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spotangel MSN, RN

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

Content by spotangel

  1. spotangel

    What is this vision therapy?

    I could feel my anger and irritation growing as I did homework with my then 11-year-old son, Sam. How hard was it to grasp the concept that the English explorer Henry Hudson sailed on the Half Moon and discovered the Hudson River in the year 1609? We were going at this for more than 40 minutes and Sam kept staring at his textbook in mounting frustration. I told him to take a 10 minute break and went out on my deck to get some air and cool myself down. Staring at the Hudson River that I could actually see from my deck and the hills of New Jersey on the other side, I had an idea. I went back and grabbed a blank sheet of paper, drew a few hills and a river with a boat and a stick figure and a sail on the boat. I named the boat Half Moon, wrote 1609 on the sail and labelled the river Hudson River. Calling Sam, I pointed out my drawing. "What do you see Sammy?" "A man on a boat?" That's Henry Hudson an English Explorer. That's his boat "The Half Moon" and look at the sail. What year is on the sail? "1609", was the excited reply. "I got it mommy! Henry Hudson discovered the Hudson River in 1609. He sailed on the Half Moon. He was an Englishman." "Aren't you smart?" I praised Sammy as I mentally realized that he was a visual learner. I dreaded homework which took over 4 hrs. Now I had an idea that words strung together made no sense to my child even though he was very intelligent. Sammy had a diagnosis of Autism, even though he was at the higher end of the spectrum. He was socially awkward and did not make friends or sustain conversations beyond his areas of interest, which was basketball news. I called his teacher the next day and asked for an appointment. When we met, I told her my discovery. She was quiet and listened intently. She then told me,"Mrs.Radcliff, I am going to suggest that you look into Vision Therapy." "What is this vision therapy?" "Some kids eyes don't work together and you cannot find that out in a regular vision examination. You need a special test and if they find out that they are not working well together, they will reteach the eyes to relearn how to read as a team." I was amazed that as a nurse I had never heard about this. "How did you know about this?" "One of my students struggled with reading and got vision therapy. His grades went up and I asked his mother what she had done differently." his teacher explained. I thanked her and started my research. I was determined to find anything that would help my son. Through my research, I found out that the problem was that the decoding of what the eye was seeing was not happening in the brain. In very simplistic terms, vision therapy was like giving physical therapy to the eyes to strengthen them and rewire the way the brain interpreted the signals from the eyes I could not believe that my ophthalmologist who had prescribed glasses for Sammy's Myopia did not know anything about this. When I called him, he pooh-poohed what I said and told me that the doctors who did this therapy (optometrists) were quacks and not to waste money on them. I decided to ignore his advice. I looked at places that offered it and finally settled on one place that had the best reputation and had government funding. I found out much to my dismay that insurance did not cover the three major tests he needed. We decided that this money was worth spending and put in the money so Sammy could get tested. They called us back and told us that he did need vision therapy and that we should bring him once a week to the center to do the therapy. We figured out a day a week we could take him from school to vision therapy which was an hour away for an entire year. They made it fun for him by making him use a computer and animated games that made him unknowingly strengthen his eye muscles. They had an intern help him with his homework especially English and he did the rest on the train as we traveled back home. He had special eye homework at home which I had to help him with. After a year he "graduated "and I was amazed at the progress he made in his Subjects especially English Language arts, social sciences and other subjects that used a lot of words. For the first time in his life, his hard work was paying off. I felt my heart would burst when he came home one day with shining eyes holding a report card with a High Honor roll. Not only did his grades improve, his confidence improved too! My eyes were shiny too with tears! Today, he is in college working hard and rewarding himself for his good grades by playing his favorite game basketball! My youngest daughter Sandra was tested for vision therapy and needed it too. The four-hour homework that dragged on and on just like Sammy's did, the frustration, the tears! She was started on Vision Therapy and also graduated but has to continue with homework for the next 6 months. It is too soon to see a difference but one thing I have noticed is that she does not take that long to finish her homework and has become more independent. So how do you know if a child or an adult needs vision therapy? Some of the most common reading issues are Struggling with "near work" such as reading or looking at a computer screen Frequently losing your place while reading Omitting or re-reading letters or words Confusing similar looking words Poor reading comprehension Reversing letters or words after age seven Seeing double If so, what can be done? Time is spent with each patient to get a complete picture of their overall health and how it impacts the health of their eyes. An experienced practitioner takes time to thoroughly assess the health and function of the patient's eyes, including: Eye and general health history Refraction Binocular assessment Eye health evaluation Glaucoma and cataract evaluation Evaluation of systemic disease, including diabetes and hypertension Routine and specialty contact lens services A Visual Skills Evaluation - examines the visual system's ability to track and change fixation, maintain and accurately change focus and maintain the efficient use of two eyes functioning together. Problems in these areas may contribute to inefficient reading and poor attention span. A Perceptual Evaluation - examines the patient's ability to process visual information and integrate this information with auditory and motor skills. Visual recognition, copying skills, visual memory, and directional organizational concepts are tested. Pre- or Post-Surgical Evaluations - examines the need for surgical intervention for strabismus (an eye turn) or the need for Vision Therapy before or after surgery. How can vision therapy help? Vision Therapy is a treatment regimen that is designed to correct or improve specific dysfunctions of the visual system, including such disorders such as amblyopia (lazy eye), strabismus (turned eye), poor eye-hand coordination, focusing problems, perceptual difficulties and eye movement disorders. What exactly do they do? Treatment plans are tailored to specific diagnosed dysfunctions and encompass the use of lenses, prisms and patching (among other things). Because the therapy is individualized, the procedures used and the duration of therapy are dependent upon the nature and severity of the problem being treated and the specific needs of the patient. I have used my experience with my children to help others that I know or hear that are struggling especially with reading comprehension within my professional and personal life. Since I presently work in Primary care, I have had ample opportunity to educate my coworkers, the health team and patients about vision therapy. Usually, the PMD puts in a referral for evaluation for visual perception. The family is advised to check vision therapy center locations that are close to them and also with their insurance company in terms of coverage for the comprehensive eye exam and vision therapy. Once they qualify for therapy they schedule dates when the patient can be seen weekly. Once they graduate they may or may not require continuing homework to strengthen their eyes and improve coordination. Recently I redeemed a gift spa certificate that was going to expire and met a total stranger in the steam room. While being steamed like lobsters (!), we talked about our children and she told me about her triplets and their challenges in school. I told her about vision therapy. She was very grateful and promised to check it out as soon as she got out of the spa. I went home thankful that yet another parent had been given a ray of hope to help her children and their future! References 1- Eyecare for Children - SUNY College of Optometry) 2- An Eye Doctor answers questions (FAQs) about vision therapy, visual training, eye exercises, pediatric optometrists, developmental optometrists, ophthalmologists, opthalmologists, opthamologists 3- Parenting Info: Learning Disabilities and Vision, Learning Disabled, Vision Therapy, Visual Learning, Visual Skills 4- Vision Therapy for Children | When Glasses Aren't Enough 5- How to Identify and Refer Patients for Vision Therapy - Vision Help
  2. spotangel

    Epinephrine Error - Broken Heart Syndrome, Part 1

    "You will likely remember that I strongly opposed the directive to move from a triage system to a direct bedding approach in which no patient waits if a room is available regardless of patient acuity." Sounds like the system was set up to fail the nurse. When staff that uses the system are not consulted, the chances for error multiply rapidly. Hopefully the CEO looked at changing the system and not just blame the nurse!
  3. The call came in while at work. My mom's brother Steve had been rushed to a hospital. He was dying. I decided to go on the weekend when I was off, as my partner at work was out sick. I flew into Canada and made my way to the hospital. My aunt, a retired RN, was there with him and had not left the bedside for the last five days since his admission. They had been married 51 years and did everything together. She decided to go home for a few hours to freshen up, while I stayed with him along with his older daughter Carol and her family who came a few hours later. As I turned and positioned him gently, he screamed in pain. His prostate cancer that had been in remission for 16 years had come back with a vengeance and spread to his bones and lungs with metastasis to his spine. He had an ineffective cough and had phlegm in his throat that we could not suction as it was deep. His lungs were clear. Every time he coughed he would begin to panic as he felt his airway was blocked. He would ask to be lifted to sit up higher and struggle to breathe. I constantly heard the death rattle and saw him struggle to breathe. It was hard to watch and I felt helpless wondering how I could ease his suffering. His mind was clear and he was fully conscious. His nurse Laly came in. I tentatively asked her if his pain medication protocol could be reevaluated as it did not seem to be helping him. I also asked if we could up the oxygen as he was only on 1.5 liter due to his Chronic Obstructive Pulmonary Disease (COPD). "At this point Laly, we would like him to be comfortable. His COPD causing respiratory depression when the oxygen is increased is the least of our worries. What do you think?" She smiled compassionately. "I absolutely agree" she nodded as she adjusted the oxygen flow meter. She then left to page the MD in charge and ask him to adjust the Dilaudid IV for pain. Later the doctor came and we talked about the plan of care. He would not be transferred to a hospice bed as there were none available but would get the same care on the floor. As uncle slipped in and out of consciousness he wanted me to sit next to him and hold his hand. "Do you know Annie that I am waiting to go? I am going on a journey. The vehicle has not yet come for me. It will come. It has so many wheels and has to make so many stops----." I smiled through my tears. "It will come uncle, in it's time." "Annie, sometimes when I see you, I think your mom is sitting next to me and Jerry my brother is standing nearby." Both uncle Jerry and my mom Mary had passed years ago. I am sure they were visiting him unseen by me but clearly visible to him. His eyes clouded and he fell asleep his breath rasping.I gently removed my hand but his grip tightened. "Annie, don't go!" "I am right here. You are safe." He lapsed back into a fitful sleep. Aunty and I looked at each other. "Aunty Bea, you have to give him permission to go", I said softly. She sobbed and shook her head. "I know. I have to. This is so hard. I can't bear to see him suffer." Her composure that had been rock solid throughout the day, when visitors had come from all over Canada and the United States, crumpled now that they were all gone and she broke down sobs racking her body. RN Lally came in to see both of us in tears crying softly as he was in a double room with another patient behind the curtain. Her eyes filled and she walked out. In half an hour she came back and signaled us with her eyes to stay quiet. "The doctor told me that he needs to be moved to another room as his condition is worsening and he needs some medical procedures done." She announced loudly. She quickly packed our stuff and took it to a private room, two doors down. A couple of other nurses came and helped move his bed over. She even got us two sleeping sofa chairs for the night. This room was big, spacious, with a bathroom attached with a stand-up shower. It had a window ledge where you could sit and get a beautiful view of the city. Once we were settled she told us that they gave uncle a private room so that he could be surrounded by his family in peace as he died. "I see that you are a prayerful family. This way you can say your prayers, sing and not be afraid that you are disturbing anyone. There is a window on one side and the hallway on the other side of this room. So you can sing, cry, talk and it won't disturb anyone." That night I forced aunty to sleep and I sat with uncle my hand linked with his. Once aunty got up around 4 am we kept him company till dawn. She gave him permission to leave and promised him that she would take good care of their three girls. "Steve we have been together for 53 years and been married for 51 years. We always did things together. I wish I could come with you and die with you but I have to stay behind for our daughters. When you go to heaven advocate for our family with Jesus. It's ok to go. I will take good care of our daughters", she sobbed, her face on his chest, her hands around his neck as she leaned over the bed. I cried stifling my sobs in the dark listening to her, my heartbreaking for her. I wiped my tears, got up and moved uncle to one side of the bed. "Come, aunty, get into the bed with him. This is the best thing you can do for him and you." She got into the bed and cradled him gently. He slept peacefully in her arms. The next day family and friends started pouring in, some driving as far as New York, Detroit, and Chicago to see him. My flight back to New York was in the evening and before I left, I kissed him on his forehead leaving my lipstick on him! His eyes flew open and he asked me where I was going! I told him I was leaving to go home but was leaving my lipstick and prayers behind! Uncle hated lipstick and that had his daughters smiling through their tears. We said goodbye with our eyes and I walked away knowing I would never see him alive again. He lived for three more days. Everyone who had planned to fly in or drive in to see him got a chance to see him. Early morning on the third day, aunty cradled him and said the Divine Mercy Chaplet in his ear and sang a song about the Holy Spirit. As she finished the song, she looked at his face. His breath had stopped and he had slipped from this world to the next. My family drove to attend the funeral. When we were at the gravesite we realized that it was close to the airport and that a plane took up every 30 seconds. When the coffin was lowered into the grave, a jet roared overhead, the familiar Orange colors of Air India, the official plane of India, his birth country. Just like he had told me his vehicle had come to take him home!
  4. spotangel

    The Vehicle Has Not Come Yet To Take Me!

    You are absolutely right! As a nurse I could not ask for better care. I saw compassion and patient advocacy in action from the RN who took care of him.She made sure that his pain med protocol was revised but also stopped the doc from pushing ativan when my uncle was not agitated.I called and thanked her for her care last weekend. I also had spoken to the night nursing supervisor while I was there and had commended the staff for their hard work and compassion.
  5. spotangel

    The Vehicle Has Not Come Yet To Take Me!

    Thank you. Still raw since he died early this month but I got a chance to see real love in action between my uncle and aunt. Marriage vow-"Through sickness and health, till death do us part."
  6. spotangel

    interview question tips

    Congrats on the interview! Hope I am not too late answering your questions---! Tell me more questions----about yourself,your interests, why would you go a good fit,your strengths,weakness,situations and how you handled it?When to escalate an issues. Dress professionally, arrive 15 mns before,know your route and parking before hand. Look people in the eye while talking, strong firm handshake, look happy and confident. If you don't understand a question ask them could you please repeat the question? Read up on the organization and the interviewer on LinkedIn if you have a name. Best of luck!
  7. spotangel

    Active investigation with board for charting errors

    Oh Yeah! Ms. Grey is alert oriented x 3 , had a restful night and sleeping in her chair. I walk in after report and find Ms Grey quite grey, very cold and sleeping her eternal sleep in the chair minus a pulse! Thankfully she was a DNR/DNI------!
  8. spotangel

    I Have to Go to Work!

    Friday the 16th of August was a busy day in the clinic. I was on triage duty. Mr Grainer had signed in for shortness of breath and near syncope. I called him in and observed him walking in breathing normally. As he sat down, I noted that he was neatly dressed in summer clothes; shorts and cotton shirt with a straw colored hat that he removed displaying his salt and pepper hair. His ankles didn't have any edema and he did not look like he was in any acute distress. I sat across him observing him as I spoke to him quietly. "Good Afternoon Mr. Grainer! My name is Nurse Annie and I am the triage nurse in the clinic today. How are you doing?" "I am good! Can't complain. Please call me Carl!" "Thank you Carl. Why did you come today?" " Nurse, something's not right." "You seem worried. What do you mean by something's not right?" "I am normally pretty healthy and can walk four miles a day but for the last two weeks, I feel like I am going to pass out after walking one block." 'Is this something new? " "Yes. I never felt like this way before." "Do you get short of breath? " "Yes! Just in the last two weeks." My mind went into overdrive as I scanned through his chart. He was a diabetic and hypertensive. In my mind I always equated shortness of breath with the heart in a diabetic until proven otherwise. Just in case, I asked him questions to rule out a Pulmonary emboli. He had no risk factors, no travel, no smoking or recent prolonged immobilization. I took his pulse manually and immediately figured out what was wrong. His vitals all were great except for one. He had a heart rate of 38 bpm. Probably a heart block but totally asymptomatic! "I have some good news and bad news Carl! Which one do you want first?" "The good news " "I figured out what is wrong with you and why you feel this way." "Why?" It's your heart. It's beating really slow and any activity puts a huge strain on it." "What do you mean?" "For some reason your heart is beating very slow and that is causing your symptoms. I need to send you to the ER right now ." " Nurse! What about work? I have to go to work tonight!" I realized that he did not grasp the seriousness of the situation. I had to give him a verbal jolt and be honest. After all we nurses are known to be the most trusted profession! "Carl, let me be very frank. I am surprised that you made it into the clinic after walking four blocks from home. It's only a matter of time before something happens to your heart. Do you think your work will care if you drop dead? At this time you need to take care of you!" He stared at me and saw the truth in my eyes. "Nurse you are right. OK, I will go. What happens next?" "Just relax. You are safe here. Let me make a few calls." I called for an ambulance ALS team, informed the front desk and lobby about their impending arrival, printed out his paperwork and informed his doctor that I was sending him. She agreed 100 percent with the plan. I then called our main hospital and gave report to the ED charge nurse who was named Carl too! I informed Carl what to expect in the ED; Labs, line, EKG, portable chest, being hooked to a monitor, no food and possibly a cardiology fellow visit and a recommendation of putting in a pacemaker. The ambulance crew came and whisked him away to our main hospital. In three hours he went through all that was discussed and was taken to the cardiac cath lab with a second degree heart block and a pacemaker was placed. He went home on Saturday with no complications. I followed up with him via phone on Monday and got him an appointment for a follow up with a provider the same week and in two weeks with his own PMD. When he came for his first visit, I was out sick and he went around the clinic looking for me. One of my nurses told me. Yesterday, I saw him in the clinic for his two week follow up waiting in a room for his doctor. He jumped out of the room and hugged me and kept thanking me. I went into the exam room, sat down and caught up with the latest in his health. He showed me the dual pacemaker site and I noted that the skin was healing well. "Nurse Annie, thank you. Thank God you were there that day." "Carl, lets give all glory and thanks to God! He put me in your path that day and I am glad that I was able to help you." 'Nurse, I want to treat you to dinner!" "Thank you Carl! That is very sweet but not necessary! " "Nurse! I want to do something for you!" "Just say a prayer for my family and do something good for someone else and pass it on!" I left the room feeling grateful and feeling appreciated. It is not often that one gets appreciated in our profession. I reflected how my years of experience kicked in when needed but more than that I marveled at the way our skills are utilized to help others in the grand plan of our lives and in the lives of others. Each person is created in God's image and likeness but we have been given strengths and weaknesses that together as a human race fit together perfectly like pieces of a puzzle. It is wonderful to be a nurse! I have a question for the readers. Can you share your stories where you felt that you made a difference in a person's life in and out of work? These stories need to be shared with each other and the world!
  9. spotangel

    Spouse of nurse

    This year marks 25 years of married life. All through out, I have earned more but it has been a non issue for us. My husband used to have hangups about making less and it took a lot of convincing for him to trust that I was more into him than into money. At home we have a policy. Home is a safe place and we are a family and not our titles. We have one account. He is better at managing money, so he manages it. We trust each other and speak frankly if the other spouse is doing something that may be an issue. Be honest with each other and ask what you can do as a team to manage expenses. Comforts and bank balances does not provide security and happiness in the long term. Don't lose a marriage but look for opportunities to make your spouse feel loved and cared for. This is the one you promised to stay with through richness,poverty,health and sickness. Tough but doable.At the end of your life how much comfort will money bring you? Thirty years is nothing to sneeze at. God bless! All luck. Take one day at a time, trust in God's providence! I will be praying for you. Peace!
  10. spotangel

    September 2019 Caption Contest

    Time for the Flu shot before the grim reaper and the invisibles take you says the overworked robotic nurse!
  11. spotangel

    When Nurses Dream...and Have Nightmares!

    Lol! The med pass Dream is so me! My version is at the end of my shift I still have not given Morning meds and am freaking out! It is also a recurring dream!
  12. spotangel

    But, she was fine this morning!

    1.20 PM The red phone rang in the ER. This was the EMS line when they called with an incoming emergency. "South side ER. This is Nurse Annie. May I help you?" "Nurse Annie, Brian from EMS unit 134. We have a two year old female, found unresponsive at home; CPR in progress, ETA (estimated time of arrival) 4 minutes." "Thank you Brian. See you in 4.Over." I hung up and quietly announced,"Peds code, 2 year old female, CPR in progress, ETA 4minutes." The team quickly swung into action. The code cart was pulled right to the stretcher. The suction, defibrillator and cardiac monitor turned on and ready, 2 nurses with IO/IV kits, NG, Foleys and emergency med box ready, and the registration clerk with her portable computer. The team gathered by the bedside as the doors swung open and the EMS team came through and was directed to Stretcher A1. The next hour passed as a blur and the team worked hard to save the young child's life. The dad was allowed to sit at the side and sat quietly in a chair, tears coursing down his face as he clasped his hands convulsively and prayed. The monitor never picked up a rhythm throughout and after an hour the code was called off. The father was in a daze and kept repeating, "But she was fine this morning. How did this happen?" The rest of the family was in the waiting room waiting for the mother who was at school and had been notified. I triaged the child Sara as a tier 1(unresponsive, pulseless,) code and noticed that she had been in our ER the night before for cough, vomiting and fever. She had been given IV fluids, labs had been sent, CXR negative, urine negative, tolerated po and had been sent home at 5 am with a prescription for antibiotics as the white blood count was 14. The discharge note from the nurse read" Sara noted to be smiling, skipping up and down the hallways, tolerated apple juice and sent home with grandmother with discharge instructions on a BRAT (Banana, Rice, Apple sauce, Toast) diet with prescription for antibiotics. Grandmother verbalized understanding of discharge instructions". EMS reported that the child was taken home after the ER visit and was fine and fell asleep on the sofa nursing on a bottle of milk around 12 noon. Mother had gone to school and grandma checked her around 1 pm and found her unresponsive. There was no one else at home. Dad was at work and came straight to the ER when grandma notified him. The mother was enroute to the hospital now. So what happened? This was definitely an ME (Medical Examiner) case. Sara's body was moved to our isolation room where the family could grieve in private. It was almost 3 hours since she had been pronounced. The family came in quietly 2 by 2 as it was a very small room that fit a stretcher and 2 chairs only. All of a sudden the double doors swung open and I heard a scream. It was the mother and she was out of control. Screaming, cursing, crying hysterically and sweeping everything in her path. She grabbed a vase of flowers that a grateful patient had brought the staff and smashed it on the floor, then picked up a computer monitor that was on the nurses' station and pulled it down. At no point did she go to the room where her daughter's body was. By then, security came in and she was escorted out of the ER along with the rest of the family. No one was allowed back into the ED from that family. Luckily no one got hurt even though the ED was crowded. Sara's body was sent to the morgue. The staff were all down emotionally as we were unable to save her and a child's death always shook the most hardened ER RN'S armor. We pored through the chart looking for any signs that we missed from her previous visit but it looked like gastroenteritis and a slightly elevated white count without a known source. The only comfort we took was that we had tried our hardest to save Sara's life even though she had been a DOA (dead on arrival). It was 10pm. One more hour, and my shift would end. I was sitting in my office going through the schedule when I got a call. The entire family was back; around 40 of them and they wanted to see Sara. As the evening ED manager, I had to handle this situation. Saying an internal prayer, I walked into the registration room and scoped the waiting room through the glass to gauge the mood. The family was subdued and I saw the parents. I called the security supervisor and asked him to have a few security guards inside the ED for easy access to the waiting room in case anything erupted. I went out to the waiting room and 40 pair of eyes swung my way. I went straight to the parents. The father recognized me. I introduced myself calmly and asked them how I could help them. The mother looked at me with tears in her eyes and whispered, "I want to see Sara. Please!" I told them, "I am so sorry you lost your daughter! She was taken to the morgue. She is not in the ER anymore." "Can we go to the morgue?" "No. No one is allowed as per hospital policy. I am so sorry" They were distraught and kept begging me. Right next to the parents were the two grandmothers and would not take no for an answer. Finally I told them to have a seat and that I would come back. I then discussed with the Evening Nursing Supervisor and the Security Supervisor who basically told me to make the call and that they would support me. I went with the security supervisor and another guard to the morgue, put on gloves and mask. I pulled the drawer with the child out and unwrapped the head. Sara looked like she was sleeping. We then went back to the ED and I went back into the waiting room. I called the parents and grandmothers and told them that I would take the four of them only to the morgue. The rest of the family could not come. I told them straight up that I was putting my job on the line as the policy strictly prohibited visitors. I told them that they had to contain themselves as the morgue was in the sub-basement which was pretty far away from the ED in case anyone fainted or fell. They promised that they would not create any issues and we went down to the morgue accompanied by 4 security officers. The next 20 minutes was very hard to watch as they knelt by her drawer and cried and kissed her. I held back my sobs though tears ran down my cheeks as I watched that mother's heart rending pain as she hugged her child in the drawer. A couple of times I thought that the grandmothers might faint and prayed earnestly that nothing happened. After half hour we shepherded them out and they waited as we closed the morgue door and wrapped her body and slid the drawer closed before joining them. As we walked back to the ED waiting room, the mother apologized for trashing the ED. The father thanked me and asked me to thank the staff for working hard to save their child. The entire family left and I thanked the security officers and huddled with the staff and informed them. Sara's body was transported to the ME's office by his team. I left around 12.30am and reached home around 1 am and went straight to the shower. Later in bed, I hugged my two year old daughter's warm body and watched her breath in and out and thanked God for her life. I knew that even though this was one of the hardest days in my life as a Nurse Manager, I had done the right thing. As I mother, how could I refuse a mother's plea? As a nurse, I could see beyond the anger to the grief of a loving mother who completely lost it when she heard that her daughter was dead. I got in big trouble for breaking the rules with the Medical Director and got a discipline for not following rules. It honestly did not change me in anyway as I would have done it again if needed (I didn't tell them that!). My gut and my heart has always steered me in the right direction and it taught me to take a stand even if it is unpopular. The Medical Examiner's report was that Sara had aspirated on the milk she drank while sleeping. Going to the morgue, seeing dead bodies and handling them was one of my biggest fears and I had to pray and ask God to take those images off my head. Recently, when my then two year old, now 11 year old daughter hugged me, I thought of little Sara who would have been the same age . I hope her family has regained some measure of peace after 9 years. I hugged my daughter back extra tightly for Sara's mom.
  13. spotangel

    Your most bonehead moment in nursing. Or 2. Or 3.

    The ER was very busy with an unusual amount of pediatric patients, a few of them wailing infants. As I focused on getting a line into an old lady with spider veins, she whispered "Nurse Annie, check your scrubs". I look down to see 2 big wet patches. I had started to leak with the "let down effect" listening to all those infants crying! I felt like diary queen, smelt of milk and was mortified! Luckily I kept extra scrubs in my locker----!
  14. Annie! Your break is over! They are sending up a patient from the ER to this bed!
  15. spotangel

    Did I bomb this phone interview?

    Sounds like you were honest and tried your best to be accurate about your whys. If this is meant for you, it will come back to you! She might have been interested if she give you more information on the job. Since this is the holiday weekend,call next week or email her if you have contact information. Just say you are following up on the status! All luck and Happy fourth of July to you and all readers!
  16. spotangel

    An Ode to Hospice Nursing

    Beautiful post! Thank you for your article. Being there for a family when they are at their most vulnerable and the emotions are on their sleeves is hard and will take a toll on you. You have to replenish every day! God Bless! Keep writing!
  17. spotangel

    Mini Rant

    Where are you in the US? Depending on the state the govt has programs where there is loan forgiveness and you can go back to school. You may want to look into it.Many health systems and peds facility require RNs. Your other option is get a LPN job in the clinic and let the union pick your tuition as long as you maintain your grades. In NY there are peds nursing homes with children on vents, traches and also kids that run around but those whohave unusual and rare syndromes requiring long term care. They are always looking for new grads. Nurses put in 2-3 years there and then easily get jobs in peds acute care in hospitals. All luck and don't give up! Those kiddies need you to be their nurse one day!
  18. To me, 30 years as a nurse passed like a fleeting dream at night, but every day brings something new! I go in like a rookie every day wondering what the day will bring and I am never disappointed! Since graduation, I worked a host of jobs in acute care, long term care, school health, teaching, home care, community health nurse and administration. For the last four years, I have been working in a primary care clinic. When I first walked in, I thought, "How hard can this be?" After all, all I would be doing was vital signs and have the patient wait for the doctor. Right? Wrong! Let me take you through a clinic day at my job. I work as a Chronic Care Nurse Coordinator in a busy clinic in an economically disadvantaged area, in a busy city, in the United States. My patients are mostly Medicaid funded with major medical issues, chronic problems and innumerable social issues including homelessness, poverty, broken homes, inadequate food, access issues, transportation issues, illiteracy, and minimal social support. Let's meet some of my patients. Jose, a former gang member with skull and cross tattoos on both arms is a forty years old diabetic, hypertensive with depression and alcohol dependence who reads at a fourth-grade level. His biggest supporter is his mother who is battling depression herself. His HbA1C is fourteen and he doesn't understand why I am so concerned. My Diabetic teaching 15 minutes visit stretches to 40 minutes as I ask if he ever sleeps with his front door open at night. Scratching his head he says "No!" "Why not Jose?", I calmly ask. "Nurse, that is plain stupid! Anyone can come in! I could get robbed!" "Jose, you are already doing that!" "What do you mean Nurse Annie?" "When you don't take your medications and ignore your diabetes, you leave the door open to infections, high sugars, kidney problems, heart attacks. They are like rival gang members!" "Oh! I see!" the penny drops as he understands. "What should I do?" "Well, Jose! You are a smart man. You need to close your door by taking meds. Let's talk about them----!" I have him hooked now as it makes sense to him and he is ready to listen and learn how to protect himself. After all, that's what he has been doing ever since he was a kid! The last time I saw him, he was back on his medications and his HbA1C had come down to 13! Jose was back on track. Tanya, 36 years old with a history of CHF, flash pulmonary edema and an ejection fraction of 15%, a frequent flier to the hospital looks bloated as I pass her in the waiting room. I stop to say hello. She smiles at me as I sit next to her in the waiting room. "Who are you seeing today? " "The Medicaid worker. I just dropped my papers. My insurance won't start back for two weeks". She looks worried and is short of breath. I inwardly curse as I suspect she has run out of medications. "Tanya, when is the last time you took your Lasix? " "3 days ago, nurse. I called the clinic and told them to ask Nurse Annie to call me back, please. It's urgent. I tried calling them again but no one picked up. Didn't they tell you?" I had never got that message as it was the weekend, the call center had taken the message but the clinic was closed. Tanya could not remember the on-call number. I gave her my personal cell number again for emergencies. I turned to the front desk clerk John and requested that he put her on my panel and took her into an exam room even though, I had 3 other patients waiting. Just like I suspected, she had put on 4 lbs and I could hear crackles at the base of her lungs. She did not want to go to the hospital for admission and we had to negotiate! I got her a same day appointment with one of our providers who titrated her Lasix and scheduled her for a followup and weight check in two days with me. As I left the room after giving a warm handoff to the provider, she called out after me, "Thanks! Nurse! You are an angel!" I smiled at her and walked away to my waiting patients. Sam looked grumpy when I found him in the waiting room. "What took you so long nurse?" "Sorry Sam, I had an emergency." "Did you bring all your medications?" "Yes, nurse". He pulled out 3 bags! I inwardly groaned as I painstakingly went over his medications. He was taking Metoprolol that had been discontinued, had not picked up his Lisinopril, was taking over the counter garlic pills with his blood thinner Coumadin and had left his inhalers and insulin pens at home---. I called his pharmacy, updated them, educated him about the dangers of bleeding by mixing a blood thinner with garlic pills, turmeric pills alongside his aspirin 81mg and ibuprofen for pain! I made another appointment for him to come back with the rest of his medication and eye drops in one week. I was running over every 15-minute visit on my panel today. I went to my office as my next patient was in an hour. I had 12 messages waiting in my inbox in our EMR for a callback, 7 forms waiting to be filled, staff schedules for the next week to be reviewed and was covering my partner that was on lunch for all triage calls. I got through 2 forms and 3 calls before I had to go and triage an asthmatic that walked into our clinic requesting to be seen. I started the 18-year-old on a Combivent treatment and found an empty slot with a provider and asked the provider to put in the order. It was time for my next patient. My next patient was from West Africa, spoke only French, was 21 pregnant and had a six-year-old child. The translator phone service put me on hold twice for 20 minutes each till I got fed up and went looking for the video translator in the clinic. I found it in the 12th room I checked and did a prenatal visit asking her a whole bunch of preset questions and taught her about breastfeeding and how to prevent and manage nausea in pregnancy. I wished my visit slots were at least 30 minutes instead of the fifteen a sure setup for not keeping time. I had to then, call a complex care patient who was paraplegic, and who self catheterized. He was running out of supplies as his prior authorization for supplies was not approved and now I was on the phone trying to get him approval----left messages for his care coordinator and the durable medical equipment store that had an automated system. All throughout the day, I was paged multiple times when the front desk had questions, the LPN needed help, the doctor needed me to call a 14-year-old with abnormal results (positive STD) and a new order for medications that needed to be picked up by the patient and started. I called the 14-year-old patient and her mother picked up the phone-------could not tell her. Told her to have her daughter call back the doctor or me, fielded and avoided giving specific answers to the mother's questions and sent a private message via the patient portal to call the clinic and ask for me or the doctor. Documented all conversations in the chart. I then had to call a hospital discharge patient and get a Spanish translator on the phone to ask our lengthy hospital discharge questions about her CHF management and coordinate calls between her primary care provider, the cardiologist and myself and work around her schedule as she was watching her grandkids while her daughter worked. I was unsure if she knew what medications to take and asked her to come in for a med reconciliation. The earliest she could come was a week later on her daughter's day off. I sent a note to her doctor. It was almost time to go home. The rest of the work would have to wait for tomorrow. I sat down and said a quick prayer of thanks. At the beginning of the day, I had sent someone who was short of breath and fatigued via 911 to the nearest hospital. I was pretty sure he was having some kind of blockage in his heart. I called the hospital to find out and finally was transferred to the ICU. Turns out he had a 100% block in his LAD and had been taken straight to the cath lab and stented. He was stable and in the ICU being monitored. I left work feeling good! My years in the telemetry and ED had helped me spot that pt and also Tanya's CHF exacerbation. My home care training had prepared me for the discharge calls, the med reconciliation and many of the triage calls. My teaching and long term care experience helped me with grumpy Sam and Jose my ex-gang patient! Every day of my nursing experience has been put to use in this job. I feel privileged to be a front line worker making a difference. I might not be recognized for my work and sincerity to my job, by a manager or coworker but in my heart, I know, I make a difference every day in someone's life. I have been blessed by my patients a thousand times over like many of you who work tirelessly no matter what the odds stacked against us! We are blessed to be nurses and have a special mission on earth! It is to touch lives from birth to death and be there for our patients and one another when no one else does! If no one has thanked you for being a nurse, let me say thank you! I am blessed and proud to be a nurse!
  19. spotangel

    The Art of Telling Patients Bad News: One Physician's Story

    That's a dangerous way to learn about the diagnosis and on speaker phone--.I hope you are fighting the cancer and that you are better now.
  20. spotangel

    The Art of Telling Patients Bad News: One Physician's Story

    That is terrible! I am sorry for your loss. I would report that oncologist. Period!
  21. spotangel

    Manager Retaliatiin

    1-Do you have a union? If you do, reach out to them ASAP. 2-Do not talk to the manager again without a witness with you at all times. 3-If others witnessed the interaction between you and the manager, get it in writing from them. 4-Anytime and every time you have any interaction with her put it in writing in a word document and email it to yourself to get a timestamp. 5-If you have cause to feel that you are being intimidated contact HR 6- If you have never had a previous write up you can challenge the verbal. 7-Look up labor laws in your state on harassment and intimidation. 8-Start looking for other jobs as it is an unsafe and hostile environment.The falls are proof enough. Chin up, stand your ground,be polite but firm. Do not let her trigger or push your buttons.You got this Nurse Djadia!
  22. Sara! You are not alone. I wish there was a way to capture the time we spend especially with care coordination and translation and a way to ping each interruption that requires more of our time.Unfortunately, the attitude is that more and more can be done as our schedule shows empty slots and we must have a lot of "free time". The visits spill over the allotted slots between the 80 year old Spanish speaking patient who has the beginnings of dementia, is hard of hearing that has brought all his meds in a pillbox for med reconciliation , the 16 year old pregnant girl who lives in the shelter and needs WIC and the non compliant 35 year old man who feels that if he ignores his HbA1c of 14, it will go away! The reward is when you are working through your lunch hour but manage to get them the help they need and they are truly grateful that you care enough. At least I do have resources that I can hook them up with and for that I am truly grateful!
  23. spotangel

    Any nurses that love nursing and love their job??

    30 years this month and absolutely love being a nurse! Read the articles I have written for the why part. I am very humbled to be part of a pt’s life and be a person they trust. Many a time my venting after a hard day sounds like bitc—ing and mourning! I don’t hate my job, I just need to vent! If you work with a good team you are all set and even better if you have a great boss!All luck! It is a hard but satisfying profession . As a Christian. I always say. “Here I am lord! Let me do your will. Let me be your comfort and strength to anyone in need!” He puts me to good use every day and I go in wondering who He will send to me each day, patient, staff or colleagues! This is my ministry of caring , not just a job!
  24. Sounds like my clinic. No med Tecs but 4 PCTs, around 25 LPNs and 3 RNs . Around 30 providers including family medicine, ObGyn, Psycologist, psychiatrists, podiatrist , cardiologist, Dermatology NP, nutritionist, social workers, Health educators etc. We offer many services!
  25. It is frustrating on most days but you touch many lives and after a while we are part of their family----! I would rather a new grad that I could train but that will happen only i f you have input into the hiring process!