RN58186

ITNS has a "Core Curriculum for Transplant Nurses" that is an excellent resource. Right now the first edition is on sale for $30 and available on their website.

arrector pili - the muscle around each hair follicle that produces "goose bumps" catarrhal exudate - my instructor wrote "aka snot" on the board for this one. I still make hospital corners on my bed at home.

I echo your thoughts Viva! I have been a patient numerous times and the psych nurses I dealt with were the best. I appreciated that they listened every time I had a concern or problem and never judged me. I felt very secure and well supported. I could never work in mental health, but I am very, very appreciative of those who do!

85 year old lady on a geriatric assessment unit. MD had ordered Premarin lady partsl cream at HS. I went in early in the evening, explained to the lady what it was and why it had been ordered. Doing my HS med rounds, I went in to her room and I reminded her of our earlier conversation and asked permission to proceed. She told me to go ahead, and when I got the applicator full of cream in place she said (rather loudly) "Oh! I haven't had anything in there in a long time!!" Good thing she had a sense of humour because there was no way I was able to keep a straight face.

Our doctors are great. I have heard attending doctors tell residents that "nurses who have been here a while know more about renal than you ever will unless you become a nephrologist - listen to them!" The medical director of our program has been known to tell a resident that "if a senior nurse tells you to come, don't ask why. Just get your butt in there." And recently when a resident from another country told one of our staff doctors (with me in the room) that it was bad enough he has to listen to a female medical director and there was no way he was going to spend the next few years taking orders from "a bunch of nurses - and female nurses at that". While I tried to figure out my reply, our staff doctor just looked at this guy and said "One thing you have to learn right bloody now. This is a NURSE run clinic, and WE are here to do what THEY need. THEY call the shots around here - not us. Our job is to facilitate whatever needs to happen so the nurses can do their job. If you have a problem with this, then perhaps you should re-think this position and return home." I work with the best doctors.

I have been a renal nurse for my entire career. I would never move to another specialty. I work in transplant now but it is still an area that I love. One of my pts told me that he thinks the best nurses are all renal nurses. I know renal gets frowned on because our pts can be challenging, but given what some of them have been through, I'd be a challenging pt too!

The High River hospital is evacuated, Canmore hospital is sheltering in place, Drumheller health centreis evacuated, a number of LTC facilities have been evacuated, the Sheldon Chumir Health Centre in downtown Calgary is closed as are a number of outpatient clinics. A number of the outpatient labs in Calgary are closed as well. All the hospitals here in Calgary are okay thankfully. I have been thinking about those pts in the evacuation zones who need dialysis and other life sustaining treatments. Scary.

I have been an RN for 23 years, and work full time. I will finish this summer a Masters degree in Theology that I have been doing online. I have no plans to go into professional ministry, I took my Masters because it is a topic that I am passionate about and just wanted to learn more. I serve as Chair of the Board at my church as well as Chair of the Deacons'. I will forever be a nurse but have thoroughly enjoyed my studies for my Masters. When I told one of the doctors I work with that I was going to do it she looked at me and said "I think it will be awesome to have someone with that kind of skill set around here" (I work in a busy outpatient clinic). If you are interested in seminary courses I say go for it. Happy to answer any questions if you have any.

I did the Nephrology exam, I worked full time the entire time while doing so. I studied mostly for 3 or 4 hours per weekend and the occasional weekend. Good luck!

Many years ago we had two pts on our floor with identical names (including middle name if you can believe it). They were in the same four bed room, and they were both blind diabetics on peritoneal dialysis. Talk about an error waiting to happen. We had requested that one be moved, but were told if we did all our checks properly an error wouldn't happen. Finally one of the pts requested a move to a different room so they were separated. It was actually kind of scary.

I must say, my manager would NEVER tolerate any of her nurses being spoken to that way. She is like a mama bear looking out for her cubs. One does not abuse her nurses. She would have stepped in immediately if one of the MD's did that to one of us. Having said that, the doctors I work with are great. They have a huge respect for nurses and treat us accordingly. Our doctors listen to us and will often ask us for an opinion because we know the patients better than they do (we do case management and the MD's rotate through every two weeks, so the nurses are the constant). And in turn we have a lot of respect for them.

I work in an outpatient clinic, one of our docs will write the letter to the family doc (I saw Mr X, I recommended this and that, he had no other complaints, return to clinic 6 months) before he even lays an eye on the pt. And gets decidedly annoyed when there actually IS something going on and he has to change the letter.

I haven't worked inpatients for a while so I am sure all my inpatient skills are rather rusty (although when I did I was good at most of them) but where I think I am really good is in palliative care. I not quite sure what it is there that people gravitate toward, but more than one manager and co-worker has told me that is where I really shine.

Yes, absolutely we need to advocate for better mental health care. In all countries. But what really bugs me is whenever something like this happens the media announces "had mental health issues" or "had stopped his/her psychiatric medications". As someone who has a mental health diagnosis, and has endured the stigma attached to it, those kind of statements I find annoying at best and offensive at worst. The media would not announce that the person was diabetic who forgot their insulin, or a cancer patient on chemo. Yet, it is considered appropriate to advance the stigma of mental health patients as violent even though most of us are not. Mental health patients are fair game for having the details of their medical condition and compliance to treatment splashed over the airwaves in a way that would never happen to any other illness. I want to know what makes it acceptable to broadcast this kind of information about anyone, psychiatric patients or otherwise. Why are mental health patients any less deserving of privacy than other patients? Okay, rant over.....

Okay, I have to chime in..... We women all wore caps for grad, the guys in my class (6 of them) did not. All the ladies paid an extra $5 in fees that year for the cap. The guys decided THEY were being discriminated against becasue we all got caps and they didn't. At least one of them went to the registrar and said he wanted a cap too. He was told that he could have one but he couldn't pick it up until after the grad ceremony because they were sure he would wear it (they were right....). Every one of the guys in my class had at least one grad photo taken with the cap on and holding the bouquet of roses same as us. Just makes me chuckle, we didn't think anything of wearing them, but the guys were not pleased that they weren't allowed to!

Last week my Mom's goals of care at her LTC facility were changed to comfort measures only. I am so grateful for the nurse who has taken my calls every day, or called me herself to give me a daily update when I cannot be there. For the nurse who called in on her days off just to see how Mom was doing. For the nurse who has looked after her for over 5 years who wasn't afraid to shed some tears with me. For the nurse manager who told me to page her anytime, even if all I need is a hug. For the aides who come every 60-90 minutes when she needs to be turned and don't complain about doing so. For all the staff that realize that I am not trying to be the miserable nurse daughter when I insist that the on call doctor be called for better pain management, but that this is my Mom and making sure she is comfortable is one of the last things I can do for her. LTC nursing takes a special kind of person, and I am glad that that person is working with my Mom this week. I would never consider LTC nurses "less" than hospital nurses, it is different skill set and focus, but still an essential part of the healthcare team. I am very grateful for them and their special skills this week.

Once on a night shift I rec'd a call from admitting to which I replied "We are full. Sorry, but you'll have to look on another unit." This was met with "HOw can you be full?" Me: "We have no empty beds." Admitting clerk: "So, you won't take this pt?" Me: "Not unless you have bunk beds around here somewhere...." She didn't call back.... :)

I will be contacting the Patient Care Manager in emergency to say thanks and will be contacting the Patient Care Manager on the inpt unit about the "go in your diaper" thing. I don't work on an inpt unit any more, but I was appalled at the attitude that was displayed. If any of us did that and my Patient Care Manager had heard about it we would be in more trouble than anyone would care to admit. We had an LPN tell a pt that once and oncde our manager heard about it, well, let's just say she never said that again. If they "do that all the time" I worry how many others have figured they had no choice. I am not afraid to point out when things are not as they should be but I am also willing to pitch in to make things a bit easier if I can.

I will contact the Patient Care Manager in the emergency deptartment and pass along my thanks. KitkatPRN, I know they are busy in LTC and they do have a podiatrist who comes around. Problem is, he can't see everyone every visit and relies on the nurses to let him know who needs to be seen. I have discussed the situation with the RN who is the team leader who looks after my Mom most days, and she said that the aides should have told her about this when they dressed her, but she also said that she should have been assessing them herself and hadn't done so. She apologized to me, and I suggested an apology to Mom was more in order. So she has requested Mom be seen the next time the podiatrist is around and said that she would try to make a point to assess Mom's feet on a regular basis. If that happens I will be a happy camper. However, I will also be looking to make sure that they don't get that bad again. And the RN at the LTC and I do speak often so we will make sure that we talk about her feet once in a while. I know her workload is horrendous, but I figure that we can work together to make sure this turns out well. Mom was admitted, and for the most part the nurses have been great. However, Mom rang tonight for a bedpan to have a BM. The person who responded (not sure if nurse of NA) told her it would be too much work to put her on a bedpan, so she should "go in your diaper and we will be in in a while to change it". I know she is heavy and difficult to move, but I offered to help so there would be an extra set of hands and was told that "we do this all the time". My Mom was mortified. Her brain is totally intact, it is her body that gave out. To soil herself is the most humiliating thing that has ever happened to her, so she felt like she was being told that her dignity was of no concern whatsoever. (I did note while I was there that the room she is in is actually designed for bariatric patients, and there was a lift on the track over her bed that can hold up to 800 lbs. I offered to help them use it, they said no, they prefer to have pts just "go" and then clean them up when they get a chance.) That whole episode didn't do much for me. But, I am refusing to dwell on that but instead going to concentrate on the good ones who have looked after her.

Last night my Mom was taken from her long term care facility into emergency because she had a UTI that was not responding to treatment and they couldn't get her fever down. At one point my sister and I were helping her move in bed and I looked at her feet. (Oh yeah, she is 82 and a type 2 diabetic). Her feet were a mess. The skin on her feet and ankles was so hard and dry it looked like elephant hide. Her toenails were so long that they were starting to grow up instead of out. One nail was so long that it had obviously gotten caught on a sock or something and was basically ripped off, just hanging there by a couple pieces of skin. Her heels, sole and toes were cracked. (I have never had reason to believe that her feet were in this kind of shape or I would have been checking them. She alwyas has socks and shoes on when I visit so didn't kow the state of them.) When my sister and I left for the night, I asked the nurses if they could please put a piece of tape over the hanging loose nail so that it wouldn't rip right off (causing pain and thus making Mom miserable to deal with). They said they would see how the night went. When I went in this evening and looked to see if the nail was taped I thought I was looking at someone else's feet! Some kind soul had taken the time, in a busy urban emergency room, to scrub Mom's feet until almost all the dead and dry skin was gone. Her nails had been trimmed, and the hanging nail had been removed and the wound cleaned up. They finished off by putting some cream on her very dry feet. They looked so much better and Mom said her ankles weren't itching anymore and it was such a relief (she can't reach down to scratch so she had been just putting up with the dry skin itch). I do not know who took the time to take care of her feet, but I am so grateful to whoever it was. I know emergency is so busy that it is easy to miss an elderly lady who just needs her meds at the right time and help to turn when there is so much other stuff going on. But it meant the world to my sister and I that someone took the time to do that little bit extra that made such a difference. I will never know who it was to tell them thanks, but colleagues like that make me proud of my profession. I just had to share!!

I remember thinking that my first clinical instructor hated me. I thought she as a really unpleasant well, witch, to deal with. She made may of the same demands on her students and yes, if we had a question we were told to look it up (but she would help us research to make sure we understood what we learned. I would spend hours on care plans, only to have them returned with a comment that I did not cover enough material, that I had missed too much and could I please re-do this and re-submit it. I spent so many evenings in tears, and thinking that next time I will get it right. I had never done that kind of work before and we were not really given any instruction on how to prepare care plans. And yes, we were expected to know why a particular test was ordered, and what the results were indicative of the treatment for them. We were expected to know our meds inside out, and be able to describe the action of that med down to the cellular level. And to top it all off we (the instructor and I) had very different religious beliefs (she had commented in her introduction to our group that she found religious people as generally a group of people she really disliked and tried to avoid; I had earned a theology degree before I became a nurse) so it seemed that instructor student relationship was doomed. I thought my nursing career was over before it started. But, by the time I got to my next med/surg rotation I sure knew my stuff and the nurses were frequently impressed at what I had already learned. Now, grant it I have been blessed with a pretty incredible memory for pathophysiology, drugs, lab values among other things so I do know that part was probably not as difficult for me as for others. Her line that always drove me nuts was that someday I would thank her. Took me a long time to realize she was right. She expected a lot out of me, and because I wanted too do well I tried hard to meet those expectations. I chuckle now 25+ years later when I remember her telling me that when being asked about side effects of a new med that answering with nausea, vomiting and diarrhea was a good cover if you could not remember what they were. (That saved my bacon a few times). And now when I tell a student to look it up because the student will remember better, I know that is true, even thought I hated being told that as a student. But, when I got to my first job, my first head nurse (before they were called managers, and yes, I am that old...) told all the nurses that they could all learn something from me about writing a care plan because I wrote really good, well thought out care plans. And because as my first instructor she made darn sure I knew my stuff, the rest of Nursing School went much more smoothly. And as a new nurse I was not quite as frazzled as those who started with me. And, the religion thing became something that we agreed to disagree on and we are still good friends. I would not be the nurse I am without her teaching. The moral of my story is that one day we all come to recognize the value to doing all that work. Hope yours comes soon....

Aweome! So glad to hear it! You are eager to learn so I think that will make a huge difference. And yeah, always nice when the doctors want you there! When do you start? Did you find out about pay scale? Is it the same as what you are making now? I am so pleased for you, congratulations on sticking through all those people to get the prize!! Keep me posted!!

I'd say that sounds pretty promising.... Good luck!

Where I work none of us have anything higher than a Bachelor's degree (except our manager, she has an MBA). We have a couple of NP's that work with the renal program, but they don't work in transplant. However, where you are things might be different. NATCO does an Introductory Course for the Transplant Coordinator which I attended 10 years ago and found it to be quite useful. No one in my clinic has the CCTC or CCTN at this point. None of us aspire to management so we are all content with where we are. We do have some movement within the organ groups (eg moving from renal to cardiac or whatever) so there is always another challenge for us to try if we get bored. Not that it happens too often.

The pharmacists in our clinic deal with refill requests. When pts run out and don't have a follow up booked, or haven't had bloodwork done recently, we will bridge their supply until we can get them into clinic and they go to the lab. And if they don't show for that clinic appt the "leash" gets shorter and shorter - i.e. we might give a one month bridge, then a two week one, then one week, and we keep shortening the time frame until they get the hint. We have some pts who have gotten themselves down to one day supply of meds, and we will not lengthen that time until they come into clinic and have appropriate bloodwork drawn. And after a week or two of having to trek to the pharmacy everyday, they decide the lesser of the evils is to come to clinic and get their bloodwork done. We absolutely do not get the doctors to see a pt just because they dropped in, unless we have assessed the pt and determine that it really must be dealt with immediately. Pts "pitching a fit" at the nurses or pharmacists (or clerical staff) for any reason will not be tolerated by our doctors and when the pts do eventually come to clinic they will get a firm talking to from the physicians. Since there are only two programs in this part of the country that deal with transplant pts, our doctors tell them if they don't like how we do things they are welcome to transfer their care to the other program 3 hours up the highway. The nice thing is we get total support from our doctors and managers and it is an established practice of dealing with these pts that we all follow so the pts always get the same message, regardless of who they speak to.