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Meagan

Meagan BSN, RN

CHF

Hi there, I'm Meagan! After 8 years as a nurse in Telemetry and CHF, I am now on a journey to reignite my passion for writing.

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Meagan is a BSN, RN and specializes in CHF.

My nursing journey began on a busy Progressive Care / Telemetry unit. This unit built my foundation for nursing and it's where I fell in love with Cardiology. After my grandmother passed away from CHF, I left Telemetry to work for a Congestive Heart Failure Clinic. I obtained my certification as a CHFN and still work in CHF today. I love this patient population and have learned so much caring for them. As many nurses do, I am now on a new journey - to reignite my passion for writing. I hope to share many things I've learned with you and inspire you to be the nurse you've always wanted to be. Happy reading!

Meagan's Latest Activity

  1. Meagan

    My Life as a Nurse

    Wow! I loved reading this and really felt your passion and true love for your career as a nurse through your stories. Good luck to you in your future endeavors. We need more nurses like you today :)
  2. Meagan

    A Letter to my Hospice Patient

    To the Patient I’ll Never Forget When we first met, it was my third year of nursing. I was young and excited to start my new job in the clinic. You were in your 80's, and had been through a lot - Heart Disease, Chronic Kidney Disease, Dialysis, and now CHF. By the time we met, you had been coming to the clinic for several years. I heard nothing but wonderful sentiments about your kindness and resilience from my coworkers. I had only known you for 6 months before you surprised me – you wanted to transition to hospice. I remember that day very clearly. We had been working very hard to keep your CHF under control, but we knew it wasn’t enough. You were more short of breath with minimal activity, had more swelling to your legs, and developed reoccurring ascites for which you required numerous abdominal paracentesis. You went to see the renal specialist and cardiologist – and hadn’t received good news – there was nothing else they could do. You see, at that time, I had been a nurse for about three years and my experience came from a busy Telemetry unit. I had taken care of and helped to transition many hospice patients, but they hadn’t walked out of the hospital to go home. They were usually very ill, and after lengthy conversations with family and physicians, they were transitioned down to the inpatient hospice unit. As a nurse, my experience was actually caring for the hospice patient. What I didn’t have experience doing was initiating the hospice transition. You were my first. And, after you passed away, I realized I had learned some of the most valuable lessons in my nursing career. I learned to slow down. When you work in the hospital, you’re always in “save” mode. You’re on high alert for the slightest change, because if you don’t catch it, it could spell disaster or even death for your patient. You’re ready at the slightest change to race down the hall and put to work those ACLS skills you worked so hard to learn. You’re ready to be the best patient advocate you can be to save their life. But I didn’t work on the unit any more. I worked in a clinic with a patient population consisting of the chronically ill. It dawned on me when you chose hospice that it was okay to slow down. I learned it was okay to use my clinical judgement as a nurse to initiate those difficult conversations with my patients and take a more holistic approach. I learned that hospice does not mean “giving up.” When we talked about hospice and your thoughts on starting the process, you told me with such conviction that you were ready. You had been through “save” mode many times. You had been stuck countless times for IV’s or labs, had numerous abdominal paracentesis’, and had already been through dialysis. By this time, you didn’t want any more doctors office visits, trips to the hospital or any invasive procedures. I remember you telling me that you felt so blessed to have made it this far, and that resonated with me. I learned what dignity truly means. By definition dignity is, “the state or quality of being worthy of honor or respect.” After you passed away, it was hard for me to see that empty chair every week. But, what I realized was that you had given yourself and your family a gift. There are times in our nursing careers when we see patients who can’t make these decisions for themselves. Sometimes they don’t have advanced directives in place, or they have family members that just can’t agree. I respected your family’s commitment to your wishes, as this is something I don’t think we get to experience often enough. Although many years have passed, I will never forget the conversations we had, and the lessons I learned as a new nurse. I think about that day often and I thank you for helping to shape my nursing career. Fellow Nurses, have you had similar experiences that changed your nursing practice? What was your greatest take-away?
  3. I work in a CHF clinic, so the focus with low sodium diet is specific to fluid retention and symptom management. For us, it's about the overnight weight gain that can accompany those high sodium foods. A Liter of fluid weighs around 2 lb, so in a patient with CHF that could lead to worsening symptoms and possibly an admission for diuresis if it's left unmanaged.
  4. Thank you for your response! We have a wonderful case management team in the facility I work in, but I do think they have to share the units and that can be so time consuming. Although discharging a patient is definitely a team effort, in my experience, the bedside nurse is the last person the patient contacts when leaving the facility. It is so important that the information we give them on discharge is accurate, as I like to compare the discharge instructions with GPS. If we give them the wrong directions, they'll end up at the wrong place!
  5. Thank you so much for your response. In my area we also struggle with transportation and lack of grocery store choices. We have several patients that are limited to food that is given from food pantries. I will often times try to help them maximize on quantity of food by seeing if there are any lower sodium options that they can pair with those higher sodium foods. Have you been able to reach them by showing them real time sodium content in fast food? This is always eye opening for my patients.
  6. What do your patients typically say when you tell them they need to reduce their dietary sodium? I hear, “What is sodium anyways?” Guess what? - Its salt! And in my clinic, most patients have never heard this before. As a heart failure nurse, teaching about sodium is something I practice daily. I’ve put together 5 ways to help teach your patients how to reduce their sodium intake. Put away the salt shaker I know – it seems obvious right? But in fact, it isn’t. Most patients have not been educated on nutrition and have never been on any dietary restrictions before. Teaching them that sodium = salt should be your first step. Did you know that a single teaspoon of salt contains approximately 2,300mg of sodium? Chances are, neither does your patient. Putting down the salt shaker could mean the difference in thousands of milligrams of sodium taken in per day. Another important consideration is to teach your patient that salt = salt. Don’t get confused by other types of salt such as Pink Himalayan or Sea Salt. These still contain sodium and count toward the total daily limit. Read the nutrition labels Would you be surprised if I told you that most patients don’t know how to read a nutrition facts label? This is an essential step in making sure your patient knows how to reduce their daily sodium intake. Start with the basics. What is a serving size? How many servings are in this container? Then move on to the good stuff – milligrams of sodium. A lot of my patients gravitate toward the daily percent – but what we really want is the milligrams (mg) per serving. The Heart Failure Society of America recommends that a heart failure patient should limit their sodium to between 2,000 – 3,000mg sodium per day. If your patient doesn’t understand how to read a food label, this recommendation becomes difficult to visualize. Ensure you know what their restrictions are, and help them understand how to stay within that range. Prepare your food at home One of my favorite memories as a new nurse in CHF was an elderly patient telling me, “Honey, I’m not going to learn how to cook now!” Cooking at home is a struggle for many patients as they belong to all backgrounds and all walks of life, but it is essential for being successful with a low sodium diet. Teaching patients that they can still have proteins that they season and prepare along with fresh fruits and vegetables is a good place to start. I always say- the fresher the better! Providing patients with a visual of options to choose and options to avoid has been really helpful in my practice because patients usually start out by saying “what can I eat?” I also like to add that seasonings are NOT off limits, they just need to be sure the seasonings they buy don’t contain sodium. Choosing seasonings like black pepper, garlic powder, onion powder, cumin or chili powder are all perfectly good alternatives to pre-made seasonings. Limit intake of processed foods As you can probably tell, I’ve created my own personal script after teaching low sodium for 5 years. My favorite line is, “if it comes in a box, a bag or a jar, you probably shouldn’t eat it!” Explain to your patient that processed foods (food that is not fresh and comes in packaging) generally contain much more sodium than foods that are fresh. Educate them that nutrition labels live on these food items and that it’s important to read them before purchasing. Also, inform your patient that labels are often tricky and can say things like “reduced sodium.” In reality, this could mean the difference of only a few milligrams versus several hundred. Check restaurant menus before you go Thankfully, most restaurants these days are sympathetic to the nutritional needs of their customers. It’s now relatively easy for a patient to Google the nutritional facts for their favorite restaurants before they leave the house. This way, they can have a plan before they go, and are aware of what foods with easily work within their sodium restrictions. Often times in the clinic I will ask my patient, where do you go out to eat? If they give me an answer, I will look it up right there and show them the sodium amounts for that particular item. It can be quite shocking to discover the chicken nuggets from your favorite place are suddenly off-limits, but this is a really great way to help your patient visualize actual amounts of sodium in processed or prepared foods. Every opportunity we have to teach a patient can help them to be more successful. What techniques have you developed in your practice to teach patients about sodium restriction? Resources HFSA Module 2: How to Follow a Low Sodium Diet
  7. Meagan

    While we were arguing; we disappeared

    In our hospital we have the color coated scrub system, but we also have badges with large lettering to indicate our positions. We have to wear two so that if our badge is turned around anyone can still see it.
  8. Meagan

    I failed twice, please help!!

    If your personal goal is to become a nurse, don't let what your instructor says get you down! Dust yourself off and keep trying. If this school doesn't work out, do what you have to do to get into another one. Retake some of your undergrad classes to get your GPA back up or look into those schools that are further away. If this is your dream, only you can make it happen. Good luck!
  9. Meagan

    What made you leave bedside?

    The only reason I left the bedside was because I knew that CHF was a passion of mine, and I had to follow it. I will tell you, it took me a long time to adjust to working Monday-Friday and depending on where you work, it may not be any less stressful.. I actually think I spend less time at home than I did when I worked on the unit. You just have to weigh out the good and the bad. If you love the unit you work on, stay and enjoy your weekdays off while the Monday-Fridayers are at work! Good luck on your journey, I am sure you will make the right decision for you
  10. Meagan

    RN career development path

    There are some certifications out there that she could obtain in order to be certified to provide dietetic education, like a CNS or a wellness coach. As an RN she will always have to work under a physician's orders. I don't know if RD's really prescribe anything themselves, in the hospital it would just be dietary recommendations (tube feeds or supplements) but I think these still have to be signed off by a physician.
  11. Meagan

    MSN but offered the salary of ADN

    The hospitals in my area just recently changed the pay scale for ADN vs BSN and it wasn't by much.. Is there any reason you aren't reaching for an upper level position now that you have you MSN?
  12. Meagan

    Best experience for a new grad?

    Does your hospital do a graduate-nurse residency? The fact that you are a new grad could be used to your advantage and you could start working on the unit you really want to without having to build up the experience first.
  13. Meagan

    Am I too stupid to be a nurse?

    You made some really good points here, and I can tell you from my personal experience with anxiety and my first nursing job felt the same in many ways. Try to find a little bit of light if you can. Maybe you needed a different preceptor, or a different unit, but most of all, you need to give yourself time. I had many sleepless nights, and even considered getting out of nursing myself. Your path will show itself to you
  14. Ever wonder what happens to your patient after they get discharged from the hospital? I'm here to tell you, it can be kind of scary. As a long time ambulatory CHF clinic nurse, I am sometimes the first health care provider to see a patient after they have been discharged. You can imagine the stories I hear from patients about their hospital stays - both good and bad. It is so important to remember that your patient has a life outside of the hospital walls, and even the smallest effort can have a huge impact on their success once they are gone. I’ve created a list of the top 5 things that bedside nurses can do to close the gaps between hospital discharge and the first ambulatory visit. 1. Good Medication Reconciliation I cannot stress the importance of medication reconciliation whenever available. It is so important to know what medications your patient was taking prior to arrival, and in my experience, this is one of the hardest parts of ambulatory patient care. Patients don’t always remember what medications they take and generally have a hard time remembering to bring these medications into the clinic. If you have family available at the bedside, ask them to bring in the patients medications for review. If the patient lives at a nursing facility, review those face-sheets. Involve your pharmacy department if they have this service available. 2. Ask the Basic Questions Yes you know the patient’s entire medical history, but what do you really know about them as a person? Do you know where they live? Who lives with them? Who will take care of them when they leave? Do they have insurance? Money to afford the new medications the doctor may prescribe? Can they read the discharge instructions you will give them? These are all questions that are imperative for a patient to be successful once they get discharged. You can imagine how many times a patient has told me, “No-one in the hospital asked.” These questions could mean the difference in a successful discharge or a patient’s readmission. 3. Discharge Instructions I know, I know…Those pesky 50 page packets you hand out 5 times a day that you think no one reads. But in some cases, they do! Think of those discharge instructions as a patient’s guide back to health. Each line on those papers needs to teach someone who (usually) doesn’t know anything about healthcare. Imagine you were stranded with a flat tire and the only booklet you had titled, “how to change a tire” was blank! How frustrating would that be? Your patient is thinking the same thing. Take the time to really go over the instructions and ensure that what they need to know is really there. If there needs to be a follow up – has it been scheduled? If there is a medication change – is there instructions for how to take it? These are simple questions your patient won’t know the answer to without reading those instructions, so be sure they are clear and easy to follow. 4. Family Teaching If you’ve asked those basic questions, chances are you know who will be helping out your patient when they get back home. Those are your people. Your new best friends if you will. Make sure they understand (if the patient is comfortable with it of course) what is going on and how much support your patient might need once they are discharged. If there are new medications – teach them. If there is a new diet – teach them. If there is a wound vac – teach them. Your patient might be overwhelmed and rely on this teaching once they go home. 5. Ensuring Prescriptions are Filled Remember when I said I cannot stress the importance of medication reconciliation? We’re coming full circle here. Prescriptions! If a good medication reconciliation was completed on admission, there’s a good chance you can tell if your patient will be sent home on anything new. Without a new prescription from the doctor, the patient could make it home and never start this new medication. Checking your discharge instructions against the new prescriptions will tell you if the doctor sent it in. Make sure your patient doesn’t leave without it! On a good day, these tasks can seem daunting, but keep in mind what you are doing it for – the patient. In the end, the patient will be grateful, and you will know you contributed to their success. What are some other ways you have utilized to ensure a smooth transition?
  15. Meagan

    7 Reasons Why You May Feel Stuck In Your Job

    These are great tips to really get to the root of why someone may want to leave. I really liked the link you shared with the "9 questions to find your dream career". Sitting down and answering those questions to yourself could be so insightful!
  16. Meagan

    Preceptor is SO BAD!

    When I was a new grad, I had a preceptor that just didn't click with me. She was a great nurse and a wonderful person, but I knew I wasn't getting what I needed to succeed. I wound up going to my manager and telling her I didn't feel that I would be prepared to go off of orientation if I stayed with her. You don't have to tell them every last detail of what you think she did wrong, but it's clear that you are not comfortable with the way she instructs you. In my opinion, it's your career.. you only get one orientation and they should want you to succeed.
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