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spotangel MSN, RN

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

Content by spotangel

  1. spotangel

    The long and winding...pre-req road

    You go girl!
  2. spotangel

    Choose Your Favorite TV Nurse

    ER RN Carol Hathaway, compassion and courage.
  3. Pace University, NY
  4. spotangel

    Nurse Face Her Fears To Help Patient

    I pulled the car to the side and put my hazard lights on. "Ok, where is this I have to go?" I asked the staffer at homecare. I jotted the address and put it in my GPS. That would be my last patient for the day. When I finally made it to the address, my heart sank. I was in the middle of the projects. Huge buildings, drunks and drugged out people sitting on the benches. An occasional family sat on a bench, soaking up the sun. I saw very few kids outside. People looked me up and down as I passed them, my homecare RN ID prominently displayed. I plastered a shaky smile and wished people good afternoon as I passed them. Some ignored me, some smiled and some looked vacantly on. I finally got into the building. I was going to Apt 124 K on the 17th floor. The warnings of never to take the stairs in the projects rang in my ears as I waited for the elevator. The elevator was small with a gate that I had to pull close. On the 17th floor the corridors were long with dim lighting. My heart in my throat I started walking trying to find the apartment. Every instinct screamed at me to turn back and leave but I forced my steps ahead. What would happen if someone yanked me into one of these apartments? No one would know. I would never see my family again I thought. I finally reached the apartment and rang the bell. No one answered. Hoping that the patient was not there, I rang the bell a couple more times. No answer. Relief coursed to me as I turned to escape back to the safety of my car and started walking. Behind me, the door opened and I heard "Wait! Don't go"! I turned around and froze. A huge young black man stood at the door with a bare chest. His shorts were barely visible under his pendulous belly. "Are you the nurse?" "Yes, Good afternoon Peter! My name is Annie." I masked my fear under a smile as I walked back towards him. "Come in" he turned back slowly and walked into the apartment. I hesitantly entered although my feet were trying to pull me in the opposite direction! The apartment was cold and bare. I looked around. He had disappeared. I walked past a kitchen and saw a door at the end of the corridor and walked to it. Something cold touched my leg and I looked down and saw a cat. I entered the room and found Peter sitting on the bed staring at me breathing hard. There was no other furniture except a TV and a few plastic milk crates. The cat followed me into the room. I hung my bag on the door. "I am sorry. I don't have any place for you to sit. You could sit on the bed." He said softly. "Thank you but I think I found a seat!"I stacked the milk crates together, put a newspaper from my bag on top and sat on it. "Thanks for opening the door", I smiled looking him in the eye. Peter talked slowly and I realized that he was intellectually challenged. My brain went into high gear as I looked at him. He was short of breath and was breathing hard after minimal exertion. I could hear a slight wheeze across the room. Since all he had on was shorts, I could see his skin that was dry and the 3 plus edema on bilateral ankles. I saw a half-eaten Chinese takeout on his bed and a 2 liter Coke bottle on the floor. As I went through a homecare assessment and a physical exam, I knew that he was in the beginnings of respiratory failure. His weight, diet, isolation and inactivity did not help matters. He barely cooked and relied on neighbors buying him groceries but that was a hit or miss. His sister lived an hour away but had her own problems. He could not walk to the store but relied on takeout food which did not help his congestive heart failure or asthma. His black cat that he called Camper (he always wanted to go to summer camp but could not afford it) was his only company even though Camper made his asthma worse. When I checked his back, I saw a stage two pressure ulcer on his buttocks and rash under his belly and breast. I gave him a nebulizer treatment and taught him about asthma, prevention and treatment. I then sat there and made a few calls to help him. One was to his MD to increase his Lasix dose and get refills on all his meds and discuss plan of care and referrals I needed for Peter. The second one was to his pharmacy to set up home delivery. The third one was to my central base to put in an order for a hospital bed and special mattress. The fourth one was to the social service dept. for an assessment referral and to hook him up with community services like meals on wheels and para transit for transportation. I spend around two hours at his apartment. I was subbing for another nurse that called out. When I left, he hugged me and thanked me and said, "I wish you were my nurse!" I hugged him back and said, "Don't worry! You are in good hands!" He had tears in his eyes as I walked out the door and out of his life. When I left the building, I looked back at it wondering how many more Peters lived in those building, all alone with no one to help them. I sat in my car and cried for Peter. I called back base and asked the director to put a compassionate nurse to take care of him as the perdiem RN who had him as a regular patient just went in, took vitals and left. The director promised to follow up. I thought about all my fears that had surfaced when I first saw him and I was ashamed of myself. Then I thought of how I felt when I left his apartment and felt happiness and satisfaction that I was able to help a fellow human being. I realized that I was put in a position to help or ignore his needs and was able to make the right choice, even though it took an extra hour. The danger I faced going into the projects was overshadowed by what I was able to accomplish. That day, I was proud to be a nurse!
  5. 5 am-The alarm goes off . I get up bleary eyed wishing I could crawl back to bed. I have put in 5 days at my regular M-F job. This is day#6. This job helps me, help my college bound kids. 6 am-I get ready, pack my lunch and am out the door. My steps have a spring just like the weather! Fitbit 500 steps! 6.45 am-I am at work ready for my shift. I listen to the controlled chaos in the Nursing office. The phones ring constantly, the outgoing Assistant Directors of Nursing(ADN) are finishing up their administrative report, attending pages and answering questions from the Staffer. Staff call from different units. Requests, demands, threats of protests of assignments. 7.20 am-I finally start getting report. The report is constantly interrupted by phone calls from charge RN/ Union rep RN asking for more staff on a weekend especially when their unit had sick calls at the last minute.The staffer is directed to take all calls so that we can finish report. Report is done and the night ADNs leave/stay to finish up their report and the day is on! 7.50am-The day ADNs go over staffing with the staffer for the day and the oncoming shift. I am covering all critical units (ED, Dialysis, Cathlab, OR, MICU, CICU, NICU, Telemetery, L&D and postpartum. I get my printout with all the names of the staff for the day and night shift. 8 am-I catch up with what's going on in the hospital (yes, some gossip!), drink my coffee as I call the operator and give her my pager number and the units I am covering. I go online, check our EMR for any issues with patients that were mentioned in report, go over the orders for the one to one observation patients and check the status of the Emergency Room admitted pts that are waiting on beds. Now I am ready for rounds. 8.30am-10.30am: My first round is a quick one to each unit as I check for hospital discharges, meet the charge RNs and eyeball all units for any potential issues.The pager goes off constantly as I move from unit to unit. 10.30am-11.30am: Discharge rounds. Meeting with social work,managed care, chief medical resident, home care etc as we go over all discharges in the house. I inform them of how many ED pts are waiting on beds. 11.30am-11.40am-Meet with patient logistics and go over bed situation and potential discharges. 11.40am-2pm-Unit to unit rounds. Check staffing(schedule book) against paper, speak to the teams, resolve issues, attend Rapid Responses and all codes. Some of the issues: 1. -ED Patient complaints-Pt can't breathe. Family can't get help from anyone as they are busy! Get staff to help pt. 2. -Attending MD complaint-Cannot get social worker. Patient just lost his wife in a traumatic car accident. Hunt and find the social worker who is not responding to his pages!(I know where this one in particular hides!). 3. -Family complaint-Dad was wandering around ED, peed on himself, was never given food. Planning to call Dept of Health and their lawyer. Spoke to RN taking care of patient and asked her to make sure that pt is put by the nurses station or is eyeballed frequently. Spoke to logistics to expedite bed as pt has been waiting two days in the ED for an isolation bed. 4. -ED Charge RN-Floor is not taking report. Called floor who is transferring out another pt to the CICU. Compromise. Take report in 40 minutes. Called operator to page housekeeping to expedite bed cleaning. Requested ED to send pt up in 1.5 hrs after alerting floor. Thank charge RN in the ED and ask her to call me if any issues that she cannot resolve. 5. -Dialysis-Worried charge RN, Staff cancelled. Go through staffing with her to see who can stay/come early/call in. Come up with a plan.Move on to the next unit. 6. -Cardiac cath recovery. Pt stable. Staff on Facebook. Pleasantly tell her to refrain from social media at work. 7. -OR-Pt in surgery. Post op RNs waiting.Pretend not to notice the food spread around! No issues. 8. -ICU-Pt needs one to one. No staff available. Call staffer for discuss if we can pull staff from a different unit to help. If not, ask them to put their Nursing Attendant.Staffing ratio safe. 9. -CICU-Pt being terminally extubated. Wife and children at bedside. Healthcare proxy not there. Staff not sure if the rest of the family knows. Speak to the daughter who is worried if her mom could handle this.Patient married for 64 years, wife has Alzheimer.Reassure family, answer their questions, refer to the MD for specifics, huddle with the Nursing staff to plan for any issues, alert security and ED charge RN in case wife has any issues. Stretcher on standby. 10. -NICU-Speak to the family of a baby who was terminally extubated and is in mother's arms. Comfort, listen, speak to the RN taking care of patient. Requests call back from charge RN when the baby dies. 11. -L&D- Discuss issues the nurses have with the ED nurses when pts are send in distress upstairs without stabilizing. Talk to the ED triage RN and reinforce safety first. Follow up with patient. Asthma teaching. 12. -Post Partum-Remind staff that they are up for inspection and discuss baby friendly initiatives. Ask them to get rid of the formula bottles that are hiding in plain sight! 13. 13. -Telemetry: Speak to the charge RN who wants an extra NA to sit with a confused patient. Round on the patient, who is sitting up in bed eating lunch, answering appropriately, call bell on the floor! Requests RN to make sure that the call bell is within reach and recommends that the patient be on enhanced observation. 2.30pm-Go back to staffing office and go over staffing for 3-11pm and 7pm with staffer. Bathroom break, hurried lunch that is constantly interrupted with pages. Call from managers on unit issues. 3.30pm-5pm- Attempt to start with administrative report,check on my family, answer pages, call supervisor of radiology, CT, Ultrasound, lab with unit issues. Page central supply, linen and pharmacy supervisors with issues. 5pm-6pm-Last rounds on problem areas.Receive calls about expiration in the NICU & CICU pt. 6pm-6.30pm-Last huddle with staffer on staffing after sick line is checked.Check EMR for unit and house census. Finish up report. 6.30pm-Code called overhead. Attend the code, expediate x-ray, stat meds from pharmacy, keep family updated, support staff, make calls to get a stat bed in the ICU. 7PM-Ready for report, pager going off, phones ringing-----! The circle of life! I have noticed that I enjoy building teams, planning with the staff for the best outcome, encouraging staff when they have a rough day and calling them out when they are not professional. I am able to guide them to react professionally when people are in their face. Much as I love the one on one interaction with the patient, I am able to do a lot more as an administrator guiding the hospital ship through choppy and calm waters! So... Calling all potential captain ADNs! Make a difference every day! This I say as I limp out at the end of my day! Fitbit-9270 steps! I sure could use some M&M (Massage and Motrin)!
  6. spotangel

    Nurse Face Her Fears To Help Patient

    All luck! Make your visit count! In my career so far, I have worked Med surg, Tele, ER, Management, outpt, homecare and have taught Nursing. My most challenging, tiring but rewarding job was in homecare. You really need to know your stuff as both pts, families and the health team depend on your input. Give it your 100% and it will come back to you a hundredfold as blessings!
  7. spotangel

    Tell on yourself, if you dare...

    Triaged a young man complaining of a rash. Asked him where his rash was. Without warning he whipped out his penis and started ranting about how frustrated he was with this long standing rash. As he talked he waved his penis around! Swallowing my laughter at the waving penis, I addressed his frustration and got him a same day appointment. In a very polite voice I asked him to tuck his member back and wash his hands! No thank you handshake please!
  8. spotangel

    Thoughts on this blog article

    "What is not okay is a patient getting substandard care because of false documentation!" Totally agree! Document what you did not what you didn't. Be honest with the oncoming shift. If you are not a chronic "passer" most staff will step up and do it.
  9. spotangel

    Loss of son and finding a future

    Can't begin to imagine what pain you went through luvmyc. Anniversaries are rough. Stay surrounded by family and friends.
  10. spotangel

    Loss of son and finding a future

    Hugs! Stay strong and nourish your soul. One day at a time and like Kooky Korky said "One foot in front of the other, friend, just one foot in front of the other. " If nursing is what you want to do, pursue it! An ambulatory setting like outpt may be a little less strenuous physically but it is pretty busy.Another option is telephone triage or case management if that is something you like doing. All luck and a lot of prayers your way!
  11. spotangel

    Nurse Face Her Fears To Help Patient

    Thank you! I love being a nurse! Period!
  12. spotangel

    Nurse Face Her Fears To Help Patient

    Thank you! Sometimes you don't realize how much you can do till you do it!
  13. spotangel

    Tell on yourself, if you dare...

    No! Batman to the rescue! This pt had once stabbed a staff in her psychotic phase , so we never turned our backs on her! The Hosp staff learned that in a hurry!
  14. spotangel

    Tell on yourself, if you dare...

    Had a mentally challenged schizophrenic patient that needed a hysterectomy. I went with her and offered to gown and step into the OR as she could get violent in a heartbeat. I was politely denied entrance as per policy. I sat quietly in the waiting room as 4 burly OR staff wheeled her away! Ten minutes later they came flying out of the OR searching for me as she had shook them off like flies. One of them had a black eye! I hurriedly gowned and went in on to the OR! My patient was holding the IV pole like a spear and the staff were by the door ready to run out at a moment's notice! I calmed her down and they got an IV in place! They gave me a chair draped in a sterile drape to sit during the operation and asked me to please stay just in case she woke up! Was trying hard not to laugh under the mask!
  15. spotangel

    Tell on yourself, if you dare...

  16. spotangel

    I Gotta See If He Is Dead!

    That is always in the back of your mind. In this case there was pooling body fluids. So I literally mopped up the body before we transferred him to the stretcher. Not pleasant at all. Need a tough stomach and a tougher mind!
  17. spotangel

    Tell on yourself, if you dare...

    Once I had to snip off the tie of a PA with my trauma shears! His tie was in a puddle of stool that he was digitally removing as the patient was impacted. I told him,"I know what to get you for Christmas!"
  18. spotangel

    Tell on yourself, if you dare...

    Laughed till I cried! Bathroom break!
  19. spotangel

    Fitzgerald agacnp live review

    Fitzgerald is very systematic although I took it for my FNP certification. All Luck!
  20. spotangel

    Question About Hiring in ED

    Googled RN residency programs and found this. Check it out. [TABLE] [TR] [TD]Registered Nurse (RN) - New Graduate Carilion Clinic 145 reviews - Cincinnati, OH [TABLE] [TR] [TD=class: snip]Located in Roanoke, Va., Carilion Clinic is a robust system of 7 hospitals and over 200 physician specialty practices. There's no better time or place to start your nursing career than now at Carilion Clinic. We have the latest of everything – a great place to work, excellent benefits and opportunities for you to grow. Open the door and see all that Carilion has to offer. Our RNs work on interprofessional teams, use best practices and the latest technology within an innovative learning environment. Waiting for you are a wide range of career opportunities, college tuition, and employment assistance for your family. Supportive leadership and staff inspire better health in our patients, their families and our communities. Explore how you can make a difference in the lives of others. Benefits of Joining Our Team: - RN Residency Program (focused on leadership, patient outcomes & your professional role) - Relocation Assistance - Seasonal Sign-on Bonus - NCLEX reimbursement - Competitive salary & Shift differential In addition, you'll be rewarded with Carilion's Total Rewards package plus paid time off, retirement benefits and childcare subsidies. Qualifications: - A degree from a School of Professional Nursing of an accredited college. - A current Registered Nurse license in the State of Virginia or eligible to sit for the Virginia licensure exam. - Must successfully complete orientation and competency requirements. - The ability to obtain CPR certification, potential ACLS, PALS, NRP - Computer skills required for automated computer systems, including electronic medical records. - Must be able to meet essential job functions. The following areas may be available: - Med/Surg (including PCU) - Behavioral Health - Cardiology (ICU/PCU) - Vascular (ICU/PCU) - Critical Care (ICU/PCU for surgical, neuro trauma, med/surg) - Emergency Department - OB/GYN - Oncology - OR, Procedural - Ortho - Pediatrics/NICU - Resource Pool - Physical Rehabilitation Interested candidates may call or text Emily Allen for an immediate interview: (540) 400-2778 Highlights of Designations and Awards: - Magnet Recognized- Roanoke based facilities (ANCC) - Beacon Award for Excellence- Coronary Critical Care, NTICU (AACN) - Five-Star Award Overall Quality inpatient/telemetry, OB/GYN (PRC) - Consumer Choice #1 – National Research Corporation - Best Organization for Leadership Development (NCHL) - Top 100 Most Integrated Healthcare Network (SDI Health ) - Gold Seal of Approval hip knee replacement, heart attack/heart failure, primary stroke center (TJC) - ACE Accreditation Cardiac Catheterization Percutaneous Coronary Intervention About Carilion Clinic: Located in America's most livable communities, Carilion Clinic includes small and large award-winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute for Orthopaedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute. Equal Opportunity Employer Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity. Job Type: Full-time [/TD] [/TR] [/TABLE] [/TD] [/TR] [/TABLE]
  21. spotangel

    The Nurse at the Bedside

    I pray that I find you in the ED/inpatient unit when I come in as a pt or family member. Too often the realization that the glue that holds pt care together is the bedside nurse comes only when you are in a critical situation. Thank you for all you do and for all these years of dedication.
  22. spotangel

    Need Help Memorizing Heart Sounds?

    Love it!
  23. He heard that he finally got a bed one floor down after waiting two days in the ED and the elevator was now out of order!
  24. spotangel

    Nursing Supervisor - Walk In My Shoes For A Day!

    Thanks lennon! Love that song!
  25. spotangel

    How to memorize cranial nerves

    [h=4]From Dr Google! I remember learning this in Nursing college. Mnemonics[/h][h=5]On old Olympus' towering top a Fin and German viewed some hops[/h][h=5]Ooh, Ooh, Ooh, to touch and feel very good velvet. Such heaven![/h] O: olfactory nerve (CN I) O: optic nerve (CN II) O: oculomotor nerve (CN III) T: trochlear nerve (CN IV) T: trigeminal nerve(CN V) A: abducens nerve (CN VI) F: facial nerve (CN VII) A: auditory (or vestibulocochlear) nerve (CN VIII) G: glossopharyngeal nerve (CN IX) V: vagus nerve (CN X) S: spinal accessory nerve (CN XI) H: hypoglossal (CN XII) [h=5]Some say marry money but my brother says big brains matter more[/h] S: sensory (olfactory nerve - CN I) S: sensory (optic nerve - CN II) M: motor (oculomotor nerve - CN III) M: motor (trochlear nerve - CN IV) B: both (trigeminal nerve - CN V) M: motor (abducens nerve - CN VI) B: both (facial nerve - CN VII) S: sensory (vestibulocochlear nerve - CN VIII) B: both (glossopharyngeal nerve CN IX) B: both (vagus nerve - CN X) M: motor (spinal accessory nerve - CN XI) M: motor (hypoglossal nerve - CN XII) If you write out the mnemonic for remembering the names next to the mnemonic for their function then they will align giving you an easier way to remember both the cranial nerve names and their function.