospital during "off hours". Overtime for those working extra. Our hospital hotel was preparing to house staff. Nutrition, pharmacy, IT, and materials management were working tirelessly to prepare for the influx of staff, families, and patients that would be stranded there as well as managing the communities needs. Transfers from coastal hospitals had started. Still category 4 with increasing strength possible before landfall. We get out all the emergency equipment. Get more water and canned meat! I project by the end of all of this, that we will all have gained 10 pounds yet be malnourished. How can canned meat, veggies, poptarts, and Doritos sustain us? Get a generator. Get the outside living areas ready and moved indoors. Reschedule all later week appointments. Many friends have beach houses. They head for the coast to literally batten down the hatches and move their boats and personal belongings to safety. Evacuations start to become mandatory along the coast by early afternoon. State of emergency is declared to assist with much-needed services and supplies. Both sides of highways leading away from coast get opened as traffic is bumper to bumper. Pets! Get your pets ready. People pleading for anyone inland who can take horses, chickens, goats etc. Bring dogs in. Set up plastic pools with sod in them for safe potty locations for dogs. Farmers are working non-stop to harvest their tobacco, (one of our largest sources of agricultural income here). Preparations for the crops of soybeans and cotton that were planted a few weeks before. Schools make the decision to close early Wednesday and remain closed Thursday and Friday so that families can prepare and/or evacuate as many have chosen to do. My in-laws (hard-of-hearing, judge-whoever-watchin, leave your chewed apple core on the couch arm...) have come......get more wine. Wednesday morning the weather celebrities bring a bit of good news. Overnight the storm has shifted some to the south. We MIGHT not get the eye directly, however, she is expected to stall adding strength and increasing our flood potential. Emergency resources start coming in. Urban search and rescue, medics, ambulance strike teams, swift water rescue and the national guard. Ok...now I am scared. Hospitals along the coast start to evacuate their patients inland. Our hospital is now on high alert. Any persons able and willing to work in any capacity at the hospital are requested. Those scheduled to work must be prepared to stay indefinitely. You will be fed, housed, and paid. The IWarn emergency paging systems are tested over and over. IT is preparing for probable power outages which makes patients medical records unattainable in our paperless charting world. Our ambulance and air transport teams are activated and ready. Facebook lights up with messages of stores that have water and batteries. Check on the elderly people in our lives. Make sure all friends and family are ready. The phone calls from friends and family out of state are increasing...."Where are you in relation to all this?" About 100 miles inland I say but this storm is huge, slow and powerful. "Stay safe...you are welcome here....we are praying for you". Kids are released early. The schools have been sending messages of how to help our children cope with the stress and anxiety of all this. With all of the panicky adults running around preparing for doomsday, with our constant news feed running on our phones, radio, and TV warning us of the damage to come, and the discussions at school and home about how to stay safe or evacuate in case of emergency, it's no wonder they are a mess. We all are. "Will our Nintendo switch work off the generator?"...sigh. Have cards, board games and books onhand...check! State of emergency starts Thursday night at 5p, meaning no unauthorized persons are allowed on the road, and YOU CAN'T GET ANYMORE WINE..... It is now Wednesday night. We are watching the latest on the storm. It looks quite beautiful from the space station. Massive (covering the state) and beautiful. Our sunset was particularly stunning tonight. Stars are out, air is cooler, wind is slight, bugs are less. Would be a great night to sit on our front porch in our rocking chairs....but alas, they are safely stored away. We are as ready as we can be. We now watch, wait and pray....and have a glass of wine.....
  5. I am a nurse...married to a Doctor. That notion seems to spark a lot of interesting conversation and questions in the non-medical public. The title of this article being one of them. "Oh wow....is it just like you see on Grey's Anatomy?" My husband and I usually look at each other, wink and giggle because at first it kinda was. I mean when you are in your twenties and dating someone new, no matter the profession, isn't it all kind of sexy and flirty? Fifteen years, both of us now working primarily from home, three kids and two dogs later, our life is more like Jurassic Park. Some kind of "crisis" coming at you every few seconds, severely outnumbered, fatigued, and in pure survival mode. (Teehee, reminds me of my CCU days). Anyway, there is no one I would rather be on this wild ride with, so I will share our story...the good, the bad, and the ugly of this Doctor-Nurse love story. To start with, we did not meet at the hospital. That's usually the first question. We actually met at a bar. A dive bar for that matter. As it turns out neither of us was planning on being there that night. He had just come off a bazillion hour internal medicine residency shift (this was back when there was no cap on number of hours residents would work) and I was out to decompress with my best Critical Care nurse friends. My husband approached me first, but I had a general rule against dating someone I met in a bar, so I flirted along a bit without intention of seeing him again. He asked for my phone number and I said no. I don't give my number to guys in a bar either. I will say I was intrigued by him that night. My husband is very funny, and smart and quite handsome, but I went on my way that night with friends I came with, lots of laughs, the smell of smoke and bad beer on me. ( I hate beer, but somehow every night in a bar when you are in your twenties has you leaving with beer spilled on you...blechh). A week or so later, I was getting ready for resident/fellow rounds on my CCU patients, and in walks my now husband...scrubs and all. He had worked all night and was reporting on his new admits. Say what???? He was going to be working in my unit for the next month! Surprise to me, but he knew I worked there was tickled with the potential. I was actually scheduled for a lot of overtime on nights that month, setting us up for the "Grey's Anatomy" questions for years to come. We started to talk a lot. Got to know each other over our sick as snot patients who circled the drain every few hours requiring both of our full attention and time. So, was it sexy? Yes it was....I mean who doesn't like seeing their guy in scrubs, a little 5 o'clock shadow from working the last 36 hours, engulfed in what he does best, focused, in control of the situation, and rocking his biceps while putting in a central line! Whew! I am not sure that I had much sexy going on at 3am in my scrubs and crazy socks, tending to our crisis at hand, but my husband tells it different and that's what matters, right?! We had tons of fun learning and working together. He would bring me a cup of coffee every morning, we would try to have lunch or dinner together, we stayed up way too late at a diner talking and learning about each other on our "off shifts". There were no negatives during that time to our nurse-doctor duo. We were in a bubble so-to-speak with working and dating in a teaching hospital. Fast forward a bit...we fell in love, got married and moved to a small town with a tiny small town hospital where we both took jobs. My husband was a hospitalist and I was an ICU nurse. The "nurse married to a Doctor thing" became a thing. I was surprised. No real negatives came his way, but I on the other hand was in a whole new world with new battles. The first thing I realized, was a bizarre sense that I married up (in the medical team world). I was treated different by my fellow staff members. They were afraid of talking or venting about their "doctor frustration" as I will call it. They were very guarded in taking me in, unsure of my allegiances. This was so weird to me. I was, am, and always will be a nurse. My job is to care for my patients and their families. I work as part of a care team. We are all supposed to be part of the same team and there should not be a nurse versus doctor dynamic. Then came the belief that if my colleagues could not get the orders they were looking for that I could call my husband and influence him to speak to his partners to get the orders. Uh...no. I am not a liason. I was asked to call to get patient's moved out or into the unit, medication changes, lab orders etc. In the small town we lived in, my husband and I would socialize with other doctors and administrators and their wives/ husbands. Now I was really "in" with the physicians and admin. The nurses looked for gossip on the doc's we worked with. What does his wife look like? Is she more relaxed outside of the hospital? Does he drink? The list goes on. I have always been relaxed around people, no matter their job title. I don't see myself as less than, or anyone as greater than me. We each have unique jobs and educations. I do mine, my husband does his. Sometimes the two intertwine but it's always professional. I don't pull any strings or ask for favors, and neither does he. As he started climbing the career ladder, I would overhear other staff members complaining about him or his team. Man was/is that hard. I really felt stuck in between two worlds. I want to say that the benefit I have found in marrying a doctor is that I am always learning. When I too would question why my doc wouldn't give the OK for morphine for my patient, I can ask why without seeming to be challenging a judgement call. I can find the medical reason why it would not be beneficial. I did not go to medical school or study in depth pharmacology. I went to nursing school and I rock at advocating and caring for my patients. When I ask why, I can then explain to my patients and families better. More information can be soothing. In my current job, I can ask my husband again for his knowledge and expertise before I approach another physician with a query. (I now work in Clinical Documentation). I do all my own work and always have, but sometimes an inhouse "medical google" comes in handy. As he and I have changed jobs and areas of work, we have encountered new challenges. Mostly the challenges are mine. When asked to join committees, or climb the career ladder at a hospital where my husband is well established and well respected, I find myself asking, did I get this role because of me or my last name? I am smart, focused, and opinionated (sometimes good, sometimes bad- it's a "born-in-Jersey-thing"). I have to strive each day to prove that I am not riding on my husband's white coat tails. It is emotionally tough when in a group of colleagues where I am treated as an outsider. I am "one of them" not just a nurse. We've come a long way since our "Grey's Anatomy" years. These days, we wake up way before our kids to start our work day, as we both work from home. We juggle work and kids in school with tons of activities. We rock paper scissors on who takes the dogs out, who scoops the cat's poop, and who makes dinner that night. Our sexy, is now a comfortable pair of yoga pants for me and gym shorts for him work attire, with medical questions and "can you read this before I send it?" being yelled across our country farmhouse with a big echo and lousy internet. We attend conferences and meetings together but sit with our colleagues and as always we strive to maintain professionalism. I will say that what has not changed over the years, is that he still brings me a cup of coffee every morning, and that he is just a sexy as ever doing what he does best. I do love our life, that just so happens to be a doctor-nurse love story!
  6. This article is featured in the July 2018 edition of our allnurses Magazine... Download allnurses Magazine School nurses have always been one of the most diverse and unique subspecialties in nursing throughout the decades. While the specific job responsibilities and pay may have changed some, the mission and purpose of the job remain constant. The National Association of School Nurses defines school nursing as " a specialized practice of nursing, that protects and promotes student health, facilitates optimal development, and advances the academic success" of its population. First and foremost I want to stress the many areas in which school nurses serve the community, the vital roles they play with our youth today, and the challenges that come with those roles. As we dive into the 2018 allnurses.com salary survey results we can see trends in the field of school nursing such as salary comparisons, full or part-time hours, years of experience etc. Are school nurses compensated for their responsibilities appropriately? I will let you decide. Let me start by saying that I am not a school nurse. I am a nurse that has worn many hats in my 20+ year career, but school nursing is not one of them. I will say, however, that I have ALWAYS wanted to be a school nurse. As a child, they were the nurses that I had the most exposure to on a daily basis. They seemed to always play a huge role in the school's day-to-day function. I was awed by what school nurses knew, the fact that they teach AND practice medicine to hundreds of students, staff, and visitors. They were so organized, knew who to call and when and what was a true emergency. At the end of the day, they knew that sometimes we just needed a hug, a listening ear, and some TLC. I decided to be a nurse because of my school nurses. After nursing school, it was apparent that I needed to get experience before applying to work as a school nurse. So I did. When the "right time" in my career came to jump in, I realized that school nurses love what they do! They don't leave their jobs until they retire and I can't say I blame them. So my career and calling as a nurse went in different directions. Then, my admiration for school nurses was taken to a new level when I became a mother to three little hooligans, who, despite my best efforts grew up and started school. I was about as much of a wreck as any other mom on our first child's first day of school. He is still to this day, at 12 years old, our clumsiest child, peanut allergy laden, and asthmatic. This added to my anxiety by sending him to school, epipen and all. No joke, on the FIRST day of school, I got a call from his teacher to tell me that my son had walked into a wall and had a large goose egg on his head. I was then asked by the teacher what did I want her to do with him. What? I said...well, if you think he needs attention, send him to the school nurse. That's when I found out that, in our school district, a school nurse visits each school only one day a week and serves up to 4 or 5 schools! During that day, the nurse's job consists of managing paperwork and teaching teachers how to give kids their medicine's, perform CPR, manage seizures, anaphylaxis etc., until emergency personnel arrives. SAY WHAT??!! Since that day, I have become a school nurse advocate extraordinaire. I believe in my heart of hearts that school nurses serve as one of the most important members of our community. Their job is so broad, ever-changing, and wide-reaching, that it cannot be compared fairly to any other in the field of nursing. They work as health educators and medical and mental healthcare professionals. One would think that school nurses would be one of the most valued members of a school system and the community as a whole, which would then lead to appropriate compensation, respect, and funding. Boy, was I wrong..... I was shocked with several statistics that I discovered in writing this article, but this is one of the most profound to me. According to the Centers for Disease Control 2017, 18% of schools have NO school nurse at all or serve in a part-time capacity, and over 55% of schools have nurses responsible for 2 or more schools at a time! As parents, we send our kids to school entrusting that they will be in a safe, cared for environment. If, in the worst case scenario, they need medical attention for a chronic illness or an emergency such as injury or life-threatening condition that the school would be staffed to handle the situation. Obviously, this is not true for many of us. How are teachers and school administrators expected to care for these needs? Teachers are educated in teaching. Administrators are educated in administration and education. Nurses are educated in healthcare, health education, and medicine. Simply put, teachers and administrators are not nurses and should not be responsible or accountable for that role. According to the U.S Health Resources and Services Administration (2016), over 20% of students that are enrolled in school, enter with a chronic health condition. Such chronic diseases as diabetes (with complicated glucose management systems), seizures, asthma, and of course allergies, (the dreaded food allergies included) are just a few examples off hand. School nurses are able to trend patterns seen with these conditions and can play a major role in student's disease management through collaboration with pediatricians, specialists, parents, pharmacies, and community health staff. They can safely administer prescribed medication and assess and intervene if necessary. When/ if an emergency arises, they can communicate effectively with other medical personnel and start care immediately which can be crucial in many situations. Let's talk about mental health in children. Many mental health disorders are not "officially" diagnosed until children are school-aged or older based on patterns in behavior, grades, and social situational responses. Collaboration with teachers, school nurses, pediatricians and mental professionals is pivotal in providing quality outcomes for these kids. School nurses participate, initiate and intervene in the treatment and management of ADD, depression, bullying, suicidal behaviors and autism, just to name a few, common mental health issues seen in schools today. Roughly â…“ of visits to the school nurses are mental health related. School nurses get to know the children and family situations they serve. From a community health perspective, think of the impact they have on children who may be abused, neglected, malnourished or lack adequate healthcare. Early intervention can prevent further mental health crisis down the road. Nurses are trained in the management of factors that come with mainstreaming children with mental health disorders. This is one area of education that is ever changing and can be very challenging for teachers and staff. Education is a key job responsibility for school nurses. They educate staff regarding health care issues of students and other staff. They participate in producing policies and procedures for environmental safety emergencies both outside and inside the school building. They educate students about maintaining their own health and wellness, diseases, social pressures, mental health, and community health concerns. They educate parents and caregivers on issues affecting their children such as diseases, immunizations, and concerns noted by school staff. This of course, is just a broad overview of some of the vital roles school nurses play in schools and the community at large. With the amount of responsibility placed on these nurses and the number of "patients" they serve each day, lets venture into some of the statistics from 2018 allnurses.com survey such as salary versus hourly pay rates per state/ regions, number of years as a nurse and years of experience in current job title (school nursing). OK...shocking statistic #2 for me....according to results from the 2018 allnurses Salary Survey, the average pay for a full-time school nurse is only $37,164 for hourly employees and $51,043 for salaried employees. The hourly pay per year feels very low to me given the responsibilities of a school nurse at large. Keep in mind with the next set of values, that for some states only a handful (sometimes only 1), school nurse answered the survey representing their respective state. Some of the highest paid school nurses reside in the states along the west coast and northeast coast. For example, New Jersey hourly paid school nurses make an average salary of $50K per year and salaried nurses make an annual salary of $67K per year. The Texas nurses that responded to the survey were all annual salary based and average $50K per year. This is a sharp comparison to Montana (who only had 1 nurse take the salary survey) making $20K as an annual hourly salary and Georgia with a few more responders making an average hourly salary of $25K per year and an annual salary of $15K per year! This made my brain spin and my stomach upset! I began to think about how much experience school nurses have and whether this plays into the average pay rates. As I suspected most of the respondents have 5 to 35+ years of career-long nursing experience. As far as the number of years in their current job, those numbers were pretty evenly spread over the span of less than one year to more than 10 years. I wonder whether this number spoke more to years as a career school nurse or years in their present job as a school nurse. Of the school nurses that responded, 99% were women. I further polled the allnurses' school nurses and asked about whether they work year-round or have the summers off. The majority of school nurses do keep their summers off to vacation or spend time with families etc. Some work part-time at their schools and other work in the hospital or as camp nurses during the summer. In wrapping this up, I have come full circle to where I began with how much I love school nurses. I admire them now more than ever, knowing how much they balance and the grand scope of their practice. I am grateful beyond words for the people who watch over our children as though they are their own. Those who put bandages on our children's wounds both internal and external. Those who watch, listen and truly hear our children and their needs. Those who advocate for our kids individually, school-wide, statewide, and nationally. School nurses are vital to our children and the community's health and welfare. So do we compensate them fairly based on those roles and responsibilities? For those states and counties where schools either don't have nurses or have them part-time or less, we need to look for creative ways to fund full-time nurses in our schools. We need to advocate and speak up for our children. As our nation's healthcare needs evolve and change over time, we have a responsibility to provide a voice for those without one......just as school nurses have done for our children for decades! As a side note, there are so many more aspects to the discussion of school nursing as a career in terms of roles, challenges, more pertain thought-provoking questions regarding the number of hours worked per day, degrees most commonly held, whether CNAs or LPNs can fill some of the gaps, continuing education requirements etc. Please add more to the conversation! by Sarah Matacale RN, BSN, CCS
  7. To all of us health professionals (professionals being the key word here), this one will leave you speechless. I am sure by now many of you have seen the viral youtube video of an Atlanta dermatologist dancing and twerking with her staff over an unconscious and exposed patient. In the video Dr. Windell Davis-Boutte and her staff lip sync and dance pointing to the patient's exposed buttocks to a song about "big bottoms". During another video....yes I said another, as there are over 20 videos posted on her youtube practice page, she cuts into the patients' flesh on cue to the song lyrics about cutting. She posts these as "marketing videos" for her Atlanta area practice. Dr. Boutte is board certified in dermatology but also performs plastic surgery and general surgery neither of which she is board certified in. Her practice web page boasts rave reviews from hundreds of her patients over her 22 years in practice. The web page states that she specializes in Brazilian Butt Lifts and Smart Liposuction. Her surgeries are performed at an outpatient "full-service medical spa and cosmetic surgery center" that is not licensed or accredited. If you type Dr. Windell Boutte's name into the google tab you will come up with a plethora of hits from her videos to the growing number of malpractice lawsuits cited against her for a variety of reasons. She has settled at least 5 malpractice lawsuits and has 4 more pending. At Dr. Boutte's surgery center, no general anesthesia is used. One of the settlements is with a patient, who was a nurse, that now suffers permanent brain damage and requires round the clock care. This patient arrested on the surgical table after 8 hours of surgery under a cocktail of sedative medications including Propofol. Within the lawsuits, she is cited for not following "board guidelines for office-based surgeries that define you to report any incident that leads to a patient's death or to a hospital". So where do we even begin to have a conversation about this? One of my questions would be how do 20 plus of these videos exist and who are the patients? Do the patients have knowledge or give consent to being on camera and presented to the world as the subject of Dr. Boutte's "marketing"? If patients have not consented, then how has she been able to continue not only making these videos but practicing medicine as well? Should patients in the videos be made aware that they unknowingly were filmed and that the videos were used as a marketing tactic? The HIPAA rights clearly were violated unless the patient waived these rights. Would you want to know if it were you? My next question is who are the staff that are participating in this behavior? Have none of the staff members found this unethical or just plain wrong? Has no one spoken up on the patient's behalf? Should they be subjected to punishment as well? Are there no other physicians that practice in the same group that are aware of these videos or malpractice lawsuits and voice objection? Should they turn her into to governing bodies? How did we get here? A few months ago the "funky flu" video filmed by a nurse in Florida went viral. In it, the emergency room nurse gave several informational facts and instructions on how to keep the flu at bay. The nurse was turned in to the board of nursing and was under a great deal of scrutiny over her "sarcastic tone". Somehow, these videos from Dr. Boutte have taken a while to reach the public's "spotlight". Why is that I wonder? My next thought is that surgeons frequently use music as a background distraction during surgery. Each surgeon has his/ her own preference of music style. At what point does the line get crossed when you trust your physician and team to care for you at your most vulnerable moments? How much "goofing and fun" is acceptable when you are the professionals? I would love to hear your opinions and thoughts on this matter and the issues surrounding it. Does anyone have any similar experiences? What repercussions should Dr. Boutte face if any?
  8. Sarah Matacale

    School nurses...do you work through the summer?

    Add additional comments or areas that apply. I would also like to know of any other work you do during the summer
  9. School nurses....do you work through the summer? Is it mandatory? If so how many hours per week? I am writing an article including the results of this poll in the next issue of allnurses magazine.
  10. Sarah Matacale

    Oh How I Miss School Nurses

    Do you have a national association for school nurses that I can send this to?
  11. Sarah Matacale

    Oh How I Miss School Nurses

    I have wanted to write this article for some time and was pulled back to it after a statewide march at our capital for teachers and school advocacy. One of the major points focused on our lack of school nurses. In the southeastern state that I live in, each school system works with their nurses differently. The county I live in has ONE school nurse shared between THREE schools. I am gonna let you think on that for a bit and revisit this point again later...... As a "sickly little asthmatic kid" in the early 80's, my school nurses and I were best buds. At that time, school nurses did physicals, hearing and vision screens, lice checks, gave medications, nebulizer treatments, assess for fever, broken bones, bandage wounds and teach classes on healthy habits, puberty, cleanliness, and how babies are made (more importantly, how NOT to make babies). They kept our shot records and medical history in a tidy file cabinet in her office. In my school, she even had a shower for the kids who, for whatever the reason, needed one. The school nurse was an invaluable part of the team/ community that helped raise and mold us as kids. Fast forward to my current stage of life as a mom of 3 children in public school as well as a nurse by trade (and spirit). My wonderful sickly asthmatic traits were passed on to our oldest son, whom I also should mention is our most accident prone of the three. No joke, he will manage to trip and fall in the middle of an open field. Oh how I worried myself sick sending him off to school when kindergarten came around. Who was going to watch over him like I do? Who was going to know when he was having an asthma attack starting so it could be controlled before getting to bad. He is also anaphylactic to peanuts.....what more can I say. You get the idea. As a parent you have to trust that your child will be cared for by teachers, administrators, school nurses and support staff during the 8 hours 5 days a week that they are not under our watch. True story here....The very first day of school for our oldest and I am at the gym exercising my worries away when I get a call from the school. Instant panic.....it's his teacher. "I just wanted to let you know that your son walked into a wall and has a pretty big goose egg." I wasn't joking...he is a genius with absolutely no sense of personal surroundings. So of course I asked if he was ok and she said that she thought so but that his head hurt. I asked if the school nurse looked at. That was when I found out that "our school only has a nurse one day a week and she is primarily responsible for keeping up with the kids medication records, shot records, physicals etc, not really working with the kids". WHAT??? So who decides when my son needs the Epipen and who gives it? Teacher. The school nurse educates the teacher when a student is in their class that has chronic needs. Ummmmm.....this did/does not sit well with me. So, I have my 4 year degree in nursing with some extra certifications and 20 years of experience as well as being a mom to these children for the past 12 years and I will say, that many many times, I am not sure what to do with childhood illness and issues. (I am not a peds nurse as you can tell). The burden of making judgement calls regarding health and physical welfare of our kids is now in the hands of the teacher. It should not be. They are teachers...educated on educating, not nursing. They already have waaay to much stacked against them in the classroom with class size, lack of supplies and funding etc, and now we ask them to care for the fragile type 1 diabetic child with an insulin pump that needs adjusting numerous times per day??! NOT OK. Funding has been cut drastically in many states for school nurses. We as health professionals and parents need to speak up. I know of times in our school system where, a child's heart stopped on the playground due to a congenital abnormality that no one knew about. I have been at the schools during episodes of new onset seizures, heat stroke, broken bones, teachers with severe hypoglycemia etc. We need our school nurses back. Each school needs a nurse on site everyday. The kids, teachers and parents all deserve this. The health and safety of our kids should not be a, "we just don't have the money in the budget for school nurses" option. Many children lack quality healthcare, food, and sometimes unhealthy and unsafe living conditions. The school nurse helps to fill in the gaps for these kids. He/she is the child's advocate, the eyes and ears for parents who send their kids to school. He/she keeps important record of illness and accidents, and at times abuse situations. This information may be the proof needed to remove a child from an unsafe environment. They may help the physician with diagnosing, mental and physical health diseases based on patterns noted during the day. He/she can assess when my breath holding child passes out during his math test and figure out whether further care is needed...if there was a seizure, hypoglycemia, hyperthermia after a hot day on the playground, dehydration...or just his normal anxiety during a test. I just want to say that I can not advocate or speak enough about how important school nurses are to our community. They are such an integral part of raising our next generation. Our children, teachers, parents, and schools deserve to have ONE school nurse per school. To have actual hands on care not only with the children within the school but the visitors, staff and parents when needed. School nurses are perhaps the foundation for community health and with all that is going on our ever changing world.....this foundation needs to be a solid and strong one! I would love to hear how you communities and states manage the cuts in funding for school nurses. How has your school worked with this??
  12. Sarah Matacale

    Nurses and Stink Bugs???

    Nurses and Stink Bugs??? Just Stay With Me Here... Tonight I read my kids a story about a bug who got mugged, robbed, beat up and left for dead on the side of the road. So far sounds like a lovely kids story right?? In the book, a group of ants come along and march right around the distressed bug and said they had no time to stop and help. Next comes several pretty butterflies who just can not help because they might get dirty...so they bless his heart and fly away. Last comes a stink bug....full of stink but actually stops to help the bug. He picks him up, feeds him, cares for his wounds and takes him to the bug hospital. This is the story of the Good Samaritan and how help comes from some of the most unlikely people. How does this relate to the profession of nursing? There are a number of reasons that men and women choose a career in nursing. Whether it be job security, the flexibility of the work schedule, steady pay, the wide variety of options in the nursing job market etc. While these things have remained pretty steady over the decades, nursing as a choice of profession has declined. We are at an all time low in clinical staffing. This is due to a number of factors, however, there are fewer students entering nursing schools than ever before. It makes me think of why I chose nursing. I am one of those people who just always felt nursing was a "fit" for my personality and strengths. Moreover, I am one of those "Good Samaritan stink bugs" that has to stop and help...all the time! Don't get me wrong...#1 I am no saint as my family and friends can attest to, #2 I often do not think through a situation before I stop to help which can be a problem at times. Good example being the large turtle crossing the road doomed to be run over. I stopped and carefully picked him up. I did think enough to grab him toward his back end, more because I was afraid of him, but in any event that nasty creature proceeded to hiss at me and tried to bite me! So I found a large stick to bait his snapping instinct with while I used my foot to push him into the field. Nasty little creature was not appreciative, but it was better than dead...right? While my daughter thought I was some kind of hero, my husband had other thoughts. (At least once a week, I have to sustain a lecture on my lack of "think-things through-ness" and unsafe practices) I can't help it, I just have the instinct that when someone or something needs to be helped, that I have been put in that spot to help. What I have noticed , and part of why I always stop to help, is the lack of others offering to assist. I have two examples of this....the dreaded school pick up line. Several times a year, someone's car battery dies while waiting the excessive length of time needed to get their child. As I sit near the end of the line (because, I am a last minute Lucy), I can't figure out why it is taking so much longer this day than others. Then I reach the problem spot of the dead battery. Crazy thing to me is that EVERYONE passes this car, makes extra effort to go around creating more traffic and hazards for the kids and cars. It takes 2 minutes to jump start the car. So everytime, I make school people stop the traffic so I can swing around...embarrass my middle schooler..and jump start the car to clear traffic and help a guy out. Why did no one stop to help?? Two minutes of time saves everyone time and effort and is just a nice thing to do. Second example, I am trying to turn right at a light and the traffic is insane. I hear a loud bang and see an air conditioner fall out of the back of the bed of a truck. By luck, the guy immediately behind him stops without getting hit or hitting the air conditioner. This causes a big traffic back up. The person behind the air conditioner can not get out of his vehicle because traffic is whizzing by on his left. Here I am...able to help. I get the guys attention and I proceed to pull this very heavy machine to the side of the road so traffic can pass. Did I forget to mention how much bruit strength I have!?! Anyway, just as I get the air conditioner to the side of the road, the vehicle that I just helped hits the gas and takes off. He leaves me in a very unsafe position in the road where the cars that were behind him can not see me as they move forward! Can you believe that? I helped and he could not be bothered to either say thank you or better yet, make sure that I was ok. What is wrong with some people??! Given what you have just read, you can imagine what I do for car accidents, hurt children on the playground, abuse or neglect, or another funny story, escaped horse running down road ....When i tell these stories, people always give me the "you are crazy?!" face. My response to this is always, "How do you not help?" As I read and experience the decline in the number of professional nurses, I can't help but wonder if our society's lack of "stop-and-help" is part of the problem. Have we become numb to others in need? Is there too much liability and blame for helping when something bad happens despite best efforts? Are we gearing our next generations toward caring for yourself and your needs before those of others? I want to conclude with another awesome story, that speaks volumes about the character of nurses. While picking up our oldest child from kindergarten, years ago, I literally drove up to an accident occurring. As I heard the crash, I saw a car flipping through the air at least a hundred feet high. Little did I know when I slammed my van into park, to get out to help even before the car hit the ground, that the driver had been thrown from his vehicle landing about 12 feet in front of my stopped car. I would have run him over had I not stopped when I did. Anyway, he obviously was in critical condition. Drug paraphernalia was scattered all over the road from his vehicle as he lay there bleeding out and not breathing. As I ran back to my van to tell my little kids that I needed to help and to get some gloves etc, I see 3 familiar faces running to the badly damaged cars. Three ER nurses that I worked with at the hospital (I was a critical care nurse at that time), were running to help. What a wonderful testament to our profession. All four of us who stopped to help were nurses. We seamlessly worked together to stabilize these people and keep the passing traffic safe. I will never forget that day and I hope every time my kids see these "crazy stunts" of mine that they don't forget either. We need more stink bug Samaritans in this world. Nursing needs more stink bugs there to care for our aging population, as well as our children, our community and society as a whole. How much better would we all be if there were more stink bug Samaritans around to help us out when we need it!
  13. Sarah Matacale

    Am I Still a Nurse?

    Am I Still a Nurse? The Question I Am Asked Too Often I will start by saying, "Yes I am a nurse and I have been one for 21 years".......after that, things get more convoluted. I don't remember ever deciding to be a nurse, it seems that I just always was on that yellow brick road. You see, I am a nurturer. A caregiver. A quick thinker. I read people's feeling and emotions. I try to fix what seems wrong. I am an educator. Most of all, I give with all I have, so after high school I followed the path to nursing school, graduating with my BSN. Straight after graduation, I went on to work in hospice for 5 years. Hospice was another natural step for me. I believe it is nursing at it's more natural and vulnerable state. You utilize minimal technology.....you watch, listen, feel, read, and teach your way through the care of your patient. I LOVED that job, but I kept hearing from so many seasoned nurses around me that I would "lose my nursing skills" if I did not take a hospital job sooner than later. Everyone said..."Med-Surg is the core and foundation for all nursing care". It worried me so much, that I left a job I loved to throw myself straight into the float pool at a major medical center. That way I would get it all! Needless to say, I put in my time, disliking the nurse/ patient ratios and the fact that I felt like no one got my full attention. I passed meds all shift long. This was not the job for me, but I got my "experience" and an inkling that I might like Intensive care. I caught the attention of the ICU staff who encouraged me to come work with them. Through life's turns, I did take a job in the Cardiac Critical Care Unit of a HUGE teaching hospital several states away. That's where I found my next loves......my husband and the level and type of care that I was able to give in the CCU. I was a fabulous critical care nurse. I loved the technology and caring for life and death issues with such precision, speed, and thoughtfulness all while having the ratio I desired so I could bond with my patient's and families. I was able to take the time to nurture and educate when families were so afraid. As opposite as it seemed from hospice care, there was so much similarity. (By the way...I continued to keep one clog in the hospice door throughout my time working in the CCU. I felt it kept me grounded, and reminded me to look, listen and feel.) After I got married and we started having kids, I took some time off to act as a nurse in a different fashion. I do truly believe every mom is part nurse. I always knew I would go back to critical care and hospice until God had another plan. After the birth of our last son, I had a very unexpected life-altering door slam right in front of me. I lost my hearing. A lot of it. Bam....bilateral hearing aides, worsening deafness without an answer or plateau of loss in sight. Tinnitus...very...loud..ringing..every waking moment. Funny how loud deafness can be. I was sad, scared, and mad. I want to say, that hearing-impaired nurses are very capable of providing excellent patient care in every area of nursing. The technology in the field of hearing devices is fascinating and phenomenal, but as for me personally, I felt that I could not provide the same level of critical care and quality of care that I had before my hearing loss. A large part may be fear. Fear that what I do not hear may make a life or death situation for my patient. With a very angry, and bitter heart, I decided that my days as a bedside nurse were over. Part of me had been lost...more than just my hearing. Nursing is who I am. I have grieved and to be honest, I still do grieve not caring for patients at the bedside.....but life had to go on. I went back to school for Clinical Documentation and Coding. I sat for the national certification exam, passed, and added CCS (certified coding specialist) to my list of letters. I currently work for a large medical center as a Clinical Documentation Specialist. I review the medical records and follow patients concurrently during their hospital stay to ensure that the care given at the bedside is accurately reflected in the documentation. It is challenging. I work with some great doctors and have learned a lot about medicine and documentation. I also found passion in writing stories that are either personal or inspiring to me. It's a way for me to share a piece of myself with others. It always surprises me, and I will admit, it stings a bit when I am asked if I am still a nurse. There is a common, sort of old-school-thought, that nurses practice at the bedside only. Honestly, I have been asked this question as often by fellow nurses as the non-medical public. As the decades pass, the role of nurses expands as we are entrepreneurs, inventors, teachers, advanced care practitioners, writers, managers etc. So when you leave bedside care, are you no longer a nurse? I can honestly say that I use my nursing knowledge, critical thinking, nurturing care every day in some capacity. My husband can tell you, I stop for every car accident, fallen kid on the playground or sports event. I get asked medical advice from anyone and everyone it seems some days, and I absolutely love when I can help a loved one with care or support when needed. All that aside from my day job as a NURSE who works in Clinical Documentation Improvement. I can only speak for myself when I say that nursing is who I am not just what I do. So when I am asked if I am still a nurse, (as if what I do isn't nursing), I can stand tall and say "Yes I am!"
  14. Sarah Matacale

    "Safe Injection Houses"- What's This?

    A "safe house" for drug users to use drugs with clean equipment and trained professional supervision using public funding.....what the what????!!! Am I reading this correctly? This instantly stirred up strong feelings and opinions for this nurse, mom and taxpayer. While this concept was news to me, "safe injection houses", which are currently illegal in the United States, have secretly been in existence in the US for at least 3 years. The idea is to provide drug users with clean needles and equipment as well as medical supervision by professionals in the event of overdose. The staff on hand is also available to guide, educated and provide services to willing participants who wish to get clean. Injection sites are legal in countries such as Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain and Switzerland. This is different than the clean needle exchange programs that at one time were also illegal in the US and now are legal in 33 states. I read an article in the New York Post about two researchers who secretly evaluated a "safe injection house" in the United States. This sparked my interest to research more on the subject so that I could form a more educated opinion on the matter. According to a New York Post article, two researchers have been evaluating a "safe injection house" for over two years and recently published their report online in the American Journal of Preventive Medicine. "As a condition of their research, they didn't disclose the location of the facility - which is unsanctioned and potentially illegal - or the social service agency running it", reports The New York Post. According to the researchers, the underground space consists of two rooms. One "injection room" with stainless steel clean stations with stools and mirrors. Drugs such as heroin, cocaine, methamphetamines, and pain pills are allowed to be used there, however smoking is not. The second room is where participants go afterward to be monitored by trained "non-medically licensed" staff. Not much information was provided through the research. It is presented that over 100 participants utilized the "safe injection house" more than 2,500 times. They released that only 2 overdoses were reported and one death at the site itself, but little to no additional information on population, cost service etc due to the secrecy of the program. Such sites have been backed by lawmakers in New York and California, along with officials in cities like Seattle, San Francisco, Boston, and Ithaca, New York in an effort to combat overdose rates as well as drug use related transmission of Hepatitis C and HIV. This report may help support lawmakers in their efforts to pass laws allowing "safe injections" to exist in the US. As one would expect, there are many opponents to "safe injection sites", for a number of reasons. According to the New York Post article: "critics have argued these places may undermine prevention and treatment, and seem to fly in the face of laws aimed at stopping use of deadly illicit drugs." As nurses we have a duty to do no harm. If we know that these drugs are so harmful that they cause death, have long term side effects and addiction, how would we stand a collective group on this subject? It is an interesting topic that I am sure we will hear more about in the coming years. The initial response from those I talked to casually about this subject was that this is the worst idea anyone has ever come up with and how on earth did we get here as a society? After much discussion some interesting questions regarding this and other similar topics arose creating some "grey areas" in the thoughts. In researching this, I think I am left with more questions than I answered for myself. I would love to hear what you all think. Do such places encourage drug use though ease of access and legal use? Would new users take advantage of "safe injection sites" to try new drugs? Who pays for these places? Does the cost of running them outweigh what is spent yearly in Emergency Room visits and hospitalizations for overdose or addiction treatments? What kind of regulations and research are needed to determine the societal worth of such places? What do you think? Report reveals 'safe house' where heroin users shoot up under supervision | New York Post
  15. Sarah Matacale

    ER Nurse's "Funky Flu" Video Goes Viral

    We've all had these moments after working a particularly insane shift. We have to vent. Your brain is still reeling, you are exhausted yet still in overdrive. Sometimes it's related to coworkers or employer issues, but many times it relates to our patients. Let's face it, healthcare is a combination of the science of medicine, the art of nurturing, the business of hospitality and service and the skills of retail and education. We deal with people at their worst. They are sick, scared, frustrated, angry for either themselves or a family member or friend. We get the brunt of it all. Somedays frustrated doesn't even come close to explain how we feel, especially when the illness or injury that brought them to be under our care is preventable. We just want to say, "what on earth are you thinking?" and "Let me tell you something right now....!" Katherine Lockler, an Emergency room nurse from Milton Florida did just that via social media. Dubbed the The "funky flu" video, Katherine went to Facebook with a bit of advice for people on how to avoid the flu and how to protect yourself and others. Her video titled "After Work Thoughts", quickly went "viral" with over 4 million views at the time this article was written. In her post, Katherine is direct, matter of fact, sarcastic and very honest about what she is seeing as an ER nurse during this flu season. The video provides helpful tips on how to avoid the flu this season, as well as how to properly protect yourself and others in a funny and dramatic way, such as how to properly sneeze and cover. She also provides some insight into what an ER nurses shift looks like during this flu season by discussing Emergency Room wait times, asking people to understand and trust that the person seen before you is more sick than you are. She goes on the talk candidly about the anger, cursing and frustration given by patients to the nurse, explaining that wait times are due to several factors that one can not see beyond the lobby. Most of the reactions from viewers has been positive especially from fellow nurses and medical personnel, but as with anything posted on social media, Katherine's video has had some negative feedback. Several have expressed their offense to her "sarcastic tone" and demeanor and according to several media sites, Katherine has allegedly been turned in to the Board of Nursing. While we can't know for sure of the facts surrounding the alleged report, an online petition, showing support for Katherine, has been formed to be submitted to the Board of Nursing. The petition reads: "Katherine Smith Locklear is an ER Nurse. She posted an AMAZING video on Facebook regarding the flu and how it is spread along with great tips on home treatment. For her time and effort, she is being reported to the Board of Registered Nursing and her hospital." Nurse calls hospital ER ‘cesspool of funky flu’ This presents several hot-topics for thought and discussion. What did Katherine do or say that presents a valid complaint to the Board of Nursing? Does a nurse have the right to vent about her job, shift, or patient experience on social media if the names and exact details are left out? What about after your shift ends and you meet coworkers for dinner and vent out loud without disclosing names? Does this border on HIPAA violations? Does the hospital or Board of Nursing have the right to penalize this or any nurse who sends a strong message via social media? Is what you do on your time your business or does Katherine's video reflect upon her employer? Does her "tone" work to educate the public here, or did it hurt? Katherine responded in an interview with TCPalm stating: "I think there's a little bit of sarcasm in my voice because the instructions were given so many times and they were not received well," Lockler told TCPalm. "I tend to be sarcastic in all my speaking, but if it's taken wrong, I would definitely apologize to that group that misheard my message because of my tone. The message is still right on the money, but if the tone was offensive, that was not the intention." I, like many others, caught this video on my facebook feed and watched from beginning to end. Of note, I rarely watch any video on social media in its entirety. Her manner of speaking, the tone, the subject matter and the stone cold truth about life as a nurse during one of the worst flu seasons in the past decade, had my attention. I found myself waiting to hear what else she would say. She did provide a public service regarding flu prevention and care, but I will say that the whole time I watched, I asked myself several of the above listed questions. I wondered how this would be received. No matter your thoughts, Katherine Lochler has sparked media attention including such national sites as FoxNews and hit instant stardom with her video rant regarding "the cesspool of funky flu in the ER". I would love to hear thoughts on this healthcare/ social media topic. How many of us know if our hospital or State Board of Nursing has policies on such matters? Did she go too far or is Katherine the "Hero nurse" that several followers have dubbed her as she speaks up and supports nurses and healthcare workers?
  16. Sarah Matacale

    My Sweet Daughter's Smile

    Let me start by saying that I am a Nurse and my husband is a Physician and neither one of us go anywhere near Pediatric patients in our professions. We don't even pretend to know what's up with that portion of the medical world's population. Since the time the kids were born, we have never diagnosed them for 2 reasons...#1 kids are not little adults....#2 they are our kids. Both of these reasons, we feel make us a bit skewed on what is an actual issue and what is a minor "normal kid thing". However, that being said, a mama does have her intuition and when you have medical knowledge and genuine understanding of the "worse-case scenario", you can be in for quite the emotional ride, when one of your children gets sick.....very sick. This fall our oldest son (11 years old), who is a serious asthmatic, got an upper respiratory virus. High fever (104 F) for almost a week, cough, wheeze, the works. After 2 weeks and a few rounds of steroids and antibiotics for secondary infections, he was on the mend and back to school. Ahhh, peaceful house again....not so fast....remember we have 3 kids! Our youngest son and I start about the same day with same symptoms. I truly felt awful and my baby boy (7 years old) was pitiful. Same story. High fever, cough, but as I got better, he got worse. He developed pneumonia. So for him, 2 rounds of tushie shots, oral antibiotics, pushing fluids and steroids successfully kept him out of the hospital. So no surprise when my sweet girl (age 9y) most stoic, toughest of the bunch, "best sick child" started down the same path. I say to this day that God was really watching over us for a number of reasons as you will read, but for now you should know that my husband (the WORST sick person in the house) never got sick AND I never had 2 sick kids at the same time. Our daughter is a beautiful strawberry-blonde with green eyes and freckles...tons of them. Her smile and giggles make everyone smile. She is tough though...afterall she is her mother's daughter! She never complains when she is sick, takes shots like a champ and even makes it to the toilet when she needs to throw up! Huge, I know! Anyway, she followed the same course as her younger brother and developed what was a clear bacterial pneumonia on chest x-ray. She too got 2 rounds of tushie shots and oral antibiotics since one would think we were dealing with the same bug as everyone else had. She started to get a bit better by Friday of the first week. Started to eat a bit and drank well. Less cough and no fever after 5 days of 104 F. That night she told me her upper lip felt funny inside. It was at bedtime when she mentioned it, and I briefly looked and felt comfortable putting her to sleep with the thought that she probably had a cold sore after having had such a high fever for several days. By then next morning, she woke me with a very swollen upper lip. I could clearly see the skin sloughing and blisters by then. I brought her straight into the peds office where we did some blood work for some more common causes, but nothing stood out. Both the Pediatrician and I feared Stevens- Johnson Syndrome (though just in one area of her mouth) or Kawasaki disease (though she is a bit old). She felt well and had no fever, so we decided to take her home and "watch her closely"....since we are medical people, everyone was fine with that. I was told that any sign of change for the worse, and I was to just go ahead and take her to our large trauma/ teaching hospital 45 mins away (since the local hospital would not handle this...whatever THIS was.. there). Oh, so I forgot to mention that my cub scout leader husband had our two boys on a campout that weekend, which I thought was for the best so that our daughter could rest. So we were back and forth by phone with all of our worries, but I convinced him that I had it under control. I am a CCU/ ICU trained nurse with burn unit experience ( sister unit to the CCU in the major university hospital that I worked in for years). Fast forward a few hours, and my sweet girl started to look pitiful. She got real weak, 104 fever came back, her mouth started to blister more around her lips and she was actually asking for me to take her to the hospital to feel better. So I did just that. My husband hung with the boys until we had some kind of diagnosis or plan and Mommy and daughter spent some quality time in the ER. We were rushed through pretty quickly as you could actually watch the blisters form and pop and begin to slough off on her lips and gums. It was moving quickly. We were staying in the hospital...still no solid differential. Among the list was Kawasaki, Stevens-Johnson and, less likely, hand- foot-mouth. (My daughter was particularly offended that anyone would even suggest that she puts her feet in her mouth!). So we get admitted by "Red" , as we affectionately called him, senior resident on-call for the night. He had red hair and freckles and our girl adored him. While she was getting admitted, I had a medical friend send me a message that encouraged me to look into this "rare" diagnosis that her cousins, nephew twice removed etc etc etc had been diagnosed with a few years ago. His symptoms sounded similar to our daughters she said. To this point, I had avoided looking anything up. I did not want to know anything that may worry me unnecessarily. I did not want to be "that-nurse-who-is-married-to-a-doctor-kinda-mom". I did look it up.....and ya know what? It did sound just like her symptoms and time course; so I turned into "that-mom". I marched right out to find Red. He was on rounds, which I interrupted, holding up my phone with my google search (I know, not even a genuine medical search) and I asked him nicely if he could look into this diagnosis. He kindly gave me a face and said..."you do know that that is just walking pneumonia, right?" I said, of course I do, but its the rest of it that I want him to look at. I admitted that it sounded out there and far fetched and did not mean to take over, but that I would really appreciate if he could look into it. He reluctantly agreed and I found out the next morning that he did. On the second morning of our hospital stay, we met Dr. Dazzle as we dubbed the pediatric infectious disease doctor. My daughter thought that was what his white coat said, but it was just creased a little funny. We found his nickname to be a perfect fit. He had a dazzling personality to go with his years of training. He was calm, cool, wore a bow tie and was full of jokes and uplifting comments to keep our girl from being scared of the unknown. He announced to me on that day that the diagnosis that I asked Red to look up was now the primary differential. Labs were drawn to definitively confirm this, and it would take several days for those labs to come back, but he felt that she fit the symptoms. Good news right...well...not really. Symptoms will get worse and spread to other mucosal areas such as eyes and "girl parts". This diagnosis came with a "symptom management" treatment plan....comfort, palliative care. As the night and days went on, her pain and symptoms got worse. The pneumonia looked better on x-ray, but her oral cavity was progressing rapidly. I watched and asked about everything. What the nurses gave her, when things were scheduled, what labs were ordered, what doctors were on, vital signs. I closely watched every assessment, read facial expressions, studied every detail of my daughters changing symptoms, and as teams of residents or nurses changing shifts gave report over her bedside, I added, corrected, and filled in the blanks as needed. I became part of the care team. We quickly realized that my daughter got upset over bedside discussion of plan of care or differential diagnoses, so we started to step into the hall. I was always asked to join in on rounds. I became my daughter's voice and advocate as her ability to talk went away. Her oral mucosa sloughed off throughout her whole mouth, down her throat, and her tongue and palate as well. Each day brought new pain and less and less smiles. The night that we got a definitive diagnosis was one of the worst nights as a nurse mom. That afternoon, our daughter's airway was becoming more affected. She had a lot of sloughing and swelling in her throat and palate. She could not swallow well and was not speaking as it hurt too much. As a critical care nurse, I laid awake all night, watching the sat monitor, and her breathing pattern. I must have dozed off at one point and woke to a nurse, not ours, squeezing by me to turn down the Spo2 monitor alarm...not the sound, the limit! I woke right up and saw a beautiful pleth and a oxygen saturation in the low 80's. That nurse did not assess my daughter or wake her, she just stopped the alarm from doing what it was supposed to do. When I think something is wrong I am a bulldog nurse and a big grizzly bear for a mama...combine the two and watch out! I knew baby girl was not ok. Our nurse's response was not enough for me....I asked for the primary care team to come in and repeat a chest x-ray, get some labs and assess her. Her pneumonia and atelectasis combined with pain medication, and most importantly her swollen airway were all contributing to her low sats. She had also started to develop sloughing in her "girl parts" and her eyes poured continuous tears with conjunctivitis. At that time, the results of her labs had come back confirming that what were in fact seeing was Mycoplasma pneumoniae with associated mucositis (MPAM). While M. Pneumoniae is a significant cause of community-acquired pneumonia in children, the mucositic involvement is rare. It falls in the spectrum of Stevens-Johnson Syndrome but affects the mucus linings in the body only. There were so few cases documented in the past 60 years, and only a handful of children (especially girls), that there was little literature about how to treat this autoimmune response. Given her respiratory distress that night and swelling, the team decided to try a dose of high dose steroids, and another round of antibiotic. By this time, she already had a PICC line inserted and we were doing TPN for nutrition, fluids, and continuous Morphine with PCA dosing. She made it through those tough few days without needing to be intubated. My tough girl! The primary care team and Dr. Dazzle had begun to utilize many subspecialties from ENT, to dentistry (mouth care was near impossible),dermatology, to pediatric oncology as the mucositis is common in the immunocompromised kids. I had the idea of getting the cold compress maxi pads from OB/GYN and dermaplast spray to make her girl parts more comfortable. Each morning the team and I brainstormed about what would help with that days new symptoms. My sweet girl whose smile could light up a room was not smiling anymore. She was getting discouraged, irritable, stubborn, and less and less cooperative. She would write notes to me in capital letters with exclamation points that she "DID NOT WANT TO TRY ANYMORE MOUTHWASH BECAUSE EVERYONE TELLS HER THEY WILL HELP AND THEY DON'T!!!" She could no longer open her mouth at all and lock-jaw was a becoming a concern. We had to get her to open her mouth and get some oral care done...it had been weeks. I was the primary source of her frustration and anger. She was in such pain and was scared and I had to get her to push through that to work her mouth open. Then we realized that her tongue had become stuck to her teeth in its healing stage, making the pain that much worse. She had to tear her tongue to get her mouth to open. I cried with her, rocked her, reassured her, sang to her, but now we needed to do this. As she wrote me the next sentence, my heart broke, "I JUST WANT YOU TO CONSOLE ME AND HAVE COMPASSION FOR ME! IT HURTS SO BAD!!!!" I had to step out of the room and call my husband...and cry. I had been comforting her for weeks and would continue, but I knew that she had to do this or it was going to become a bigger, more complicated problem. Even with our efforts, it still might go there. So, I asked her to be strong with me and that my heart hurt worse than hers to see her go through this. I would truly do it for her if I could......then she took a deep breath and she did it. Crying the whole time with her finger on the PCA button continuously, she did it...she opened her mouth. We quickly did oral care which made her more comfortable. We could get a look in her mouth for the first time in days and it actually looked better! She started to improve from then on. Talking and eating were huge challenges as her tongue had some damage. She could not talk well, the muscles were weak. She could not move food around her mouth and had to have speech therapy come teach her how to move food around with her finger and how to practice her speech. Her taste buds had been harmed as well, making food taste not like it should. She did not want to eat what tasted bad or bland. Ultimately what should have been a 6 week ordeal (according to the literature) lasted a few weeks and she was able to go home. The day after she discharged from the hospital with a huge smile and tears over leaving the doctors and nurses she would miss, she headed back to school. She wanted to be "normal" again. She missed her friends and routine and even math! I have a newfound respect for pediatrics. Those care providers have the entire family to care for, not just the patient. Watching my daughter go through this, was one of the hardest times of my adult life. Being a nurse, was helpful overall, but really set my anxiety bar very high. After she would fall asleep at night, my husband and I would discuss all of the what if's, her labs, the updates of the day, our medical worries, how we would work out the schedules for our boys and dogs, her school work etc. Life was very hard for the whole family those weeks but we made it! I will never forget my little boy's reaction when I picked him up from school one day while his sister was in the hospital. She started TPN that day and I was tearful. He started to cry and asked if she was going to die since she could not eat. He was hysterical stating that she could not die because she was not just his sister, but his best friend (they have always been exceptionally close). Of course, I explained it all to him and we both settled down some, but whew...tough stuff! She is 100% healed now approximately 2 months after the beginning of symptoms. She has definitely had some post-traumatic stress since that stay. While she coped so well at that time, she has been overly worried about every sniffle, cough, lump and bump thinking it will all lead to a PICC line insertion or hospital stay. We are getting through it though. The visits from school staff, her friends, our friends and family, cards, flowers, stuffed animals, prayers upon prayers, the amazing child -life specialists who brought crafts each day and played games, the Ronald McDonald House and donations of time, food etc were so overwhelming. Seeing these things day in and day out as a nurse is one thing, but when it's your baby, you realize just how important support and love are to a sick family. Seeing my beautiful strawberry-blonde, freckle faced girl smile each day makes my heart smile. I have not taken that smile for granted even one day since!