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spotangel DNP, RN, NP

ED,Tele,Med surg, ADN,outpatient,homecare,LTC,Peds

DNP,FNP,RN,CEN,CPEN

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spotangel has 32 years experience as a DNP, RN, NP and specializes in ED,Tele,Med surg, ADN,outpatient,homecare,LTC,Peds.

spotangel's Latest Activity

  1. spotangel

    Nurses, invent what you want.

    A smell detector on your ID that sprays deodorizing scent when you walk into a patient room or the staff bathroom-----!
  2. spotangel

    NP Please help!!

    Is this Comedy Central??! OP teach the gal to fish--! I got daughters and I would ask then to Google local NP office and ask them to call. Prepare the child for the road not the road for the child! All Luck as your heart is in the right place! Parents---we want to fix it but sometimes you have to back off and watch them take off!!
  3. spotangel

    Florence In My Time

    The Nursing Unit was abuzz with the news! There was a new Chief Nursing Officer (CNO). Her name was Florence Nightingale. “Have you seen her?” “No, but I heard there is a Nursing Meeting with Breakfast tomorrow from 7 am - 9 am so that the incoming and outgoing shifts can meet her tomorrow and next week Tuesday!” The next day the nurses were surprised at the breakfast! Fresh fruits, oatmeal, freshly baked bread and cheese and of course hot coffee, tea and hot chocolate! Florence turned out to be a practical, data-driven but compassionate leader. She talked about her work during the Gulf War and the issues nurses faced from understaffing, lack of supplies, the cluelessness of the rest of the team about the nursing role. The nurses found themselves nodding as she accurately portrayed their issues. She broke the group into smaller groups for brainstorming sessions about the Covid crisis and the nurses' suggestions on handling the issues. A group of nurses came up with a system to monitor the PPE, and equitable distribution based on a WhatsApp group for days and nights nursing teams. The Nurse Managers were also part of that group. Another group decided to monitor patient outcomes related to staffing ratios. Yet another team of outspoken nurses volunteered to be on Zoom meetings when discussing the hospital’s Covid recovery plan. It was a productive meeting. The nurses left the meeting feeling rejuvenated and it was not just the non-greasy breakfast! Finally, they were really part of a team! Utilizing the nurses' feedback from the bedside, Ms. Nightingale used the data and showed not just positive patient outcomes but an increase in patient satisfaction scores, a decrease in rehospitalizations after a safe nursing discharge, Nurses' retention scores, a decrease in mortality due to Covid for patients and staff. There was a designated 24/7 hotline number for staff to call if any kind of crisis, a “calm down room for all staff ” in every wing and Ms. Nightingale involved the Nurse’s union to set up these resources. Nurses were encouraged to bring their ideas for a better workflow to the table and were listened to. At the same time, they were expected to be professional at all times, dress in uniform and be on time. Slackers were taken to task and “a three times you are out” rule was instituted with the approval and support of the union! More and more nurses wanted to come and work in this hospital. The CNO was looked upon as an innovative leader and role model. Her Nurse Managers took the lead in understanding the data and showcasing the skills of their unit Nurses! It was the ripple effect. One of the initiatives that the nurses came up with was a liquid diet for the covid patients that were easily digested and helped them recover faster. The hot coffee and tea truck rolled through at 10 am and 4 pm. This change in diet correlated to speedier recovery for many patients and also became a cost-effective measure that saved the hospital a ton of money. This model was then adopted by other hospitals effectively. All these initiatives had the backing of the CNO and empowered the nurses. I am happy that Florence is now in my time!
  4. Congrats! Well deserved! You had me bawling my eyes out reading your story!
  5. spotangel

    Nursing Intuition- What Is It, and Do You Have It?

    I can't even begin to start----! Too many examples! Initially gut feeling--now can verbalize it in terms providers can understand. The one that stands out is the lady that walked into the ED on Christmas Eve. I looked across the ED, saw her and knew she was going to die and she did not make it out. She had a septic look, with very slight tachycardia and normotensive. I wrote an article about her @allnurses"Mary's Gift'
  6. Crying! PTSD in full form here! Brings me back to March /April 2020 @a covid unit at work. Now, hearing that family members in my home country died, dying, struggling to breath---! How much more lord! GIVE US STRENGTH AND GRACE!
  7. No! I made up the doc and the pt's name! You would guess wrong as the names are totally different from the real names and I practice in a different state! Is there really a doc by that name in IL?! I must have given you an MI! LOL! I agree that HIPAA needs to be adhered to and I have! Been doing this for too long to lose my license. I appreciate the concern though Gillyboo! Thanks!
  8. A very hard place to be. That's why it's important to tune yourself to what's happening and help to the best of your ability. What I admire about Sarah is that she is so positive and tries very hard to help herself despite all issues.
  9. Thanks monkey205! I am a sucker for happy endings! Always rooting for the underdog-----! She's a young brave lady trying to survive every time she gets knocked down. The good thing is that she trusts us!
  10. She slipped and fell on----the GI Bleeder's poop on the floor!
  11. I always had a soft spot for Anna and knew her for the past three years. She came off and on for BP check and diet counseling. The last time I saw her was over a year ago for a BP check before Covid started. She looked very happy to see me! "Everything is GREAT!" "Dr. Annie! How are you?" "Great! It is so nice to see you today! You are looking spiffy today! Typical New Yorker! We laughed as we went into the exam room. "Anna do you need to pee or do you need a drink of water before we start?" "No, I am good Dr. Annie!" "OK. You are here for a BP check today aren't you? I see that Dr. Sue Kin had a telephone visit with you two weeks ago and wanted you to come in to check your BP." "Yes!" "How is everything?" "Great! Just great!" We proceeded with the visit and everything was going smoothly. The Phone Call - "What Do I DO?" As I got ready to print her after visit summary with her next appointment, her phone rang. I nodded my head as I typed as she looked at me as phone calls during visits were strictly discouraged. She took the call and her face blanched as she listened. She stood up shaking, looking very upset, wiping her brow and sweaty hands. "Anna, what's the matter? You look upset!" "This is not good! This is not good!" "Anna, talk to me!" She kept wringing her hands muttering, "What do I do? What do I do?" I am sure her BP had shot up and her PTSD was kicking in. She was sitting on the examination chair rocking herself. "Anna calm down! May I have your phone please? Who are you speaking to anyway?" "It's my aunt Sarah!". She gave me the phone. I put it on speaker. Aunt Sarah's Story of Abuse "Hi Aunt Sarah! How are you? This is Nurse Annie. Anna looks upset. What's going on?" Aunt Sarah launched into a long story. The short version was that there was a woman, Red, staying in Anna's section 8, government housing apartment that Anna's ex- boyfriend coerced her into staying with her. Red in turn now had been giving copies of the apartment keys to others who came in and out of the apartment at all odd hours. Red made Anna move out from her bedroom and sleep on the couch while Red took over her bedroom. Earlier in the day, Red walked in at 3am with a strange man and a baby. When aunt Sarah, who lived one floor up, confronted her an hour ago, Red slammed the door on her, almost slicing her hand off! Aunt Sarah called the cops who shrugged and told her that since this apartment was in Anna's name, she would have to make the complaint. That's when she called the patient. Anna was visibly shaking and wringing her hands. In addition to depression, PTSD, head trauma and abuse, she also had an intellectual disability and was socially inept. Nurse in Action "Are you her health care Proxy, Sarah?" "No, I don't have any papers. I took Anna's care once my sister, Anna's mom, was put in a Nursing home for dementia as Anna cannot safely take care of her and I have to work most days." "OK. We have to get you some kind of paper or the police won't listen to you as she is an adult. Let me call you back!" I hung up and got Anna some water to drink. "Sit tight! I'll be back." Anna nodded quietly as I walked out of the exam room. I went to her primary care doc, Dr. Sue Kin, who was in another room catching up with her notes. I briefly explained what was going on. "Sue, I think if we give her a letter stating that she has these medical conditions and that her aunt is assisting her based on her needs, the police will take them more seriously. She needs to file a police report and aunt needs to advocate for her." "I agree, Annie." Sue quickly typed up a form letter with her medical conditions, stating that her aunt was assisting her. She printed it, signed it and gave it to me. I made 2 copies and gave it to Anna. We called the aunt again from the room and I spoke to her. She planned to take the letter to the police station and both of them were going to file a police report against Red. I gave Anna an appointment for one month for a follow up for BP check and she left. I huddled with her provider and the administrator as I wanted to discuss the possibility of adult abuse at home. The team agreed of the possibility and I ended up talking to the social work manager offsite who agreed. I called Adult Protective services and they gave me a case number and asked me to call the next day to find out if the case was accepted. I did and was told that her case was accepted. I ended up talking to the case worker and her manager there and she received a home visit within two days. They helped her get Red evicted and continued to monitor for a whole month. The Outcome Last week Anna came back for her BP check, which was normal and told me that the police case and order of protection against Red was still in effect. She heard that Red had got arrested for something else and was in jail. She had also gone to family court with her aunt. The judge ordered the landlord to change all locks of the apartment and the front door so that Red or her cronies would not have access to the building. Anna looked happier and continues to see a therapist who helps her with her issues. Her mother is fully demented and in a nursing home. Anna's aunt watches over her and helps her with her appointments, groceries and any help that she needs. Anna loves to come to our clinic and says we are her family and we are nice! There are many young and older adults like Anna that are taken advantage of and my antenna is always on high alert when I see them. I always feel grateful to be in a position to help the Anna's of the world as in their case it truly takes a village to raise them and keep them safe! References What is Intellectual Disability? Traumatic Brain Injury and Concussion
  12. Nobody wanted to take care of her! She kept ringing the bell and everyone was fed up. Nurses were running around like crazy with really sick patients in March-April 2020 and we didn't have enough PPEs and enough knowledge and feared the unknown. Since I was deployed and didn't have access to the inpatient computer system, I was the helper, taking vitals, feeding patients, cleaning them, holding hands and comforting them. I had to constantly go in to the room and she was covid positive, coughing constantly, refusing to eat. I kept making her hot TEAS, getting her hot soups and praying I wouldn't get infected. One time, I had to go in to check her blood sugar and she asked me what would happen when she fell off the cliff. I sensed that she was asking about death. I told her not to fear and that the fall would be gentle. I asked her if she believed in God.She told me that she talked to Jesus all the time and saw angels! 'So then, you are never alone!" I reassured her. " I like you!" she declared.Then she wanted me to walk her to the bathroom, set her tray, help her with washing up-------the list went on and on! I was patient and honest with her and let her know when I couldn't come in to help. I would check on her when I had a minute and tease her gently, making her smile! She was getting progressively worse. "I hope to see you tomorrow. Stay well. Say hi to your angels if they come visiting or checking in on you!" "I sure will!" We both laughed. The next day, someone else was in that bed. She had died that night. Her angels had come and taken her home to Jesus! She had "fallen" but the pain was mine. It hurt bad---and still does!
  13. She thought activated charcoal was best given without gloves and then the patient had projectile vomiting---and there she was right in front of him!
  14. "This woman I cursed out for holding up the line yesterday in the cafeteria is the Nursing Dean?!!
  15. spotangel

    Davey Do Toon Caption Contest | Nurses Week

    "When you said shot, I thought you meant a drink!"
  16. Whatever happened to patient care? If you are totally opposed to say, abortions, don't work there. I am pro life and in my clinic we do both prenatal care, contraception and abortions. My partner or the provider counsels patients that are interested in abortion as an option. I am not part of it but the patient gets the help they need. They come for help and get the help. Trust me, I find it hard and uncomfortable but make sure they get the help they need. On the same token, I had an anaphylactic reaction to the Moderna vaccine first dose and cannot take the second dose. I just signed up for next weekend vaccination clinic to give 600 doses. At the end of the day, I am a professional and help my patient regardless of my beliefs. I am a resource if they have questions both pro and cons. Our patients trust what we say as we ARE the number #1 trusted profession in the world!