Shania Lynn
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COVID19

Being Grateful for the Little

January 25, 2022 by NurseTwain

. “… The foundation for greatness is honoring the small things of the present moment instead of pursuing the idea of greatness.” – Eckhart Tolle, A New Earth

Last night, I cared for a lady with covid who seemed very down when I first walked into the room. She remained on the phone with family as I tried to speak with her and give her her nighttime medications. I began to get frustrated because she was not acknowledging me as she continued to talk on the phone while I do my assessment. After she took her pills, I stepped out of the room and completed the rest of my med pass.

Throughout the night, I checked on her every couple of hours to make sure she didn’t need anything.

At the end of the shift, I rounded my last time and she asked me to bring her a piece of paper and to write down her care team for the night. I brought her the paper and she looked at me with tears in her eyes and said, “you are my favorite. You are the first person that has come in here to check on me multiple times.”

That broke my heart for a couple of reasons.. First, from our first impression, I was not going above and beyond to make her happy since we did not develop a connection due to the initial lack of mutual communication. I felt almost guilty because I shrugged off her persona since she wasn’t wanting to talk with me when I was in the room. Second, Something so simple as to walk into the room to check on a patient should not be so unheard of. This patient so greatly appreciated the human interaction that she wanted to recognize us for simply caring for her.

These covid patients are locked in their rooms for days and unable to see family. Oftentimes, nurses are the only people they physically see while they are in the hospital and it is at those encounters that we can provide the encouragement they need to get better.

Don’t forget the impact that little acts of care and kindness can bring.

Until next shift,

Shania

Filed Under: patient stories Tagged With: COVID19, hospital, medicalsurgical, medicine, nurse, nursing, patient, patientstories, patienttalk

Nursing Tidbits: Insights from an Inpatient Nurse

January 10, 2022 by NurseTwain

Has anyone told you “don’t do it” or regret that they became a nurse?

  • Did you know that the national turnover rate currently is 8.8-37%, costing hospitals up to $56,000 per nurse according to NSI Nursing Solutions?
  • Nursing is a very stressful job especially in inpatient settings, however nothing is more fulfilling than pursuing your calling. It is important to focus on the “why’s” of becoming a nurse and keeping a list of positive patient stories, in order to remain at the bedside.

How long are actual nursing shifts?

  • Typically, 12 hour shifts. Actual times may vary, but most common is 7a-7p and 7p-7a. Actual clock in time is 6:45 a/pm and clock out is no earlier than 7:15 a/pm.
  • We get two 15 minute breaks and one 30 minute breaks. In reality, we are lucky to get a full 30 minute lunch.
  • My facility limits hours worked in a single shift to 16 hours.

Are raises common?

  • Many hospitals promote annual raises based on a yearly appraisal score. This is a point-based system in which rates performance and quality and then based on your score, your hourly rate will raise by a percentage.
  • Raises can also be given based on credentials. Oftentimes, a certification, higher degree, and more experience will pay more.

Do I have to be a bedside nurse?

  • There are many many nursing jobs that do not involve direct patient care. A nursing license can allow you to work in case management/ discharge planning, nurse educator, Quality, clinical nurse instructor, insurance companies, law firms, office jobs, and so many more!

Do I have to start on a medical floor?

  • I highly recommend beginning on a medical unit for your first year as a nurse. It is not required, but it is a great area to hone all of the skills you worked tirelessly for in nursing school. You also see a huge variety of different cases and learn time management skills.
  • It is not required, but starting out on a mother baby unit for instance will not allow you to perform certain nursing skills and you can lose them if you don’t use them!

How do I prevent burnout?

  • The most important way to prevent burnout and promote a healthy work-life balance is self-care. This can include exercise, a healthy diet, sleep, or any hobbies not medically related that you personally enjoy.
  • Overtime is great to an extent, but it is not something that you want to do every single week if you can avoid it.
  • If you notice you are overly anxious before a shift, connect with a mentor, your nurse educator, or even a licensed therapist to talk about your concerns. Sometimes, just talking to someone can do wonders!

What is something that surprised you about the hospital before clinical rotations?

  • I never had clinical experience in a hospital setting besides volunteering before I started nursing school. I was very naive when it came to actual patient care.
  • I was terrified to even take vital signs. I highly recommend a student nurse externship and tech position.
  • I had never seen a naked man prior to nursing school.. You can only imagine lol.
  • I didn’t realize people were placed in restraints if they became unruly.
  • I didn’t know bed alarms were a thing to prevent falls.
  • I didn’t even know we gave patients a bath in the hospital.. It makes sense, I just never though about it.

Do you have any patient stories that immediately stick out to you?

  • My first ever shot I gave was to a screaming elderly man in a nursing home.
  • I cared for a patient who had necrotic fingers.
  • My oncology patients are the ones I connect with the most.. I followed one lady from the time of her diagnosis until her death from multiple myeloma. We brought her downstairs to play the piano one time and I still watch the video her daughter shared with me.
  • The first hospice patient I ever cared for was also a man in his 50s with raging cancer. He was yellow and looked like a literal skeleton. He and his family were so kind. After he died, his daughters showed me what he looked like prior and he looked like a completely different person. I went home and cried that night.
  • My worst Covid case was a 60 year old woman. She was maxed on optiflow plus a nonrebreather. She kept saying how she didn’t want to be intubated and wished she got the vaccine. She was also so lonely, so I sat and talked with her for awhile. Later that night, we had to transfer her to a step down unit, during the transfer she crashed and her O2 was in the 40s. She was placed on bipap and recovered then, but she eventually died in the unit while intubated.
  • Most recently, I cared for a nurse in her 40s. She developed a psychosis after Covid and was a completely different person.. That one hit home.
  • SO many more…

Until next shift,

Shania

Filed Under: patient stories Tagged With: COVID19, hospital, medicalsurgical, medicine, nursing, nursingadvice, nursingfaqs, patient, patienttalk

The Great Resignation: Nurse PTSD

January 6, 2022 by NurseTwain

They say cardiovascular disease is the “silent killer”, but did you know that many nurses post Covid are suffering from the silent killer of PTSD?

During the peak of Covid, frontline staff were plunged into a plethora of uncertainty. No one knew what Covid was, how it effected the body, what the disease process was, what type of isolation was appropriate, etc. Then came concerns over PPE supply, vaccination status, and most recently, questionable CDC guidance. Nurses lived in a constant fight or flight response as they obsessively watched O2 monitors and prayed for an uneventful shift. The Delta variant proved to be brutal and rampant as more patients were intubated at bedside and transferred to the ICU than many of us saw in our whole nursing careers combined. These patients were so sick and everyone was so critical that nursing had to prioritize patients who were originally healthy and able-bodied, full codes, in order to preserve respiratory equipment as much as possible.

Crisis protocols were in place and meant that we reused single-use PPE and placed a 6L nasal cannula plus a nonrebreather on a patient because we didn’t have enough high flow cannulas. Allow these things to continue for nearly 2 years and now dealing with the third Covid variant, means that nurses are tired and burnt out.

Many nurses are leaving to travel and make more money for the same job duties, some are leaving the bedside and stepping into less stressful job positions, and others are retiring or even just leaving the profession for good.

The struggle we face as a facility and as a nation is critical staffing shortages. Patients will never stop flooding the ER, but what happens when we have no healthcare professionals to properly care for all of these people? More money and incentives are only temporary. A long-term solution involves staff retention and recruitment coupled with staff engagement and empowerment.

Until next shift,

Shania

Filed Under: patient stories Tagged With: COVID19, hospital, medicalsurgical, medicine, nurse, NursePTSD, nursing, patient, patienttalk, PTSD, staffing

Patient prayers

September 15, 2021 by NurseTwain

Every morning during huddle, the off going shift provides updates to the oncoming shift and then we say a prayer to start off the day right. Nowadays, there is less news and more avid prayers.

We pray for peace and healing to ourselves and patients as everyone is emotionally drained.

We pray for unity and strength for both ourselves and patients to fight the unrelenting covid virus.

We pray because it’s all we have right now.

Last Sunday night was such an emotional day. Several patients coded, one died that family was not ready for, 3 patients were placed in restraints.

Nurses spend their entire shifts watching oxygen monitors and running into rooms when numbers drop.

We expand critical care to 3 different floors, place two patients in one room, compromise oxygen supplies because we don’t have enough supply, and we pray that machines become available as patients need them.

Confused patients pull off their masks and some die because of it.

Adults in their 30s and 40s are intubated and will never leave the hospital.

The average patient stay is roughly 10 days inpatient.

Patients ask if they are going to die. Some come in with their family members and are discharged alone.

Right now is not a fun time to be a nurse, so we pray.

Until next shift,

Shania

Filed Under: patient stories Tagged With: COVID19, hospital, medicalsurgical, medicine, nurse, nursing, patient, patientstories, patienttalk, RN

A neverending nightmare

September 2, 2021 by NurseTwain

Shania Lynn The Cure For The Common Read Photo

Tonight was one of the worst nights I have had taking care of Covid patients. Nearly our entire 52 bed unit is covid and majority of them are either on high flow oxygen or optiflow. Patients are now put on a list to transfer off the unit as step down and CCU beds become available.

One of the patients I was caring for, was maxed out on optiflow plus a nonrebreather and interchanging those with a CPAP. This is all while she is at rest. We finally got a step down bed for her and was in transport to her new room when her oxygen dropped to the 40s (a normal being 90-100%, her baseline in the 80s). RT put her on a nonrebreather for transport but it was not enough to sustain her for the short transfer downstairs. We called a code and she was quickly placed on a CPAP continuously and her sats gradually improved.

The CCU charge nurse informed me that there are currently 5 patients among their many covid who will most likely not survive… including a patient in their 30s. All the charge nurses now must keep each other informed of our most critical patients to plan for transfers.

Some patients look terribly sick and others look fine but their lungs are just not exchanging the nutrients needed to sustain their blood saturations. Lungs are often clear with their sats in the 80s or lower. O2 can change from 2L- 15L and higher in the matter of one hour.

I know we are gripe, complain, and beg for people to stay healthy etc., but it truly is a terrible never ending nightmare

Until next shift,

Shania

Filed Under: patient stories Tagged With: coronavirus, COVID19, hospital, medicalsurgical, medicine, nurse, nursing, patient, patientstories, patienttalk, RN

Covid-19: Misinformation Kills; All about Vaccines

August 24, 2021 by NurseTwain

Before I begin to provide evidence-based, accurate information on all three different types of the Covid-19 vaccines, I want to paint a real-time picture for you.

  • If you saw what healthcare workers see every day, would you change your mind?
  • Currently, hospitals are at full capacity and resembling the peak of the previous Covid-19 strain. We are diverting medical cases elsewhere, we are expanding nursing units, we are converting surgical/orthopedic floors into medical overflow units and training non critical care nurses on how to care for critical care patients, we often have to move patients into a different room in the middle of the night to make room for an influx of covid patients, we are losing nurses as patient ratios have increased from a safe 4 covid patients per nurse to upwards of 5-6 because we don’t have staff.
  • The worst feeling is seeing multiple patients in need of a bed, but no nurses to care for them. The charge nurses end up taking a full group of patients and there is no help for the unit.
  • Last weekend, we had to double room two different sick couples, putting even an additional strain on staffing as we still only have 52 beds, not enough to staff those, but now upwards to 54 patients.. it is a nightmare.
  • I have had family members yell at me because “I don’t believe in Covid. I am not leaving the bedside.” Security was called to escort them out of the hospital.
  • I have had family threaten to kill nursing staff if anything happens to their family member. A police report was made.
  • I have had family yell at me because it took 8 hours to get a bed.. Sorry, sir, the hospital is full… Comments like this are ridiculous and I do well to not get myself in trouble.
  • I have had multiple patients crashing at the same and some who need a higher level of care, but there are no beds available, so they risk dying due to lack of critical resources.

So, what can the public do to help? Not call us heroes. Covid is back and just as bad, if not worse than before. Take a global pandemic seriously, wear your mask (at the very least), and get the vaccine if your medical doctor encourages you to.

PFIZER/ BIONTECH

  • FDA Approved
  • 2 doses 21 days apart, Booster recommended for immunocompromised 28 days after completion of 2 doses.
  • 12+ y/o
  • Possible Adverse Effects: injection site pain, allergic rxn, flu-like sx, *myocarditis/pericarditis in young men 12-17 y/o (RARE), syncope
  • Ingredients: Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2, 2[(polyethylene glycol (PEG))-2000]-N,N-ditetradecylacetamide
  • https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Appendix-C

MODERNA

  • Emergency Use Authorization (EUA)
  • 2 doses 28 days apart, Booster recommended for immunocompromised 28 days after completion of 2 doses
  • 18+ y/o
  • Possible Adverse Effects: injection site pain, allergic rxn, flu-like sx, *myocarditis/pericarditis in young men 12-17 y/o (RARE), syncope
  • Ingredients: Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2, PEG2000-DMG: 1,2-dimyristoyl-rac-glycerol, methoxypolyethylene glycol
  • https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Appendix-C

**Effectiveness of both Pfizer and Moderna were very similar with efficacy of preventing severe illness from Alpha (first strain) at 93.7% and Delta 88%. https://www.nejm.org/doi/full/10.1056/NEJMoa2108891

JANSSEN (JOHNSON & JOHNSON)

  • EUA
  • one dose
  • 18+ y/o
  • Possible adverse effects: injection site pain, allergic rxn, flu-like sx, Guillain-Barre Syndrome, CAUTION: Women <50 y/o, risk of blood clots
  • Ingredients: Recombinant, replication-incompetent Ad26 vector, encoding a stabilized variant of the SARS-CoV-2 Spike (S) protein, Polysorbate-80
  • https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Appendix-C
  • Effectiveness: 74.5% Alpha and 67% Delta https://www.nejm.org/doi/full/10.1056/NEJMoa2108891

*Patients will be observed for 15 minutes post vaccination.

*Neither of the vaccines contain metals, eggs, latex, gelatin, or preservatives.

Things to consider:

,We will not shame you for choosing not to get the vaccine, but we do encourage it. At this time, children are not at a risk for serious illness, however they should be vaccinated to protect the vast public. We all need to work together to protect society. Yes, we all have freedoms, but we also have the civic duty as humans to protect our fellow neighbors. Covid is real, rampant, deadly, and why can’t we all work together to resume our pre-covid lives? Let’s be mindful of our actions. Lets continue to mask, get the vaccine, and fight the pandemic together.. Then, we can all be heroes.

Until next shift,

Shania

Filed Under: patient stories Tagged With: COVID19, hospital, medicalsurgical, medicine, nurse, nursetwain, nursing, patient, patienttalk

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