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spotangel MSN, RN

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

Content by spotangel

  1. spotangel

    Your Patient is Neutropenic - Now What?

    Thank you Ashley! You got me with that fresh flowers and fruit bit!
  2. spotangel

    Heartbroken (long winded-sorry!)

    You are meant to move on. Don't fight the tide . Stay civil, be professional at all times and start job hunting.Two years from now you will look back and say lucky I didn't take that job. I got laid off from my ED manager job by a vindictive Nurse Manager and was hurt and angry! I went through a couple of other jobs and am back in the same hospital system at a different location 7 years later. Those jobs I did gave me tremendous experience, and a network of friends that support me and me them! Looking back it's the best thing that happened. I got my present job based on the experience I got on the outside. Nursing is a small field. Keep good relations, stay professional and move on. You are meant for something greater! All luck! This too shall pass!
  3. spotangel

    Stubborn CNA in ICU

    My 2 cents! To get to the bottom of this(Sorry! could not resist!) start off by reading the policy on skin care and incontinence of your institution. Have a consensuses from your nurse colleagues, Nurse manager and health educator on acceptable practice. Have a staff education session for all and promote a trial of the new practice. Everyone has to be consistent in order for change to happen. The CNA is part of your team and if all of you are doing it and it is a standard of practice, she will either fall in or fall out.
  4. spotangel

    Weird Thoughts While Pumping at Work

    Had me laughing! We had a tiny room(closet size) that seats one chair , a side table and a outlet in the wall to plug the breast pump. The lock would not lock and I sat with my feet propped on the door to keep it shut! I had nightmares of the door opening, my breasts hanging out and a bunch of residents gaping as they tried out the doors looking for the bathroom! The breast milk was pumped and stored in the sterile urine cups in the fridge with a sticker prominently proclaiming Annie's breast milk! One time an ER attending teased me that his coffee tasted better with my milk! Had me running to the staff fridge! Now , since we are a baby friendly hospital, "Breast is best" , patients are offered exam rooms or new lactation rooms(none of the nurses know where they are!)for breast feeding!The nurses keep hunting for rooms to pump! A shout out to all nurses who covered me while I pumped! Some days I felt and smelt like Diary queen! I stopped breastfeeding when my youngest whipped out my breast to feed during Sunday mass---!
  5. spotangel

    But, she was fine this morning!

    You are welcome joey4468! This is what I hope to do full time one day . Sharing unique nursing true stories make people aware of what we do and the challenges and solutions we come across on a daily basis. No nurse can say that yesterday and today are alike. Just when you think you have seen it all, something else comes up! All luck and God's blessings on you!
  6. spotangel

    Not a Near Death Experience: A Shared Death Experience

    Wow! Chills! The soul connection is very real.
  7. OR nurse to coworker. " Does he know Dr. Plastics is drunk and doing his wife's nose job?!"
  8. OR nurse to coworker" Do you think we could talk to him about unsafe staffing?
  9. spotangel

    But, she was fine this morning!

    No ! It was ruled accidental
  10. spotangel

    But, she was fine this morning!

    I love it.That is exactly what I would do 3ring nursing!
  11. spotangel

    But, she was fine this morning!

    All peds death in the ED except for kids with bad medical/chronic issues get referred to the ME automatically in the ED I worked in. A lot of people touched Sara from grandma, EMS,ED staff to family who saw her after she was pronounced . So the issue was not tampering with evidence . The two issues were compassion and safety and to manage it.The same Hosp has a different policy now for morgue viewing but then strictly prohibited it. I knew I did the right thing but I was between a Nurse Manager who was extremely narrow minded and always tried to pull me down(She had a field day with this incident ) and a medical director who was into lot of shady stuff and did not like the fact that I was straight up. So I was not part of the in crowd--ever ! Incidentally the Medical director was fired a year later for something big and couple of years ago , the Nurse Manager was stripped off her title and is not allowed to work a management job anymore.So I have learned that God works in mysterious ways and don't fret anymore! Thank you for all the comments ! I am very humbled !
  12. Lawyer outside ObGyn OR- I smell something fishy!
  13. spotangel

    Can you refuse to give care to a resident in LTC?

    Make sure you don't work with him alone. If possible get another assignment. Document the verbal abuse and inform your supervisor.Keep a paper trial. Do not put yourself in jeopardy of harm. Stay professional at all times despite the provocation.All luck!
  14. spotangel

    I Broke Rule # 1

    Brings back memories! I got my vent pts in/out of CT like a military op.The planning always helped. Had a couple of dislodged tubes and R main stem intubations that we had to fix! Our CT team always had a couple of "big brothers"that you could count on if the pts were very disoriented but like you said, communication was key!
  15. spotangel

    THE SCENT OF DEATH

    I froze by room 650 as I wheeled the med cart. The scent hit me. The overpowering scent of flowers candles and incense. The smell, I associated with death. This was a very familiar smell to me. I had lost both parents as a teenager and this was the smell in the viewing room that was filled with flowers, wreaths, candles and incense. I hated it with all my heart. Two decades later, the smell was hitting me right outside Ms. Watson and Ms. Grey's hospital room. I parked my locked cart and went in to investigate. The smell was not around Ms. Grey's bed but around Ms. Watson's bed. Ms. Watson lay sleeping peacefully, the early morning sun gently glowing on her face like a mother's caress. The scent was overpowering and I slowly backed out of the room. I went to the nurse's station and sat down, my mind whirling. What should I do? This was not the first time; I had smelt death on this telemetry unit. The first time was a few months ago when I was taking care of a very sick septic patient John Perkins. I smelt it around his bed and was puzzled. I did not connect the dots and thought I was being overly sensitive. I thought I imagined the smell and ignored it. He was a full code and coded two hours later. He did not make it. I began getting the smell more and more frequently before patients coded. Some made it, some didn't. I cursed this "gift" of sensing the angel of death. I tried very hard to ignore it. I dared not speak up about it as I did not want to have a Salem witch hunt or my coworkers look strangely at me. I wanted to be part of the crowd and blend in and not create waves. My conscience started pricking me. Maybe, if I had told someone else, we could have been better prepared. Maybe, I could have setup the suction machine on the wall, ready to go; maybe I could have asked the telemetry monitor room to observe that pt's rhythm more closely. I beat myself up every which way without relief. One night I sat pondering about this wondering aloud about why I, who was so uncomfortable with death and dead bodies, was given this gift. I argued loudly with God as my kids were sleeping soundly and my husband was at work. I got tired eventually and went to sleep. The next day, I resolved to do things differently. I decided to be proactive. I went in to work with a plan but of course did not smell anything for almost a week! God had his own plan--! On a Friday, I smelt death outside a single room. The smell was overpowering in the room. There was not a single flower in sight, so I was sure of what I smelled. I quietly checked the suction (which was not set up in readiness---my pet peeve) and set it up ready for any emergency. I then went to the nurses' station and rolled the emergency cart to outside that room. The patient crashed within the hour. We successfully resuscitated her and transferred her to the CICU. She was forty five years old and the mother of three. Later, when the patient's primary nurse asked me how I knew to get the equipment in readiness, I told her that I had a" feeling". She believed me as us nurses are famous for our feelings and intuition. The team noticed me doing this before unexpected codes and started joking during report at shift change. They would finish report and then ask "Annie, any feelings?" and snicker! I took it in stride .There was an older wise nurse from the "Islands" who suspected that there was more stuff going on that I was letting on and once gently asked me. I told her not to label me a witch and told her. She told me simply, "Annie, don't fight it. It's a gift not a curse. Use it to help others". I still was not sure as patients still died, so what was the point of the gift. I did not realize why I got this gift until Ms. Watson room took on the now familiar smell of death. Ms. Watson was a walkie talkie with three daughters that she always talked about. I had met one of them Beth, who came every day after work. I enjoyed watching the mother daughter interaction as they teased each other and joked about the hospital food and planned for the upcoming summer. Ms. Watson was a renal patient waiting on her shunt to mature and had come in with hyperkalemia with tented T waves on her EKG and chest pain. Her pain had subsided and she was waiting for a cardiac catheterization as her Echo had shown some possible issues in her heart. She was chest pain free but there was a possibility that her Potassium would go up again, hence the wait and monitoring. Her other daughters lived out of state but called every day in the evening without fail. Beth was walking out of the room and saw me park the emergency cart outside her mother's room. Ms.Grey had been discharged and was waiting for her son to pick her up. Puzzled Beth asked me, "Who is that for Nurse Annie?" I attempted to give her a vague answer but I could never lie convincingly! She saw something in my face and persisted with her questions. I told her that I was being extra cautious. She bought it for the time being. Later she asked me seriously, "Annie there is something you are not telling me. Please, tell me." I did not want to freak her out so I kept it simple. "You know Beth how nurses are very intuitive. I just feel we should be extra careful with your mother and monitor her more closely." She read between the lines, looked me straight in the eye and asked me, "What should I do?" "Get your sisters to come and stay with mum for the next few days." She nodded her eyes filling. The next day she called me from work. "Annie, I took a couple of days off to stay with mum. My sisters are flying in. The three musketeers will be there in the evening! Don't tell mum". That evening I spoke to the nursing supervisor and got permission for the family to stay in the visitors lounge at night past visiting time for the next few days. Thankfully telemetry was slow and her roommate bed remained empty which was surprising as those beds filled like hotcakes. I told Beth about getting them permission to stay. She was very grateful and introduced me to her sisters. I left for my weekend off with their laughter ringing in my ears as they surrounded their mom who was ecstatic that they girls had surprised her! I came back on Tuesday to find an empty bed. I was surprised as she was supposed to have her cardiac catheterization that day. I asked around but no one knew as the weekend crew was off. I took the admission discharge log and checked it. My heart leaped to my throat when I saw the Monday 3 am entry. Ms. Watson had died. I was in shock. I pulled Beth's number from the paper chart that was still there. Drawing a deep breath as she picked up, I carefully said, "Beth, this is Nurse Annie from the hospital. Can you talk?" I heard her crying and then she told me what had happened. Ms. Watson was fine all weekend and insisted that the girls go home but they all refused. So they kept watch at the bedside, talking softly in between with mom when she woke up. At around 2.00 am, Ms. Watson had a massive heart attack and arrested. She was coded for almost an hour and declared dead at 3 am. Beth told me, "Nurse Annie! I do not know how to thank you. Mom's last three days on earth were her best and she never looked happier. The memories in this last three days with our mother will comfort us. We have these memories thanks to you. Bless you for giving us that chance to be with mum. I think she is at peace and so are we." I was too choked up to speak. A month later, I received a bouquet of flowers with a thank you card that said, "Mum thanks you from heaven! We thank you too!-Beth, Pam and Sara". I treasure that card more than a paycheck! Once I moved from acute care, I did not get that scent again. I hope I don't either! Since Ms. Watson's death, I realized that my gift was to be used to help the patient, family or staff to get prepared. I never knew what the outcome would be but I knew now that every patient got a fighting chance to live or die in peace. As a nursing supervisor covering that same unit, I still see some of the nurses I worked with, who remind me that before we had a rapid response team or a cardiac arrest team we had Annie's ESP!
  16. spotangel

    Calling off :-(

    I am just amazed! If you are sick,you are out period. You should not have to worry about finding a replacement. Just make sure that you have informed the hospital officially as per policy. I am not sure if your hospital has a cut off time as per union regulation like mine does. The only exception is if it was something that happened within the last one hour before the shift, a true emergency! On the other hand, as an administrator/ Nursing supervisor , my expectation is that you would call out as soon as you have an issue in order for the staffer or me to find a replacement and not wait for the last minute before your shift. This is a courtesy to your coworkers who may have to work short as I cannot find anyone at short notice. Remember the shoe can be on the other foot as well.The earlier I know, the more chance of me able to find someone. I would not be as cut and dry when calling the nursing office, as being unprofessional has a way of coming back to bite you unexpectedly! The hospital is responsible to ensure safe staffing but you can't pull people off the street. Our RNs are not so easy to replace, so one has to be mindful that we signed up for "essential service' and not a 9-5 pm job. It comes with it's pros and cons. I would encourage you to find out the policy and make sure you did not sign up for that in your job contract. If so, you are bound until you break that contract. Have an honest conversation with the manager about expectations for callouts and make a decision if this is what you really want. Feel better and take care of your health. If you are not in good health you need to heal first! All luck!
  17. spotangel

    THE HEALER

    Thank you.
  18. spotangel

    If you could redo it....would you choose nursing?

    Love being a nurse! Love helping others! Won't have it any other way!
  19. spotangel

    THE SCENT OF DEATH

    That's reassuring! Never heard of intimations of death before. I hope you don't get admitted and stay in good health and happiness! I am also plugging my nose cause I don't want to smell "the scent"! It is a gift that I very reluctantly accepted but I haven't smelled it for a few years now. I have noticed however that I have got very intuitive and tell people things that make perfect sense to them and have no idea where the thoughts come from. Now plants---I am still working on them!
  20. spotangel

    Registered Nurse Salary Purchasing Power Across States

    Thank you! I will stick to my state!
  21. spotangel

    What Called Me to Nursing.

    You will marisa.m, help people because you have been in those shoes. Maybe someday you will inspire someone else to be a great nurse by your compassion and critical thinking skills. Best of luck with school! Go for it!
  22. spotangel

    THE HEALER

    I don't begrudge anybody any services that they need from any place including planned parenthood. I also know very well that planned parenthood offer other services as I interned with them. Yet, it is hard to stomach the lack of respect or choice that an unborn child has while preaching about a woman's choices. To me that is self righteousness. This is not just a "good article", this is something that happened to me and is deeply personal. Sitting there listening to people laughing and talking about abortion was hard for me who lost a son while helping a nurse's aide and now was waiting to go to the preop area. I appreciate and respect your views like you should mine. We do not have to necessarily agree on them. I am very well aware of how touchy people are about their views on prolife and prochoice. What I shared was my experience and what I felt at that time.Peace!
  23. spotangel

    THE HEALER

    I did not inform them right away. I was out for 2 weeks after the procedure.I then went to back to my regular job. This was my perdiem job. I went back months later but did not tell anyone as I was put in different units daily. My husband and I decided not to sue the hospital. We lost our son who money could not replace. Many years later I met the Chief Nursing Officer and we discussed this and she was shocked. I never stopped praying for others that have been touched by violence and always ask for protection for all. In terms of Planned Parenthood, on that day people sitting next to me were discussing abortion freely and it was painful to listen to when I was desperately hoping that by some miracle my son was alive. I also had done an internship at Planned Parenthood during my NP studies as I wanted to see the other side and hear their perspective and not be judgmental. In all honesty most women that I saw came to abort used Planned Parenthood like contraception. Some freely told me that they didn't like condoms. Others told me that they could not afford to be pregnant, the condom broke, it would affect their figure etc. The worst one was a woman who tried to become pregnant for 8 years, got fertility treatment and finally got pregnant. At 5 months she decided this was not for her and drove 200 miles to this clinic so that she could abort and then claim a miscarriage to her gullible husband who was clueless.So their choice was to take away the choice of their child. I had all this in mind when I sat at that clinic hoping to trade my dead child for a live one at least in theory----
  24. spotangel

    While You Wait

    dpgRN, you are so spot on! Thank you for everything you do on a daily basis! The other side of the ER door is controlled chaos and only staff that have worked the ED know that. I have had staff asking me to expedite them since they work in the same hospital when I worked as an ED nurse and as a hospital supervisor. Sometimes you can, but most of the days when the ED is bursting at it seams, you get a bunch of disgruntled staff commenting about the "madhouse"! The only good thing is that most of them leave with a better appreciation of what an ED nurse does. When pushing for beds for ED pts, I tell the nurses on the floor, "Remember you can say no once you have maxed out on your census, they can't. Their doors are open 24/7, so let us work together as nurses to help each other and our patients!"
  25. spotangel

    Thank God for nurses!

    "It's everyone's responsibility. I don't want any explanation as to why you didn't know!" Tom, the administrator's voice was clearly frustrated as he spoke to the outgoing Night Nursing Supervisors. He was talking about a patient that was admitted who was waiting for a bed for almost 40 hours in the ED. The patient was an elderly 87 year old that was vented. "Imagine that poor patient on a hard stretcher for all those hours. You should have intervened!" The supervisors were silent. The administrator was on the phone getting morning report about the hospital from the outgoing Supervisors. I always came at least 15 minutes before my shift as the morning Nursing supervisor and was listening in to the report. Tom then asked, "Who is coming on this morning?" One of them answered, "Annie and Gwen". I piped up, "Good Morning Tom!" "Good Morning Annie. Can you please follow up on this?" "Will do, Tom", I quietly answered. After he hung up, I asked the outgoing supervisor that covered the ED what kind of bed the patient was waiting for and was told that the patient was waiting for a critical care bed. After report, when they left, I checked my units on EMR, got the patient's name and checked the admission status for this patient who did not need a critical care bed as I was told in report but a regular medical floor vent room! I called admitting and asked them to prioritize her admission. I then went over staffing with Gwen, the other supervisor and the staffer. Now it was time for rounds. I started off at the admitting office and reviewed with Chris the admitting clerk all the vent rooms in the hospital. This was a four day holiday weekend. All rooms were occupied. The chance of a discharge/ transfer from those rooms was very slim. This meant that the patient might end up waiting another day for a bed. I went to the ED and asked where that patient was located. I then went to the patient cubicle and saw 2 family members there. I introduced myself and was told that they were the grand daughter and great granddaughter of the patient. They were not happy. The granddaughter was upset that the patient was vented even though there was a clear DNR/DNI in the chart. "They waited till her son had left and then tubed her", she fumed. "My grandmother never wanted a tube down her throat and they still put it. Once I get her in a room, I am taking this up!" I did not comment as I wanted to check my facts. "This must be really hard on all of you. Do you know what the plan is for her? ", I asked her. "She is admitted and waiting for a room. When she goes up they are going to pull out the tube in the room". She had been admitted under pulmonology and had got a palliative care consult in the ED after being vented. I thanked the granddaughter for being patient and told her the bed situation. I asked her who the health care proxy was. She told me that it was the patient's daughter, her aunt Veronica. I went and spoke to the attending physician and nurse of the patient both who concurred that the patient was vented before their shift and they were not sure why as the patient was a DNR/DNI. I also heard about a panicky family member who had been at the bedside in the ED, and insisted that the patient be tubed after Bipap had failed, although that person was not the health care proxy and that the doctor "gave in". I checked the records and found a recent DNR/DNI in the EMR. It made no sense to hold a vented patient for the next 15 hours waiting on a bed on a four day weekend, and extubate the patient once she reached her room upstairs. The family was very clear on the wishes of the patient. They were fighting for what she wanted. "Can we do this extubation in the ED and honor the patient's wishes"? I asked the attending as the ED was slow and we did have a few empty private rooms. He was comfortable with extubating as long as we followed all protocols. So, I initiated a call to palliative care who then walked us through what to do. I then sat down with the family and told them of this option. I requested them to discuss this as a family and asked them to also call the health care proxy. She called back and was in full agreement and said she would be there in the next hour or so. The patient was moved to a private room in the ED. The entire family arrived. Lot of tears and hugs and goodbyes were initiated. The patient was already on a fentanyl drip. The proxy confirmed the DNR/DNI with the attending. The tube was withdrawn and she kept breathing. The family had been prepared by the staff for this scenario and used the time wisely by staying by her. An hour and half later, the patient's son walked through the door and the monitors went crazy! Ten minutes later, she was gone peacefully. I walked right in as the son walked out crying and the granddaughter looked at me with tears in her eyes and I just knew. I introduced myself to the rest of the family and they told me, "She just passed after her son came. She was waiting for him." They wanted to put her dentures and asked me for permission and I said" Absolutely!" and assisted them. One of them introduced herself as the patient's daughter's friend. She told me that the patient was mother to many of them who were not related by blood. They all called her "Ma"! I told them that she sounded like an awesome Ma and she went in peace surrounded by those who loved her and those she loved. They thanked me for my help and one of them ferverently said as I walked out," This is why I like nurses! Thank God for nurses!" I informed the attending that the patient had died and he went in and pronounced her. Later on at night, I gave Tom, my boss, a quick rundown of the facts and he was appreciative. I went home feeling that my shift was worth it. It felt good providing closure and advocacy for this patient and family. I thanked the ED team before I left especially the new attending that had taken over the case and agreed to the extubation after initially having qualms that quietened when I told him, "Let us do right by this patient even though we did not create this mess or situation". He came back to me and told me that he had completed all the paperwork (death Certificate), calls (Medical Examiner) and notes. The nurse had called the organ donation network as per our protocol. We left the family to grieve and celebrate her life. Driving home, I thought of this patient that I never once spoke to and hoped that she would now advocate for us, in the nursing profession, from above and be our Ma!
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