Recovery from an illness is tough, no doubt about that. It’s painful, stressful and exhausting. Your body is taxed beyond its measure and then in order for it to heal it has to work twice as hard. The hard part about recovering from any illness is understanding the concept of ownership.

Most patients expect the very best from us and our medical team. They expect the medical team to ‘fix’ them. No matter how small or great the ‘illness’ is, we are supposed to fix them and make them all better. Patch them up ‘as good as new’. Unfortunately there comes a point of (no return) critical mass when the recovery process can progress no further without the help and motivation of the patient themselves. We simply cannot do it for you.

We can’t deep breath and cough for you. We can’t get out of bed and ambulate for you. We can’t do your active and passive exercises for you. Put simply, we can’t be you.

Sooner or later the ball will be in the patient’s court. Sooner or later their recovery will either move forward or stand still based on their actions. When these actions are not being done, when the patient finds every excuse imaginable to not take ownership for their health while still in the hospital – that’s when the tough love of nursing shows up.

Yes, we will get mean. We will harp on you. We will annoy you to no end. We will check up on you repeatedly. We will ask you to go above and beyond what you think you can or cannot do. We do all of this to get you better. You may think we are torturing you. Heck, you might even think we have it out for you and we just don’t like you. The truth is it’s all for your benefit. You may not understand it, you may not see it or comprehend it at the time, but all our torturous ways are delivered with the hope of getting you better, getting you out of the hospital and getting you home.

Because in the end, isn’t that what we both want?

Image: Christopher Robbins | Photodisc | Thinkstock

I thought it only appropriate to address proper hydration during such ‘heat wave’ –like weather (at least where I live right now). Most people will of course increase their fluid intake when it gets super-hot outside, but it’s not just while you are outside. You should be keeping yourself well hydrated even when indoors (like when you are at work!). Besides, you’re body loves to remind you when you are dehydrated in the form of body aches, headaches, loss of energy, slower response reflexes, decrease awareness, etc.

Sweating along with the thirst reflex are your body’s last responses to overheating (yes, I know my fellow nurses are aware of this), but for some crazy reason we use them as a marker for when and how often we should drink fluids. It’s a standing joke at work right now that I’m well hydrated. I drink close to 3 quarts of fluid during my typical 12 hour shift (along with the occasional cup or two of coffee- yes, I have my vices). I drink so much so often that my visits to the restroom are now a source of ‘ribbing’. 3 quarts of water have to go somewhere!

*clearing my throat* – anyway!

With all that being said, do you know how to measure if you are properly hydrated? There is a cheap and easy way to figure it out. Ironically I blogged about it quite some time ago on my personal blog. Check it out:

How do I know I’m hydrated?

So we all know about the recommended daily intake of water. Somewhere around 8 glasses of water. Their are a ton of websites and tons of information on how much and what kind of water you should drink.  Then you have the bottled water vs. tap water debate. I think it’s safe to say we all know the benefits of water.

The human body’s percentage of water is somewhere in the range of 65% or higher. I think I read an article that it can be as high as 78%. The take home message being that your body makeup is more than half water.

So it’s safe to say drinking water is good for the body.  Drinking more will definitely hydrate your body. As to how much and how often we won’t debate (at least not today on this post) We also won’t even skim the surface on the debate of water vs. sports drinks either.

I wanted to talk about how to monitor or measure your body’s hydration. I want to share a quick-fast and easy way to determine if your currently hydrated and how to measure if your hydrating yourself adequately. Now this lil’ trick does not exist in a bubble and is in no way a substitute for true medical advice and medical analysis, but it’s an easy and inexpensive trick.

It’s really simple. Look at the color of your urine.  Is it dark or light? I really don’t care about the shade of yellow or amber, but more importantly how clear is it? Is it really dark or does is it almost take on the consistency of… uuhhmm I don’t know … water?

The more hydrated you are, the closer your urine will look like water. Pretty simple huh? How can you forget that one!?

Now there are some important facts to note while using this little trick:

1. Let me reiterate this method does not exist in a bubble, there are a million other factors out there that can affect the color, smell and consistency of your urine.
2. Yes diuretics and other popular drinks (soft drinks, cola, sports drinks, tea, coffee, etc) can and will give you the clear urine, but you may not be hydrated. So don’t expect to drink coffee, or tea and be hydrated. Some drinks like coffee and tea act like a diuretic and can inhibit a hormone in your body, therefore causing you to urinate more and more often.
3. Just as what you drink affects your hydration, so do the foods you eat. Just imagine the amount of sodium content in a can of processed food.
4. Yep your physical activity plays a HUGE role in your hydration, as well as how much you sweat. Everybody sweats differently. (I sweat standing in 30 degree weather and my wife doesn’t ever perspire until it’s almost 100!)
5. Drinking more water will definitely make you pee more!!!! But trust me, barring you don’t have any pre-existing medical conditions, your  body will adapt and you won’t urinate quite as often.

This is great for determining your level of hydration as well as monitoring if your ‘becoming’ hydrated. Is all that water helping you hydrate? It also lets you know just  how dehydrated you really were.

So, how hydrated are you?

How do I know I’m hydrated? Originally posted on My Strong Medicine

Now this particular ‘thing’ about nursing only seems to happen in the smaller rural hospitals (at least that’s what my experience has been). I truly am not a fan of the ‘feast or famine’ phenomenon.

Feast or famine: You as a nurse are either running your rear end off to the point where you didn’t have time to relieve your bladder or eat any food. OR – things are so slow you find yourself staring at the clock. The census on your particular nursing unit is either busting at the seams or you can hear an echo down the hall.

Now we all know how most nurses (including myself) feel about that horrible ‘Q’ word. You never say quiet, or bored while at work – Murphy’s law will definitely slap you back into reality if those words are spoken. You’ll either have a patient’s condition go  sour, or you’ll get a handful of admission back-to-back, etc.

This past holiday weekend was my weekend to work. Neither good nor bad, just was. It was ‘my’ weekend in the rotation. Well I guess everybody in my community decided to get well and heal themselves?! Better yet, during the weekend, they avoided the hospital and the Emergency Room?! The entire hospital census (including my nursing unit) was at an all time low. Far be it from me to complain about people getting better, but I tend to think it had something to do with the warm weather, the holiday, and of course the long weekend.

Once again I’ll be the first to admit it was a nice change of pace, but I think that’s where the appreciation ends. Inevitably to save on costs and the budget someone gets put on call, or gets cancelled. Now – once again who wants to complain about that? But, both of those actions will definitely hit the pocketbook eventually.

I’m probably going to catch a lot of heat for my gripe, but I’d love for there to be some consistency in the roller coaster ride. Yeah, I know – I’m asking for a lot.

Do you have any similar experiences? What are your thoughts?

The great thing about being a nurse is the unlimited employment environment opportunity. A nurse can work almost anywhere. You are only limited by your choice and your imagination. Everything from the popular hospital setting, to out-patient facilities, offices, independent health care businesses, working from home, etc. Each job and their responsibility carries with it a certain type of ‘working hours’.

Some nurses can work a Monday through Friday job with weekends off. Some can work just weekends with their week free. While others work varied shifts throughout the week.

I myself have found out I am a shift-worker. Anything else just makes me tired and a tad unhappy. I like having a day or two off during the middle of the week. It’s probably just me and my delusional thinking, but I feel like I get ‘extra’ time to myself.

(Now let’s be clear, technically there is more time to myself. A 5-day work week usually entails a 40-hour work week. Shift-work ‘usually’ equates to a 36-hour work-week. I stress the word usually.)

The drawback to shift-work is having to work weekends. In some instances every other weekend, or one weekend per month. Yep, working weekends is not something anyone enjoys (for the most part), but if it’s a choice between working 5 days straight and then 2 days off (the weekend) or working a couple days and then off a couple days during the week with some weekend shifts – I’ll take the shift work.

I tried the Monday through Friday job. It was awesome for about 2 or 3 weeks, then it started to become tiring and overwhelming (for me personally and physically). I felt like I spent every weekend playing ‘catch-up’ for all the things I didn’t get done during the week. There was no rest or reprieve. 5 days of work and then 2 days of ‘catch-up’ madness.

Maybe it was just me? I’m not sure.

What I do know is that working the shift work gives me a false sense of ‘rest’ during the hectic week. I don’t know how those bankers do it. LOL

What about you? Are you a banker-type nurse?

Image: Siri Stafford | Photodisc | Thinkstock

‘As seen on TV’ does not apply to the real world of medicine, nursing and health care in general. I for one fell victim to this urban legend until I entered the world of nursing and became entrenched in the ‘real’ world of health care.

We’ve all seen the TV shows. Everything from the ground breaking ER, Third Watch, House, Grey’s Anatomy, Nurse Jackie, Hawthorn, Mercy, Three Rivers, Trauma, etc. The list is endless. I’m talking about health care in general – not specifically medicine, or nursing, or ‘hospital’, ‘pre-hospital’, etc. I’m just talking about anything ‘medical’.

Yes, I’m well aware it’s all about TV ratings. Yes, I’m also aware that you need to ’sell’ the audience on the plot of the series or episode. But, sometimes Hollywood medicine is so ‘out there’ and so far from the truth that it’s mind boggling. I think what leaves me speechless and slightly angered is the notion that John Q. Public actually thinks what they see on TV or in the theatres ‘must’ happen in the real world. When they enter the hospital, or the ambulance, the ER, the ICU, etc they will be experiencing exactly what they saw! My fellow health care professionals and I have to do ‘damage control’ quite a bit by dispelling the myths and propaganda.

I thought I’d share with John Q. Public some of the frustrating falsehoods that are misrepresented out there in Hollywood medicine. I apologize how random this may be.

• No, the doctors do not come to your bedside and draw your blood for impending surgeries. It’s the phlebotomist, or lab technician, or even a nurse.
• No, most patient’s who have brain surgery or multiple surgeries in one sitting don’t wake up talking after they ‘recover’ with no oxygen! Most can remain sedated or still have a breathing tube in place for patient safety. At the very least -they won’t be carrying on full conversations immediately after surgery (especially if it’s a 4-10 hour surgery)!
• No, the last time I checked – and in most cases there are far more nurses on a hospital unit than physicians. Not even at the larger hospitals.

4 more Hollywood gaffs, including  bogus treatment of defibrillators…

We should practice what we preach. Or better yet, we should practice what we teach. Patient education is a corner stone of the healthcare profession. No matter what your medical specialty is, no matter what facet of healthcare you contribute to, you teach. You teach your clients, you teach your patients, you educate your fellow colleagues, etc. The list goes on.

Here’s my conundrum. How in the world can you one educate another if they cannot themselves follow their own advice and suggestions??!!

For instance:

How does a dentist educate his patients on proper care of your teeth, if he himself has a mouth riddled with cavities?

How does a respiratory therapist take a ’smoke’ break and then have the audacity to educate a patient on smoking cessation techniques. All the while smelling like cigarette smoke?

How does a personal trainer/athletic trainer educate and discipline his clients and/or athletes on weight loss suggestions and training techniques, when they themselves take the elevator instead of the stairs??

And finally, how does a nurse educate their patients on maintaining and improving one’s health and then during their lunch break they have the nearest fast food burger, take the escalator instead of the stairs and squeeze in a cigarette or two before returning to the floor??!!

I understand the difficulties in time management, overwhelming tasks and uncooperative working environments, but seriously? You wonder why you are always tired, and can’t walk up those flight of steps when I see you drinking a cup of coffee and some sort of Danish, donut, or candy bar every chance you get?

I liken it to a nurse licking their fingers, instead of washing their hands, after cleaning up a patient’s bodily fluids. Or telling a patient the importance of washing one’s hands to help prevent the spread of germs and bacteria, while the nurse goes in and out of all their patients rooms and never even uses a hand sanitizer. (blegh)

Do what I say, not what I do. Right?

What do you think?

‘Practice What You Preach‘ originally posted on My Strong Medicine

Image: Jupiterimages | Photos.com | Thinkstock

I think we all can appreciate the argument. Nurses feel overwhelmed when the nurse-to-patient ratio is extended beyond our means. Not only beyond our means, but also when it borders on compromising patient safety.

That has always been the source of our angst and distress. Having one nurse care for additional patients in a single assignment becomes cumbersome and borders on unsafe. We nurses have always felt that when the ratio increases sooner or late something can or will be missed.

There is of course many details that are involved with nurse-to-patient ratio assignments. The most important of them all is the ‘gold standard’ acuity level of the patient. How ill (sick) are they. We some how have transformed a patients’ illness into a classification system? You of course have your general medical floor patients (med-surg), then your telemetry (monitored) patients and then the critically ill (intensive care) patients. And with each of those classifications you are further delineate into how ‘severe’ each is. I won’t tie up this post with all the measures I’ve come across that evaluate and ‘classify’ how sick a patient is according to whomever has created the classification. It seems these classifications differ by state, by facility, by administration, etc, etc. It’s quite exhausting.

Here’s my beef.

How can we ‘classify’ a patients’ level of acuity? In my humble opinion some of the most stable and ‘healthy’ patient’s require the most amount of time and nursing care? I mean that what it boils down to – manned work hours right? I know there is some sort of ‘formula’ out there that crunches a bunch of numbers to evaluate and decide what the ‘appropriate’ nurse-to-patient ratio is. How the heck does that make any sense? Just because the patient isn’t critically ill does not mean you will be providing any ‘less’ nursing care.

In the end it’s the patient’s who suffer. We nurses have always put up the good fight in advocating for our patients. I think we can all agree we never have an ‘enough’ time. We always want more time to provide that optimum care for our patients- but when you are overwhelmed with call bells, phone calls, responsibilities, etc time just slips through your fingers.

My ‘rant’ was fueled by a recent study that researched the new state law in California. Does the new mandated minimal level of nurses on duty have an impact on patient outcomes? Study Suggests a Lighter Load for Nurses May Aid Patients – NYTimes.com

Researchers concluded that 225 hospital deaths in New Jersey, or 13.9 percent of all deaths in general surgery, and 200 deaths in Pennsylvania, or 10.6 percent, could have been averted with rules similar to California’s.

It sure is one heck of an argument? Don’t you think?

Thanks,
Darlene

Dear Darlene,

We all feel your pain. I myself created my own worksheet out of sheer want and need. In the beginning of my career their wasn’t a ‘template’ for me to us. I was on my own. Then when I worked in the Trauma ICU they offered an assessment template we could use for report, but it didn’t have much function during the hour-to-hour functioning during your day. Each nurse has their own ‘way’ of organizing their day, their responsibilities, their duties and their tasks. For the most part, a lot of our ‘tasks’ are the same every day and every shift (checking labs, meds, the MAR, etc), while others are patient specific depending on their medical needs and challenges.

I’ve seen some old school nurses use the little drawing to record their patients’ labs, I’ve seen flow sheets used and I’ve even seen a worksheet that is broken down into every hour of your day or shift. I personally believe it has everything to do with the environment you work in. Each specialty setting requires such a great variety of information, skill, tasks, duties, etc. I think we can all agree that caring for 12-15 med-surg patients is extremely different then caring for 2 critical care patients.

So with that in mind here is my suggestion to you for creating your own worksheet: Do some mental imagery. Follow your footsteps through a ‘typical’ day.

• What do you do first? How about report – what information is needed and wanted?
• How many patients (on average) do you care for?
• Each patient and their significant information (labs, history, identification, allergy, etc)
• Medication administration – what do you need and require?
• Are their specific nursing responsibilities you are required to perform each shift (12 hour MAR check, orders, I’s & O’s, treatment record, etc)
• Do you tend to ‘carry’ everything with you in your pockets – or do you have your ‘brain’ on a clipboard?
• Do you like or want a checklist type worksheet to help remind you of meds that are due, tests, procedures?
• What about common phone numbers? Or common dosage calculations?

With all that in mind take all that information and write it out on a blank sheet of paper and try to organize it to your liking. I took all that information and created a worksheet using Microsoft Excel. I chose that particular program since I can customize the size, shape and location of whatever I want within the context of the area of paper. Make the worksheet work for you and customize it for YOU.

For me, I carried around my worksheets. It was feasible for me since I took care of 2 ICU patients. I actually used the front and back of each piece of paper. The front of the paper was for my report and at the bottom of the back of the sheet I had 12 columns for my 12 hour shift. I used the columns to help me keep my meds in order as well as notate when I had labs due, blood sugars, record my I&O, scheduled tasks, etc.

Also, some nurses are big fans of the color spectrum. Using a red pen for the ‘emergent’ or important information and then maybe utilizing a highlighter for the pertinent labs or other information that needs to be addressed during your shift.

As you can see your worksheet is up for grabs. You can snip and cut it to your liking. I like to think of it as a ‘work in progress’. Once you start a ‘template’ you always seem to find or discover other things you want to add and eliminate useless information that is just occupying space on the paper.

Best of luck with your creation! I’d be happy to share my worksheet if anyone is interested.

I myself have had 2 reactions to this problem. My first reaction was a defensive reflex. “What do you mean requiring me to wear a specific uniform?” Are you paying for it? What the heck? What’s wrong with what I have been wearing for years?

I can’t say I was agreeing or disagreeing with this, I just questioned the notion. Honestly I have always only worn one uniform color of scrubs. I’ve never been one to wear the patterned scrub outfits (I hate to say it – is it because I’m a guy?).

I also starting having this overwhelming nightmarish vision of nurses being in all white again. Whether good or bad, I really can’t say I ever liked the stereotypical all white uniform, or the cap, or the skirt, or polished white shoes. Maybe it’s just me, but when I see an all white uniform I think of the orderlies who work in the psychiatric ward (yes, I fully admit to watching too much television). I guess I just feel that we as a profession have grown and evolved beyond what that uniform represents. We are not hand maidens, nor are we subordinates. We are independent thinkers and patient advocates who demand and require a great deal of critical thinking skills and knowledge. I despise the ‘I’m just the nurse’ attitude and answer.

So, color coded professions ehh? I’ve learned that the movement to go back to all white, or at least one color is motivated by those wonderful people from Press-Ganey. For anyone that has some familiarity with this program, company and service, they provide a measuring tool for how well a certain facility, profession is doing their intended duties. Patient satisfaction is the cornerstone of nursing, and Press Ganey has become the experts on patient satisfaction. (If you’ve ever been a patient, you get a lil’ survey during or after your stay – asking how your stay was)

So, patient satisfaction scores (from surveys) has informed us that most patients have no idea who is going in and out of their hospital room because of all the multiple outfits, uniforms, colors, etc. Are they a doctor? A nurse? A surgeon? A radiology tech? The list goes on.

It was discovered that patient satisfaction increased when the facility made each department and service have an exclusive color/uniform. When a person in a ‘white uniform’ entered their room – even if they weren’t told, they assumed and knew it was a nurse. This is unfortunately due to the stereotype I talked about earlier.

I for one really hate the all white uniform, but I’m all about providing the best care possible for my patients. While I’m joining the ranks of complaining of solid colored nursing uniforms and the all white persona, how can I / we argue with an intervention that increases patient satisfaction?

I’d love to hear you thoughts on this one.