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spotangel BSN, MSN, DNP, RN, APRN, NP

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

Content by spotangel

  1. OP, if BON doesn't come to you, you could go to them and volunteer your services as they desperately need ICU nurses! That would be real nursing instead of these "people have rights to be unmasked and Europeans have grown a backbone" statements of yours in other threads! I did at NY and survived! If a next pandemic hits us at NYC, I am in. Lets see some action instead of words! Don't wait to be called. Help your fellow nurses! The time is now not maybe!
  2. spotangel

    New protocol - No report from ER to floor...

    Interesting post! Valid comments from all! Here is my perspective, having being a floor nurse, an ED nurse and an administrator from management! Floors are generally swamped between sick pts, emergencies and staffing issues. It is important for staff to document and give management a protest of assignment in unsafe situations. Floor controls discharges,bed cleaning and accepting pts to the unit. Once the unit reaches capacity,no more admissions from the ED. The ED is generally a mad house with controlled chaos! They cannot close their doors to emergencies and have to keep accepting patients. So they "Stick them, fix them and move them out" to the floor to make room for the next emergencies. Sometimes, the care is perceived as "not stellar" by the floor' cause the pt came in poop, drenched, not fed,IV dry----the list goes on and on. The ED nurses-some are thorough,some are not.Sometimes they get crashing pts and might not do the last peek beneath the sheets even if they are stellar nurses. When I worked in the floor, I saw a lot of games being played by some not all nurses. "I am not taking an admission at 5pm as I have meds, dressings and charting to do". Meanwhile the pt is an 85 year old on a stretcher in the ED for 36 hours waiting on a telemetry bed (imagine your loved one on that stretcher). Calling report from the ED-no one picked up the phone or put you on hold as they were busy or dare I say didn't want to talk to you and accept the pt. So we piloted a sheet in the ED along with the floor nurse's wish list. We did it as a team having reps from every floor and ED-all nurses. It had the pt's report in easy to read format(Name,medical record number, diagnosis, med/surg history, meds given,IVS/transfusions and heplock gauge and site, any tubes(NG,Foley) or attachments(colostomy,illeostomy),implants (AICD,Pacemaker),allergies,Code status and barriers-Hard of hearing,language etc,signature (legible) and extension. Takes 3-5 mns to fill out. This sheet was faxed and the ER secretary paged the charge nurse on the floor's beeper. Every charge nurse carried one including the ED charge nurse. The floor had 30 minutes to call back( hold for another half hour as we are running a code on another pt).Both teams attempted to work with each other. Few weeks before the project started ,floor nurses spend 4 hours in the ED with an ED nurse observing the flow. It is also working well (better than before)because the entire bedboard is online and everyone is involved when a pt is discharged, so that beds can be cleaned and made ready. In case of issues, administration steps in. As an administrator, I make sure protocol is followed, both parties are polite with each other and reach out to resolve in real time (if possible) by connecting the second party on a conference line. Sometimes, I would ask the ED to hold off or even move the pt to a different available bed on another floor, if the first floor is having a major issue or a prolonged code. At the end of the day, working together makes it much more of a peaceful day within your control. We all want the same things-staff practice safely, pt get good care and go home feeling what you did was productive and not a finger pointing session. In this Covid stress and racial injustice climate let us be kind to each other! We work hard enough and should build each other up and not tear each other down.Together we are stronger!
  3. Go on with a union rep if you have one and keep an open mind. See what the issue is. Ask if you can have a copy of that note and a callback number. Say "I don't recall that on the top of my head but can I call you back if I remember something? "
  4. spotangel

    Nursing may not be for me.. help!

    I agree with all the other comments! Not everyone holds a love for nursing,some are burned out, others are stressed and to some it is just a job! Look at the complaints as venting session for others. Be polite and stay focussed on what you can do to help pts. If your gut says nursing go for it! You won't regret it as you can move from one speciality to another till you find your niche/love. You can leave bedside or do it along with teaching---or administration----! Learn to make quick, meaningful but not lengthy connections with your patients. You won't finish your work otherwise! The sky is the limit! In some areas you have more autonomy and in some you have less! Don't be discouraged and remember online classes are the wave of the future due to social distancing! Forge on and become a terrific nurse! God knows we need them!
  5. spotangel

    What just happened?!

    Dreams are a portal and there are many documented dreams in the bible! You have to be attuned and "open" for families to come through in dreams. Maybe you can have casual conversations about life and death with that person if you dream of an impending death.Get to know their wishes and unfulfilled desires. Sometimes, the Lord uses you to give that person a heads up . I always pray to the Holy Spirit to guide my conversations and for the right words to come and He always come through! We are surrounded by angels and spirit guides especially when we are struggling and I always ask for protection and wisdom . I rebuke evil spirits from entering my home and always ask God's angel to protect my home and family. Don't fight your gifts, use it for the glory of God and to help man! Peace!
  6. spotangel

    What just happened?!

    Has an incident at work left you wondering if you were being helped in some shape or form? I am going out on a limb here to share my experiences and hope you are open to it even if you do not agree or believe. It took me 31 years to get comfortable with it myself. If you told me when I was a child, that I would see, feel and smell things that others couldn't, I probably would have run the other way and not joined the nursing profession! In nursing school, I remember how I felt being watched in the break room of the ICU and never feeling sleepy during my one hour break, no matter how tired I was. I heard veteran staff talk about someone sitting on their chest while they were lying down on the couch in the Nurse's Lounge! I eyed that couch with distrust and always sat bolt upright during my break, feeling eyes on my back! The first time, I felt something was in an old hospital in New York, while working a night shift. As a staunch Catholic, I always carried my rosary and felt protected. Pregnant then with my now 22-year-old son, and working the night shift, there was one room I never wanted to enter. Room 813 on that floor was always icy cold and I felt nervous entering that room at night. I had a patient, Linda, dying from AIDS and I tried keeping her company after my work was done. Sometimes, I would sit and hold her hand but my eyes would always stray to bed A by the door which was empty. I found out from two experienced older nurses that the room was haunted. Apparently, one time that room was empty, and Ms. James, a Jamaican nurse, went on her break to sleep on bed A. As she dozed, an old white guy woke her up and told her to get off his bed! Half asleep, Ms. James told him to use the other empty bed to sleep. He protested and told her, "But this is the bed I died in!" Ms. James shot up and took off! She went back to the nurse's station and told Ms. Joseph, an Indian nurse, that she was not taking her break, not telling her what had just happened! So Ms. Joseph, unsuspectingly, went to the same room and came running out 10 minutes later----! I was terrified now to go into that room and begged Ms. Chambers, the Nurse Attendant to come with me when I had to give 2 am meds to Linda. A few days later, Linda died. I am not sure if she joined the old man in that room and I did not want to find out! I always prayed not to get room 813 on my assignment! Leaving that per-diem job for a full-time position, I thought I would not feel anything strange or weird anymore! As I started working in an acute care hospital, on the telemetry floor, I noticed that I started smelling flowers where there were none. I smelt roses (felt like hundreds of them) and felt the presence of many peaceful beings (room felt packed) when one of my patients was dying. There was a sense of calmness and rightness and once the patient died, the smell and presence were gone in five minutes. None of my coworkers smelt it and the room was bare. I never shared that at work as I did not want them to think that I was strange! Death was something I was uncomfortable with and I did not want to have any part of it! Little did I know that I was going to get upgraded to a different smell! While still working on this telemetry floor, I started smelling a combination smell of flowers, incense and candles in certain rooms. This smell was familiar to me as back home we did not have funeral parlors. When someone died, the body was brought back home, washed, put in a coffin and placed in the living room or outside, under a makeshift canopy and surrounded with fresh flowers, candles, and incense for an all-night of prayers. The next day, the body was taken to the church with special church hymns sung for the dead and then buried after mass. I was now smelling this around patients that were dying or would have a sudden cardiac arrest on my floor. Even though I did not tell any of my co-workers, they soon caught on that I sensed something, when they would see me push the crash cart and park it outside the patient's room or check and make sure that the wall suction was working! We saved many patients and sometimes I used that sense of smell to gently nudge a family member to stay. One time, the daughter of my walkie-talkie patient watched me park the cart outside her mother's room and asked me point-blank if she should stay. Taking courage in my hands, I followed my instincts and I told her to get her sisters too! They flew in two days later and I got permission to stay overnight in the family lounge. I saw them when I came to work in the morning and there was so much laughter in that room. Four days later when I came back after the weekend, I heard that the patient arrested suddenly was coded, and died at 2 am surrounded by her daughters. The next month, I got a thank you card and flowers from her family, thanking me for their time together with mom as a family, during her last few days on earth. I still have that card! I soon started working in the ED and my senses went into overdrive. Sometimes, I would tell the patients things that made no sense to me at that time but made perfect sense to them. I remember telling this pregnant girl with a history of two miscarriages, who had abdominal pain but no bleeding, that she was going to have a boy and not to be so worried. A year later she came in to see me with a little boy to say thank you! Another time I was helping another nurse who had a hard stick with a crusty uptight older lady who warned me that I had one shot to get "bloods"! I thanked her and got her "bloods" in one shot and joked that I thought she was going to send me to Alabama if I missed! She stared at me and then burst out laughing as she was from Alabama! I had no idea! I also heard my angel whisper in my ear if my patient in the ED took a sudden turn for the worse when I was with another patient. As soon as I went I would find that most of the time the patient was having an acute episode of bradycardia, hypoglycemia, hypotension, or Altered Mental Status. I would always thank my angel Providence and would ask him and my other guardian angels to watch over all of us in the ED and in the hospital! One time, a patient walked in with her son and my angel told me she was not going to make it. Turns out that she was septic, got intubated and died on Christmas eve! Just before she died, I was catching up on my notes in the ED during my "break" and heard my angel clearly say, "It is time"! I immediately got up and went to her side, pulled up a chair, and sat next to her, holding her hand. She had been made a DNR. I said the Lord's Prayer and as I finished, she flatlined and died. She didn't die alone thanks to my angels! All throughout these years, I felt uneasy with my "gifts"! I moved away from acute care to Long term care(LTC) after a layoff. In 2012, I was in a bad accident with my entire family! Our car was totaled but we walked away without a scratch. That same year, I remember getting stuck for three days at a Pediatric LTC where I worked, as we were snowed in and relief could not come in. Finally, when I was leaving to go home, I walked into a chapel within the building, to thank the Lord for three safe days. I told him that I was worried about my commute home being that the accident was recent and my other car was old with slippery wheels. I asked him to send the chapel angel whom I saw when I walked into the chapel as a brilliant pillar of light, as soon as I opened the chapel door. Initially, I was nervous about the light but soon got used to it. After my prayers, I left, dug my old van out of a three-day snow pile, and drove 10 miles an hour with my flashers on. When I reached home, I locked the door and started walking up the stairs. I realized that I had the car keys in my hand and so turned to walk down the stairs to hang the keys by the door. I stood transfixed as there was a big ball of light shooting back out of my door. The chapel angel had kept me company and was leaving back now that I was home! Talk about a quick answer to prayers! Another time I was rounding in a room of a pediatric patient. The child was around one with a tracheostomy and sleeping peacefully in the crib while I was talking to his mother, Crystal, who was taking classes to become a nurse. This was a double room and there was a new admission (mom and child) also sharing the big room. The curtains were pulled around the sleeping child's crib and I was next to the crib. The lights flickered three times and I thought that the other mother was checking the lights. It was around 9.30 pm and the room was bright with the lights on. All of a sudden all lights went off and I instinctively checked on the sleeping baby in the bright moonlight. I gasped as on the other side of the cradle stood a familiar figure in a nun's habit, Elizabeth Ann Seton, whose statue was in the lobby of this center! The lights came back on and there was no one there. I checked the other bed. The new admission and his mother were not in the room. So who turned off the lights? "Did you see that? What just happened?", I said. I couldn't believe what my eyes had just seen! "What did you see? I always felt a peaceful presence in the room but have never seen someone!", Crystal said. "Just know your son and you are protected by Mother Seton!", I told her as I walked out of the room, shaken. I had heard other staff at the LTC talk about seeing or sensing others in the children's rooms but had never experienced it myself! I felt reassured that the children had loving eyes on them always! After two years there, I left to work in a larger LTC with 750 patients and around 200 staff. This LTC was extremely busy with active codes, dialysis patients with hypotension, admissions, hospital transfers, discharges, missing or wandering patients, along with sick calls, staff issues, supplies issues, and a huge narcotic count and distribution to the units. Sometimes I would see big house flies come into certain patient rooms and they would die within the week. I remembered that I'd seen that happen in the hospital too! There were times when I needed help, prayed and help would come miraculously. I would be pulling my hair desperately, trying to even out staffing based on acuity on days with a large number of callouts. Staff would wander in that were not on the schedule and tell me that they thought they were on to work or I would get unexpected calls from the staff offering to stay or come in for overtime. On those days, I knew I was getting heavenly help to maintain safe staffing and keep our staff and patients secure and safe during their shifts. This trend continued when I moved to a job closer to home to work in a clinic. Now I am inspired in the clinic to ask my patients what really matters to them. Many of my patients request me to pray with them and I do. I am surprised at their priorities which have at first glance, nothing to do with health. Some of their priorities are: "I want to be independent as long as possible." "I want to see my children." "I want to stay in a home that I won't get kicked out from." "I want to not forget my family. I am losing my memory." "I need money to buy food and medication." "I don't want to go to the hospital again!" Since I work with an immigrant population that has 70% illiteracy, multiple comorbid conditions, social determinants of health, poverty, and transportation issues, it is challenging to say the least! I try my best and utilize the help of our health team to coordinate their care. During the recent COVID pandemic, I got deployed back to a medical-surgical unit in my hospital from the clinic. The enhanced smell of death returned but this time most of these COVID patients were DNR/DNI and I used it to pray with them, give them comfort and strengthen them in their last days. Many times, I called their family on Facetime on the phone and had them talk or see each other. These encounters brought them comfort and for most of them, it was the last time they would see or speak to each other. Last August, I was inspired to write a book entitled Sightings After Death (SAD) about 25 true stories that dealt with death and hope. At that time I did not know why I was writing this book in the middle of a fulltime job, doctoral studies, and being a wife and mother. I self-published it in December 2019 on Amazon. Looking back now, I know why the Lord was so insistent that I publish it before the end of December 2019. I realized that He wanted people not to be fearful of death and in His tender mercy and grace wanted me to write hospital-based stories that offered solace during these times. I hope this book helps at least one person. The COVID experience hit the pause button in my life and made me re-evaluate and reinforce my priority list of God, family, work, school, and everything else. I have learned to appreciate my family, blessings and be present in the moment, fully. I am thankful that none of my family or immediate coworkers have died from COVID. One nurse that I knew from a previous job, died from COVID. In her memory and all the other staff, patients, and family who have died, I will continue to use my "gifts" to better mankind. In the meantime, I am just grateful for another day and an opportunity to be a nurse!
  7. spotangel

    What just happened?!

    Lynn,I don't think my brother wanted to keep up with Karen after she left!
  8. spotangel

    What just happened?!

    Thanks Dr. Madenya! It took a lot of praying before I decided to share my experiences. My book is available on Amazon.com and is titled Sightings after death if interested. Stay safe! Cheers!
  9. spotangel

    Thinking of leaving nursing altogether

    OK Mia 1234, you know you best! Go after your dream and most ardent wish! Mine is to write which I pursue! You know what you like doing, go for it! I will continue to pray for you! I wish you peace and happiness and most of all the Grace of our Lord!
  10. spotangel

    Back Charting - DNRCC patient

    Couple of things! First, take a deep breath and just breath! You are going to be just fine. Second-If you did not write late entry-Epic timestamps it anyway. Best practice is to start off a late entry note by writing "Late note- On this date at approx this hr, writer rounded on the pt and found pt sleeping in bed. No acute issues observed. Third- If you keep going into a deceased patient's chart-it may flag your entry for review. Avoid unless absolutely necessary. Fourth- I would check with my manager to see if there was anything else you needed to document since you did not get to document on the day of your care. She/he could review the chart and let you know. Fifth-You may want to find out if Epic has smart phrases you can use or create when you need to document accurately in a timely manner. A smart phrase for rounding could be for example Writer rounded on the pt at ------am/pm. Pt sleeping/awake, comfortable/in pain. Informed provider/RN from next shift in report. You could save on time when using a smart phrase and you can make one for each common scenario and insert it in your note. It will auto populate once you put in your smart phrase. Hope this helps! Chill! I have been in your shoes and survived! You will too! Each day is a learning experience!
  11. spotangel

    BSN vs. MSN-Weighing my options.

    Go for it! No education goes to waste and your options are more. Hope you are getting tuition reimbursement as the bills add up fast! Stay safe and Good Luck!
  12. spotangel

    What just happened?!

    Thanks LynnRN53 and NAtoRN. It is interesting but not comfortable at times! I held off of many more stories as I didn't want to spook you all!! LOL!
  13. spotangel

    Thinking of leaving nursing altogether

    Hi Mia1234, Sorry to hear that you are going through rough times. I say, every job is a chance to reinvent yourself. From a personal experience of being bullied and harassed at work for over 5 years, I know the feeling. What I have learned to do is to ignore the petty, stand up and not tolerate it when someone crosses a line and be frank. I am polite and never rude. If I make a mistake, I apologize sincerely and move on. I don't hold grudges and don't expect my friends to be from work. I have healthy interests like writing, singing and I try and spend at least half an hour after work daily in church, hanging out with the lord and chilling and talking with him! If you are a believer, get ready for the crosses but always know that you can cast your burdens on HIM and He will give you rest! When you enter a workplace, cover yourself with the precious blood of Christ and watch the cloud of negativity around you take off far away from you! Now, in terms of work, I am an NP but work as a complex case care coordinator. There are many insurance related jobs, utilization review or documentation review jobs, telephone triage or per-diem NP jobs. If you like to teach, being an adjunct may be an option. Don't give up but give it up to the Lord and watch how the Holy Spirit works; the impossible becomes child's play! I will be praying for you! Remember, what you can give the world is precious and unique to you! Chin up! Don't Quit! You got this! This too shall pass!
  14. spotangel

    Farewell Esme - In Loving Memory

    Hugs to you bunky Lou! Kristi sounds like my mom, my best friend who died in 1982! I always thank the lord that she was my mum. May Kristi's soul rest in peace! Become an awesome nurse like her! We will miss you Esme!
  15. NurseBlaq! On point! Lets focus on saving lives and helping others! Learn from other states! Texas brace yourself. You will live through this and help countless people. Please insist on PPES and take precautions yourself. At one point some of us in NY stayed in hotels to protect the home front. Working with Corona pts, some helpful hints. Put them on oxygen at all times. Hi flow works better. Be persistent and get them out of bed and sitting. If they insist on sleeping, prone them and use pillows. During the IDT(interdisciplinary team rounds), advocate for a liquid diet with lots of hot fluids-tea with lemon and honey/sugar perks them right up. Get extra chargers-most phones die. Get their family's numbers early and call them on the pt's or your phone/facetime. Seeing family improves their morale. Get PRN orders for tylenol for all pts unless contraindicated. Not every drug works for everyone. Steroids for some, Remdesvir for others, Hydroxychloroquine for some(get baseline EKG and watch the QT interval), Zithromax for some others and most people were put on heparin subcu (lovenox) or coumadin. Pray for and with your pts. If pts talk about death, listen. Don't brush them off. Think differently about codes. Wear your PPES before entering to help. I saw very few getting coded due to the futility. Vent pts are labile and you have to watch them like a hawk. They need to be vented early. Attitude is everything. Be kind and patient with your patients. Everything takes effort and makes them extremely short of breath. I would be the cheery sunshine nurse even if I was anxious or weeping inside! Take time for yourself. Talk to others as you end up with PTSD. Be there for the conspiracy theorists, the don't trample on my rights group, the no mask group when it hits them or their loved ones. Don't be "firm" and tell them to go home and quarantine themselves! Be the nurse that the public trusts! God be with you all ! In God, we trust!
  16. spotangel

    "Life does not cease..."

    Hugs Davey!
  17. On point on routine after work. It is so important to walk into your home and family safely. My routine when I park my car- Call home-one family member opens the garage and all doors leading to the laundry and bathroom downstairs. Come in and close the garage. Strip on a plastic garbage bag. All clothes that I am wearing go into another bag. Shoes stay on top of plastic bag. ID,PENS gets cleaned with wipes and are left in the garage. Put clothes to wash, throw plastic bag. Go buck naked to the bathroom and shower-head to toe. Wear clothes left outside the bathroom and come upstairs to elbow hug family. 1 month inpt with pts and coworkers dying left and right. PTSD and lots of praying. COVID free so far! Praise God!
  18. spotangel

    I can't believe this - wearing a mask during the test?

    Try a cloth mask! Much more comfortable. Best of luck with your exam. we are rooting for you!
  19. spotangel

    Saving Frank!

    This article was written and initially submitted in December 2017 and at that time I asked for it not to be published yet. With what just happened in the last few weeks, I feel now is the time. Ironically enough my initial title was, “I can’t breathe!” I had changed the title as I did not want to evoke or trigger emotions. Now that same title is a hashtag! It is out there now. Trevor Noah called it and gave us all a perspective of how the shoe feels on the other foot. Frank In the last two weeks, we have seen blatant discrimination captured on camera in NYC and Minneapolis. As a human being, it was extremely hard to watch George Floyd die. As a professional, my mind was screaming to let up on the knee pressure, start CPR on the field and right a wrong. I imagined the other end of it as the ER staff now received a patient who was clearly dead and desperately tried to save him. It took me back to 2008 when my ED team and I were in a similar situation. Frank was brought into my ED when a Group Home staff's good intentions backfired. Here is what happened. Saving Frank in Today’s World “Not again lord!” my brain screamed as my hand reached for the red phone calling with an emergency. This was our 5th code in the space of 2 hours that EMS was bringing in on a Saturday. A 25-year-old black male without a pulse and CPR in progress. ETA (Estimated Time of Arrival) 5 minutes. I marshalled my weary troops again and set up for the code. We had plenty of time as they took around 20 minutes to arrive. We took over once they rolled in. Behind the ambulance around 6 squad cars pulled up. As I went in and out of the resuscitation room, my eyes lingered around 20 police officers by the entrance of the ED. “Something is cooking!” I thought to myself. The Story of What Happened The patient, Frank, was DOA (Dead on Arrival) and had been coded in the field for over 40 minutes. We worked on him for over an hour without a rhythm. He was finally pronounced. The EMS gave us the story. Frank was a schizophrenic and lived in a group home. He had no family. He was agitated and pacing and so one of the staff got worried. They asked him to go to the ER and he refused. They called 911 after consulting their manager and EMS arrived as so did the cops. When Frank refused again, the cops called for reinforcements and struggled to contain him. He struggled violently. They then put him in an Emotionally Disturbed Person (EDP) body bag also known as a "burrito". Every time he raised his head up and screamed, they held him down. Soon he stopped struggling. The EMS team got him on the stretcher to put him in the ambulance. One of the EMS workers noticed that he was not breathing and had no pulse. They called for reinforcement and started CPR. The ALS team arrived to help and intubated him on the scene, continued CPR, and brought him to our ER. I saw the ED Tech take his belongings and clothes after the code, label the bag with his name, date of birth, Medical Record number and the date, then put it in our utility room. The weary staff moved on to the next emergency disheartened that we could not save him. Police Arrive I saw two more unmarked police black SUVs park at the ambulance bay and a few suits come in. They wanted to speak to the ED attending that ran the code. I pointed him out to them and they thanked me. They were from the police IID (Internal Investigation Division) as a call had gone out to them. They were also directed to Medical Records as they wanted copies of the ED course and copy of the medical chart as part of their investigation. Medical Records would direct them on our hospital protocol to obtain records. Frank's Group Home Contacted A phone call was made to the group home and the phone number obtained for the manager. She was not informed of his death but asked to come to the ED. She came with the assistant manager and the doctor and I took them to our family room. Sitting around a small table we informed them gently of his death. Rose, the manager, began shaking and crying. “I should not have asked them to send him to the ER. I should have come in and calmed him down. He would have been alive!” Sara, the assistant manager, raised a trembling hand and put it on Rose’s shoulder to comfort her. “I can’t believe it! Poor Frank. Dear God! What did we do! We only wanted to help him.” Both women sat crying. The doctor walked out after hearing an overhead page for him leaving me with both of them. Swallowing my tears, I asked them if they wanted to view Frank’s body. Hesitantly, still in shock, they agreed. I walked them into the resuscitation room and pulled 2 chairs for them to sit by Frank. They sat silently, tears rolling down and dripping, shoulders shaking, Sara covering her face while Rose stared at Frank’s face, her eyes anguished. I silently offered them a box of tissues and murmured that I would be back in a few minutes. Frank's Belongings I walked into the utility room and put on gloves and took out the bag of Frank’s belongings and the belongings list clipped to it. Silently, I opened the bag and checked all the items against the list. A watch with a cracked dial, shoes and socks, a tee-shirt still wet with his sweat and sweat pants and underwear soaked in urine, a wallet with a $2 Lotto ticket, and a train monthly pass. Eyes smarting, I put all the belongings back imagining his last struggle at life as with every ounce of his strength he struggled to live. I Wish ... I wish he had got a second chance in life. I wish he had been with staff that knew how to handle his pacing and increased agitation. I wish it had been a weekday with full access to a psychologist and other trained personal that could have handled his issue in a safe manner. I wished that the EMS and cops that had come in contact with him had dealt with him differently given a second chance. None of the wishing would change the outcome. Wiping my tears away, sick to my stomach, I walked slowly back into the room and gave them his belongings. They left and Frank was sent to the morgue as he had no family. The police group and the IID also left. De-escalation I went home feeling drained, wondering what we as nurses can do to educate others in handling psych patients. Many times as situations can quickly change, chances of violence and harm are high, triggering the choice to use force to subdue a patient. De-escalation is a learned art. How much training and mock practices on de-escalation are our first responders getting? What kind of training should health teams get to help patients, keeping ourselves safe at the same time? What is the aftermath of the ones left behind and the ones that worsened the situation while meaning to help? Which professional schools teach these techniques in mainstream classes as anyone at any time can be affected as one goes about their daily life? I have seen videos of how to deal with an active shooter scenario but very few on psych outbursts and de-escalation techniques. How Can We Help Save the Franks of the World? For starters, the focus should be on primary care. Many times, these situations escalate during off-hours and weekends when there is minimum help available. Primary care health providers including Nurses, Home Health Aides, Med Techs, Community Health Workers, and all who touch the patient in clinic or at home (family members) should be taught mental health awareness, de-escalation techniques and how to recognize early signs of agitation and mental health changes. The training should include: Scenarios Role-playing Drills on a yearly basis Safety for both staff members and patients is critical. Always be near a door Be fully aware of your escape route Have a backup plan in your head Watch for nonverbal cues of increased agitation from the patient Always listen to your instincts as they will guide you to be safe This could be done as a public health funded program where training is offered in a primary care setting. The next group that could potentially touch the patient are EMS, police, and firefighters. There should be yearly mandatory training. The response team should preferably include those who excel at de-escalation especially when responding to an Emotionally Disturbed Person (EDP). Once they arrive, they should collaborate with someone who works well with the patient as much as possible. NYC police (NYPD) presently have a dozen crisis de-escalation teams that collaborate with Health professionals and are on call for street calls. The Receiving Emergency Department The ER that the patient is brought to should preferably be a psych ER. Since this is not always feasible, the ER should follow the protocol for EDP to keep both staff and patient safe. It is amazing is to see how certain doctors and nurses excel in dealing with these patients, so they would be your first resource when available for a smooth transition. I was heartened to read a recent article about a collaboration of a healthcare system with emergency services to provide ongoing training for first responders in New Mexico. The University of New Mexico’s Department of Psychiatry and Behavioral Sciences has an ongoing collaboration with Albuquerque Police Department to improve patient outcomes, including 24/7 contact with officers and continued education for both police officers and physicians. This would be a model of care of collaboration within a community and would be more proactive than reactive in nature and help save lives. Yet another article talked about mentoring youth that are touched by violence (Youth Alive, a California based nonprofit organization that work with hospitals to instill leadership traits in adolescents and prevent further violence). Increased Mental Health Issues During the Pandemic The reality of our lives is that these cases are becoming more the norm than the exception. The COVID-19 pandemic has increased mental health issues among Frontline Workers along with the general public! It is important for us nurses as frontline staff to be aware of how to deal with volatile situations and have a few plans in place both as individuals and as teams. Staff at a supervisory level should have safety as a top agenda and mandate trainings and drills. In primary care, people coming in for doctor’s appointments should get screening questionnaires that trigger referrals to appropriate services that support their mental health and teach caretakers how to deal with exacerbations or flare ups of a patient’s mental state. Another collaboration would be a group home supervisor reaching out to the local police precinct and building a relationship with their clients and the cops so that there is a connection when the call comes in. Our call to action as nurses is to get in touch with our local government and be their resource and expert when needed. This requires time and commitment but think of the lives you can save with your actions! The ripple effect can go far and wide! I have worked in a group home setting in the past and learned to build a trust base with all clients. What I learned to foster de-escalation was to use activities that calmed the patient at the beginning stages of agitation and not to ignore the behavior. For one, it was walking to the store and getting a cup of coffee (fresh air therapy as I call it). For another, it was putting on his favorite show or music in a quiet space. For yet another, it was tearing down white paper methodically and piling them up (sorry trees). Each of these activities helped the individual get to a safe space within themselves and made the situation more manageable. An approach that worked with Frank might have kept him alive instead of being in a body bag at the Medical Examiner’s office. It is easier for us to point and blame than recognize the underlying problem and come up with ways to fix it and thus save the Franks of the world. This Year, Let Us Mark Mental Health As One of Our Priorities Let us not forget our mental health and the mental health of others entrusted in our care. Be kind to one another! Use your professional expertise to advocate for others that cannot advocate for themselves! I do not know if Frank ever got justice and what was the outcome of the investigation. In the case of George Floyd there was no known mental issue but a suggestion of “awfully drunk” on the initial 911 call that needs to be verified by toxicology report. It still does not justify in any shape or form the overuse of restraint techniques used by the policemen. I hope and pray for swift justice for George Floyd, his family, an end to innocent people being harmed and for us to heal as a community. Every life is precious and every day is a chance to be a better person! As we cry out against injustice, let us persist for justice to prevail and be there for one another. In this time of unrest, I pray that let there be peace on earth and let it begin with me!
  20. spotangel

    Saving Frank!

    I agree 100%. De-escalation should start early and not at the point when the person is extremely agitated. In Frank's case they had him inside the EDP bag, face down and 6 cops sat on him till he "stopped struggling". By then he was probably in cardiac arrest.The cops didn't recognize the fact till EMS arrived ,found him pulseless and started CPR. This was a preventable death. Mental health is a priority and prevention and early de-escalation is key to saving lives.
  21. spotangel

    Saving Frank!

    Just to clarify.Frank was brought in to our ED in 2008. I wrote this article in 2017 but did not publish it.
  22. spotangel

    Momma and I

    Yes she is! Praying for all of you!
  23. spotangel

    My Nurse Hero

    Beautiful! I pray for you in this special day of Pentecost that your dream of creating an NGO to help your community bears fruit! Peace!
  24. spotangel

    Finding My Spark

    Thank you for a beautiful glimpse into your life. Nana was precious and she has certainly lit a spark in you that will be lifelong!
  25. spotangel

    The Superpower of Compassion

    Love it! Thank God for Clara! We now got a super nurse in you! Soon you will become a hero to another person.Never under estimate the power of a nurse!
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