Nurse Practitioner Procedures Class This Semester

These are some of the things that I will be learning this semester. I can't wait to get started. This stuff is extremely interesting because I like "to do things". I've already gotten a few things done in the ER last semester so I'll be ahead a little.

1. Basic laboratory microscopy
2. Basic and 12 lead EKG interpretation
3. Suturing and wound care
4. Cryosurgey and punch biopsy
5. Interpretation of primary care X rays
6. Splinting and casting techniques

I'm also taking NP II this semester. We will be covering in depth..

Neurology, Psychiatry, Constitutional Diseases and Oncology, Infectious Disease/HIV, Hematology, Respiratory, Cardiac, Urology, Gastrointestinal, Rheumatology, Endocrinology, and Women's Health.

The focus this semester is disease process and diagnosis. I look forward to cramming even more into my poor brain.. I'm also going to be working on two thesis hours. 8 more months to go!!

Go See the Best of Nursing's Change of Shift!

Click on the Change of Shift sign to enjoy this installment of the best of nursing's Change of Shift at Emergiblog!

Check out my attempt at E-commerce

In an effort to pay for some of my schooling, I have put ads on my blog obviously. I thank those who have supported my efforts.

I am playing with another endeavor at Squidoo making it my new NP store. You can go there to find Amazon, Cafe Express, The Superstore, and of course, Google Adsense ads.

I have made a "store" at my other place.

I have done pretty well from Amazon and Google Adsense ads. Not enough to quit my job, but enough to pay for a few books. I know we can't go running around revealing just how much or Google gets a little mad, or so I'm told.

How do you supplement your schooling etc? Anything better than others? All of you lurkers out there need to chime into this one!! (Smile)

An Important Note Regarding Communication Between Healthcare Providers

After reading Kim's post at Emergiblog regarding this subject, I decided to rehash an old entry of mine about the same issue. This is a very important issue in healthcare because it involves the care of patients. A nurse who can communicate to NPs and doctors well can save a life. Many times it's like crying wolf. If a doctor has been called with "stupid stuff" too many times, they won't listen to the important things.

April 2005
Recently, I attended a meeting at our hospital and one of the discussions was "preparing yourself to call a doctor on the telephone.." (A dreaded thing to most nurses.) I have had varying successes in this endeavor. The obvious problem is calling unprepared with all of the important information in front of you. Nothing is worse than being called from a patient's room in the office to try and give orders to an unprepared nurse. So, I decided to try and come up with a plan for new nurses and some veterans in order to ease this tension...

Ask a veteran nurse (after explaining the details of the problem) whether or not it's worth a call to the doctor. Use other's expertise!!! Often, we have already seen this problem many times before and can tell you what to do first.

Try my new acrynoym.. GYST (pronounced jist... which stands for "Get Your Shit Together... this of course means... a current set of vitals, the chart, a list of current medications, exact symptoms, etc...
Nothing is more irritating to a health professional than getting called out of a room to try and answer a question about a patient with little or no pertinent information. Being called out multiple times is some of what increases your wait time in the waiting room.

According to the studies, they say you have about 7 seconds to hold a person's attention, which means about 5 for medical professionals. We have very short attention spans and rarely tolerate wasted time. This is due to having to juggle several physical and mental tasks at one time.

I have been hung up on numerous times as a nurse. This is extremely rude by the doctor. My solution is to call them right back and say "I know we must have been disconnected because I know that you didn't deliberately hang up on me.." This often jolts some professionalism back into play.. If not, I let it roll off my back. I don’t take things personally unless a doctor deliberately makes a personal attack.

To sum things up; please make sure that you are prepared when calling health professionals. It makes things easier all around. It also helps keep our standards of professionalism higher in the doctor’s eyes. It’s hard enough out here to care for patients with the workload without the battles between the caregivers..

Carry on troops!!!

Toot! Toot!

I'm sorry.. I know people aren't supposed to toot their own horns but...

I got my final grades today for the semester and by the skin of my teeth made A's in both classes. I'm so glad this semester is over! I get to pleasure read for a few weeks. A little relaxing time, justly deserved.

NOT!

Now I have an abscessed wisdom tooth! ARGH!!!! At least it waited to flare up until my finals were over. I can't get it pulled until the 21rst and am on antibiotics in order to get the horrible pain in my jaw to subside a tiny bit..

Sometimes I wish that I could just pull them all out and get plates. My mother lost her teeth early to a gum infection when she was about 40. She said that she never regrets having dentures. I don't like the color of my teeth and have said that as a graduation present to myself would be to get them whiter and more healthy.

I HATE going to the dentist. It's a white knuckle ride for me every time. I had a horrible experience as a child and it scarred me for life. 4 molar fillings with NO anesthesia, not even a shot of novacaine. Talk about torture! The assistant told me that if I cried that she would slap me! I told me mother about it after we left the office and I didn't go back to the dentist until I became an adult. I had to take Halcion in order to get a root canal.

Now that's good stuff! The dentist told me that I wouldn't remember even being in the office. I didn't remember a thing until my husband pulled me out of the car into the house. My children all stood by guffawing while one of my legs drug behind me like a drunken sailor. My oldest son called and I don't remember what we talked about but it must have been hilarious.

I am on the waiting list for Tuesday in case someone chickens out (oops.. I mean cancels an appointment).. Wish me luck!

Stick to the subject please!

I just took my Pharm final today and was aggravated by all of the questions that should have been on the OTHER test.. They weren't pharmacology questions!!
Word of advice to instructors out there... STICK TO THE SUBJECT OF THE TEST!!!!
ARGH!!!!!!!!!!!!!!!!!
Off to take the APN 1 test and I'm SURE that I will see Pharm questions mixed into it as well....

This is just like me!

Two-Minute Job

By Elizabeth Bussey Sowdal, RN

I go into a patient’s room with a specific task or three to perform. I want to give the morning medicines, do a dressing change and chart vitals.

In the process of giving the morning medicine, I notice that the IV tubing needs to be changed. I do that quick job, it only takes a few minutes after all, and, since I am right there anyway, I untangle all the monitor cables.

As I finish this job the feeding pump beeps and, since the bag is empty anyway, I decide to change the feeding tubing. As I start to connect the new tubing to the enteral feeding tube, I notice that it has slipped out a bit and must be replaced. No sweat: 2-minute job.

I explain it to the patient, remove the displaced tube, teach the patient about what comes next, and place the new tube. I check placement, call for an x-ray and comfort the patient.

Done. On to the dressing change…

But if I am going to change dressings anyway, I might as well get the bath out of the way, too. Besides, it will help the patient to feel better to have a warm bath and a little attention after the feeding tube placement.

And you cannot give a patient a bath and leave him on old linen. Plus, he will need fresh pajamas, a shave, help with his oral care. He might have a story to tell me after all of this, and that might remind me of a story to tell him. By this time he has more medicine due. But his IV has infiltrated. No sweat: 2-minute job.

Only it never, ever takes just 2 minutes, does it?

I spend more time than I really need to spend looking at the patient’s veins and reassuring him. It’s bad enough to be in the hospital and to have to be stuck and prodded and rolled and all, without having your arm flopped around and jabbed at like it isn’t connected to a human being.

So that 2-minute job takes 10 minutes. But when it is over, we are both happy and minimally traumatized.

Next I have to DC the old IV, maybe bring him a warm pack, dress both sites, date and initial the new one.

Finally, I am done for a little while. Now it is time to get my charting all caught up.

I leave the room, and just as I reach for the flowsheet, someone asks me to come and help them. Off I go to help with a linen change: a 2-minute job.

Only, if we are bathing part of the patient, we might as well bathe the whole patient. Since we are there, we might as well do wound care. And since there are two of us in the room anyway, it is the perfect opportunity to change the ETT tape. Done and done!

Time to chart...

As I leave the room, I hear my other patient’s call light. I go in, help with a bedpan, tidy up the room a little while I’m waiting, and then help her off the bedpan. Of course, I spill it. I always do.

I have helped one million and seven people get off the bedpan and the only time I have not sloshed it was when it came out empty.

So… bath and linen change.

One thing leads to another and I am not out of there for 30 minutes. But, now that my second patient is all squared away, I have time to chart on both of them before anything else is due.

I get both flowsheets, both charts, dig in my pocket for my jotted notes and sit down to document. At this point, the charge nurse comes to find me.

The visitors in my first patient’s room would like to see me. They tell the charge nurse that they have not seen a nurse all day. All day being the 30 minutes they have been there.

But that’s OK.

Two-minute job.

Then I will have time to chart.

Elizabeth Bussey Sowdal is a trauma ICU nurse and writer based in Oklahoma City.

This is soooo me at work! I'm sure that most will agree that it sounds like you as well. I get interrupted several times a day while trying to get one thing done. Nursing is all about multi-tasking. One day I will write down everything that keeps me from doing my nursing job and I'll post it.. My final exams are tomorrow for the semester and then some free time from the books for a couple of weeks. WHEW! Thanks for all the support and well wishes!

What a Relief!

Well everyone, I made it through this semester's clinicals. My instructor stopped by for my my evaluation and I'm waiting for my clinical grade. I think I did pretty well. My weakness is Pharm.. I'm used to acute inpatient orders and have to back up my thinking to the non-acute mode for the office.

I got to put in five stitches in a patient's lower leg for my last hurrah this evening. It was pretty cool and he didn't mind my practicing on him.

I'm studying hard for the finals at the end of the week and then I'll be off from school for a couple of week, not from work though. I REALLY need a vacation. One can hope for later!!

While you're at it, enjoy Change of Shift!