RiverNurse

The hospital should have a back up plan in the event the nurse is not reachable. I also do not think writing the nurse up is appropriate, given the situation. Reliability is important, however, reliability should not soley rest on the back of one nurse. If that is the case, there is a problem with the system.

Yes. I did remove the pt's MIC-Key button for one day. The pt does not have prune belly syndrome, but her abdominal muscles are hypotonic. In addition, she has a history of button displacement which further complicated the issue. At our facility, if the pediatric team also agrees, the order is placed and the button removed for the specified period of time so that the musculature can contract with the hope that leakage can be resolved. However, in this instance (and this is why I posted my question), the pt's issue has not been resolved by this method. The pt continues to leak formula from her site. As to the question regarding nutrition, this pt had leaked a significant enough amount of formula to cause her electrolytes to be off. As a result, I recommended (and the team agreed) to have an NJ tube placed, and the button removed. There was still some drainage, but not nearly as much. I returned 24 hours later and reinserted the button with no difficulty. At first, there was no drainage and I had hoped the issue was fixed. Now, though, the drainage has started again. The other potential option is a MIC Key GJ - but the patient is still likely to leak non-formula gastric contents from the site. While likely not as much, I would still be concerned about electrolyte imbalances. Rivernurse

First off - hang in there. I think almost every nurse has experienced this sensation and stress related illnesses. Mine was diabetes (II). It is definitely a crucible, trial by fire. It's like eating an elephant... you do that one bite at a time. Being a new nurse is much like that. It's one crazy, sleep deprived, basket case step at a time - at least that's how it was for me. This is my second career - I thought the first year would kill me. All the stress, night shift work and surprisingly co-workers. The best I could do back then was just trudge along. The PCAs would not help and complaining didn't work, either. I had to get creative with solutions - how to avoid the radar/laying low/avoiding conflict - but I learned. Plus there was so much I felt I didn't know. Crazy making stuff... and I was in a marriage that wasn't working... Bad, bad combo. Now, though, I've been in nursing for almost 7 years. I've specialized and love it. My marriage ended a little over a year ago and things have calmed down considerably in my personal life. Now the only drama I have is deciding what's for dinner - and I like it that way. Take it easy (seriously), RiverNurse

Hi all, I am fairly new to pediatrics. I'm a wound care nurse and have been working in pediatrics for a year now. I work primarily with the infant population that have had issues with gastric mucosa visible around low profile buttons (MIC Key buttons - that is what we use in our facility) along with large amounts of drainage. All of the infants with drainage/leakage issues have all had poor muscle tone and three of them have had their MIC Key buttons replaced with MiniONE buttons. I have found the design of the MiniONEs have helped to clear up much of the drainage and hypergranulation tissue problems. However, I have two patients where this solution hasn't worked. In both of these patients, their buttons have become dislodged previously and then each began experiencing excessive drainage. I have also tried removing the buttons on each patient for a day to see if the stoma would begin to contract. Initially it did, until the button was replaced. I would like to see if there is some way to at least slow down the drainage so that these children do not experience any nutritional/electrolyte disturbances as well as protecting the skin from breakdown. Thoughts? Thanks, RiverNurse

Not yet. In fact, I just finished up the distance learning Ostomy module yesterday (through Emory). I have read about it - now I'm just wondering about the "Oh my Lord" moments that aren't always listed in books. Thanks ~ RiverNurse

Hi all, Any tips on stoma site marking? RiverNurse

Scream? LOL... Rant? Not as much as I used to! Now if I have an off day, I usually refinish a piece of furniture or do something creative to get my mind off of it and to gain perspective.

I did the distance learning option for my CWCN last year. Back then, that module for the didactic portion only was $1200.00 (not including registration fees, books, clinicals, lodging). I attended bridge week there - technically three days for the wound scope, bit the bullet and stayed an extra week to do my clinicals at a local wound care clinic. I am considering (due to work requirements) finishing the ostomy and continence portions. Now, the modules are $1500.00 each. This time I will still have to attend bridge week, but will do my clinicals in my locale. When all is said and done, the approximate cost for my education will be right around $6000.00 - ballpark estimate - factoring in hotel costs and food.

Yes. PM me privately and hang in there.

Thanks for this. Apparently I received the wrong info from KCI. I was told by our KCI rep that there were income requirements and that the family "made too much money". I did find out from them that the VIA would be the way to go with this situation. Take care, Rivernurse

All I can say is, I wore those "shoes" when I turned 40... If you want it, go get it. Another "word of advice" from the peanut gallery - take care of your back (think Yoga), your feet (always by the best shoes - 2 pair and rotate them), and your down time - don't let anyone guilt you into working more overtime hours than you *want*. I learned really quickly where the "off" button was on my cell. Best wishes, Rivernurse

Hello all, I have a question about wound vacs. Scenario: Ped pt in foster care and is on wound vac. Wound is about 9 x 7 x 2 cm with approx. 75 cc drainage per day. Pt needs a vac for home. Foster family is in process of applying for Medicaid - but isn't approved yet. The vendor has a "charity vac" program, however, the vendor states the foster family makes too much money to qualify for a charity wound vac. I was thinking of a disposable wound vac, like KCI's Provena. Has anyone worked with a disposable vac like this? Thanks, Rivernurse

Yes, nursing is hard, but has it's rewards in the end - like a bad back and bunions. LOL LOL...

How long have you been a nurse? Now then, onto options: 1. Get out of Med-Surg. Sounds like you're burned to a crisp. 2. Continue your education (i.e. specialize) 3. Consider nursing informatics (downside - then you'll have a different level of "entitled clientele"). Just a few thoughts from a middle aged frumpy nurse, rivernurse

Update: We had a 3M brand of durable barrier cream. I tested it on my hand/arm before introducing it to the pt. Love, LOVE the stuff! However, the pt refused to try it. Rivernurse

Rock on! YES! Sometimes I just have to get on YouTube and look at excisions, etc... :-0 TMI, TMI... Depends on the "type" of wounds you "enjoy". If it's pressure ulcers, nursing homes have their share as well as MedSurg units. If it's diabetic ulcers or venous stasis - I did a rotation in an outpatient wound clinic that did a ton of unna boots and the occasional profore. I did get to see a pt with graft versus host disease while there. I'm more of a pressure ulcer/wound vac kind of girl. Rivernurse

Thank you! I will try that - and will let you know my experience with it.

Hello all, I am working with a pediatric patient that has midline prolapsed fistulae complicated by old surgical creases and divets from former surgeries. In addition, due to poor pouch fit, the pt has extensive maceration on the lower R/L abdomen. The pt is, as a result, in pain, both physiologically and psychologically. The pt refuses stomapast and stomadhesive as they burn the macerated skin. The current ostomy/continence staff has attempted multiple times with limited success to pouch the site in a way that contains the output. My current question is (and there will possibly be more), is there an alternative to stomadhesive that might be used? I've heard of a "homemade" version using stomapowder and glycerine - but as I'm wearing in on my hand right now, I'm noticing cracks in it and it does take a while to firm up/dry. Many thanks, RiverNurse

I don't often share this story anymore - it's been so long ago - but it has shaped who I am today. When I was 24, I was the mom of two little boys. I needed healthcare for them and couldn't get it. My husband couldn't get insurance at his work due to a pre-existing condition. I couldn't get insurance because I stayed at home with my sons. Getting a job was possible for me, but my pay was .50 less per hour than the cost of daycare for two children. Fast forward two years. I'm a newly single mother with two boys. I'm in school full time, no job prospects still... due to the cost of living. So, I did what I had to do. I got Medicaid, food stamps, and rental assistance while I was in school. I was on it for about two years. I promised myself that the government would be making an investment in me. I haven't been on government assistance since. I do not know of a perfect answer to the healthcare dilemma. On the one hand, I see some here in America demanding food or housing with little regard for the sacrifice that went into making that possible - and wanting the benefits without contributing even the small things that can mean so much. Then again, I also understand what it is like to do without - to resort to Jack Daniels gargle until I could afford a root canal... My wish is that we all do the right thing at the right time - in a way that does not enable - but rather - helps each become more self reliant. Rivernurse

I'd like to live in Canada to have that perspective on healthcare. I'd like to experience it for myself so I could make a side by side comparison. As to rights, the only comment I have is that I'm seeing a lot of entitlement among the younger crowd. At first I thought it was an anomaly - but I'm seeing it more and more. Instead of "returning the favor" to the country, I'm seeing more and more demands made. Just two cents' -- about nothing much really on a boring Friday night. Cheers, RiverNurse

I went back to school when I was 40. In fact, I'm still in school... I jokingly say that I spent the last decade with my nose in a book (well, only halfway joking). You can do this. Rivernurse

I worked in an ER setting after working nine months on a med/surg floor. Big city, downtown ER - Me? I was from a little town... I was a very little fish in a huge pond. I could go on and on about the experience - but suffice it to say - I realized I was in way over my head. I, too, thought I was doing well - but found out I was "slow". I was asked if I would be able to pick up the pace by the end of orientation. I was honest and expressed my doubts - but that I'd think about it. I did. I thought about it for two days and turned in my two week notice. I returned to med/surg. Things have a way of working themselves out. Hang in there. Rivernurse

That's exactly what I heard at my last place of employment. I was told that I couldn't stay past the end of the shift - and yet - I had to complete my charting, LPNs assessment charting (sometimes as many as five or six additional patients - and do the work of a CNA when short staffed... I was told I'd be written up if the charting wasn't done - and if I stayed - I'd also be written up. Needless to say, when staffing levels became not just frustrating - but frustratingly dangerous - I left. The longer I'm gone, the more I realize how right I have ALWAYS been about this.

NRSKarenRN - has anyone told you today just how amazing you are? I'm currently doing my wound care clinical rotation (CWCN boards to follow) and all your tips and links are most helpful! Many thanks, RiverNurse

Oh yeah... been there. Was in Information Technology for 12 years. The market went bust. I took a job making 50% less and working 60 hrs/wk. Finally, after going to ER for chest pain (dx: panic attack), I decided to do something different. I went into nursing! LOL... and I thought it would be less stressful than I.T... I didn't work while in nursing school. It was stressful on my marriage - neither my husband or myself had any clue what we were in for - even though we researched it. Yikes! I did hear about it - again and again from him about me not working, him supporting the "entire project"... even though we both agreed on the career change and me not working while in nursing school. It got so bad that we separated while I was in nursing school. Ugh. Obviously not fun. But - I had peace and quiet to study. I got through school, we got back together right around graduation/pinning. Since that time I've gotten my BSN and am currently in wound care school. I just enrolled in a Master's program at a local university. Yes - he and I are still together :-) I attribute this, in part, due to our knowledge of what nursing is - and isn't, and what is required when pursuing additional education in this field. As to your sensitivity to what your siblings are saying - well - it's been my experience that those that haven't been in nursing school just do not understand what that means or what it entails. Lazy? BWAH-HAHAHA! I laughed in their faces - maniacally - when it was implied that I was a "lady of leisure"...and not working while in school. At first I was way too sensitive, but eventually learned how to sharpen my wit... er, uh... sarcasm. I still succumb to it now in certain conversations... LOL... I guess what I'm saying is, if you want this, do it. No one knows your financial/career plan better than you - or the requirements and commitments it will take to get you there. And, frankly, is it really any of their business? Just a thought. Take care, RiverNurse