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spotangel MSN, RN

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

Posts by spotangel

  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!

  2. Thank you !

     I got the feeling that uncle was afraid to die.Aunty kept telling him that Jesus would be there, that his angels would accompany him and that he was going to a better place. When I prayed for him ,asking God to ease his terrible suffering, the scripture that I got from the Bible was from Psalm 12:7 about silver being refined. When we are refined, the creator can see his image in us. We prayed for courage and acceptance during his passing.I was grateful that I could be with him and offer him comfort and safety. No one should be alone when they are sick and dying.

  3. 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.

  4. 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!

  5. 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!

  6. 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."


    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!

  7. 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!

  8. 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----!

  9. 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!

  10. 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!

  11. 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!

  12. On 6/24/2019 at 8:38 PM, traumaRUs said:

    I found out about my cancer diagnosis over the phone while speeding down the highway at 60 mph with my granddaughter in the passenger seat and my phone on speaker of course!

    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.

  13. On 6/24/2019 at 6:49 PM, Kjorn2 said:

    I thought my husband had gallbladder issues based on his symptoms.  Finally pain was so bad went to ER.  After many test the ER doc said “your gallbladder is fine but there are spots on your lungs and liver  It might be cancer that’s metastasized so we will have to admit you for work up.  No bedside manner at all.   EGD showed esophageal cancer and spots were Stage 4 metastasis.  Given 1 year.   Oncologist came in and gave her spiel in options.  Then she said “ so what do you think - you don’t want to hear anymore, you’ve heard enough.  You aren’t going to go home and blow your head off are you ? “.  In my 35 years as a RN i have never heard anything like it. I am upset I didn’t report her.  I was too busy taking care of my husband.  He was gone 3 months later. 

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

  14. 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!


  15. 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!

  16. 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!

  17. Sounds like you have great experience! How about working as a clinic Nurse M-F, Weekends off, holidays off? It is a busy life but doable. No charting at home or on call. You will actually have a personal life-----!

    Another option is school nurse. Look into these options.May your wish to become a parent become a reality.Being a person who always shares my problems with God, I have found that , it relives my stress to a manageable level and I feel I am not alone. He in his providence ,is always looking out for me! All luck and will keep you in my prayers!

  18. Report him to the BON and let them know about the camera. I happened to walk in during rounds as a nursing supervisor into a room in a pediatric long term care facility and heard crying behind a curtain. I peeked and saw the a new LPN on her last day of orientation, roughly handling a peds kids with Cerebral Palsy. I had her relieved of her duties and wait downstairs in the lobby while I called my boss the Chief Nursing Office at 8pm. We send her home suspended and she was let go the next day. I never regretted speaking up and thanked God, I walked into that situation. I am not one to make you lose your job but abuse should not be tolerated. Period.