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shania@shanialynnvo.com

nurse

Covid-19: Misinformation Kills; All about Vaccines

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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)

*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

Crash Carts and Comfort Measures

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How does one determine the end of another’s life? How does one know when the best option is really to let nature run its course and allow the body to naturally shut down? When do fervent prayers for a miracle need to be shifted into prayers for hope, strength, and healing in the years to come?

Questions like these are frequent in the hospital setting. Many patients come in for a slight pain or elective procedure and are diagnosed with terminal illnesses. Some never leave the hospital and others are readmitted shortly after discharge. Many patients do not fill out advanced directives before terminal events, making family decisions challenging and burdensome for the appointed surrogate who must make the above decisions.

Imagine a middle-aged woman being diagnosed with metastatic, stage IV cancer. She is a “frequent flyer” back and forth from the hospital to the nursing home. She is “call-light heavy” and asks for minor things every thirty minutes such as her pillow fluffed, right leg moved in the bed, or to be pulled up a couple more inches to the top of the bed. Then, imagine family issues as she has no advance directives, is borderline confused, and the family disagrees on the plan of care. It is a disaster.

Now, the patient has returned, each time getting progressively weaker and lethargic. She doesn’t call as much and staff is concerned because we know she is far from her baseline. Her prognosis, originally at one year, now at only a few weeks.

Discussions about hospice and comfort measures were repeatedly getting declined by family. The patient remained a full code as she was actively dying with her respirations becoming slower and labored, blood pressure in the 70s systolic, level of consciousness decreasing, and PO intake next to nothing for several days.

Nurses would sit outside of her room with a crash cart just watching her breathe and observing the fluctuating O2 sats. We realized at the end, that her family did not want to be the one to make the decisions about neglecting CPR and opting for comfort measures. Eventually, the doctor strongly encouraged and at roughly 14 days inpatient, actively dying, the patient was transitioned to comfort care.

This is not a story of simply ordering a DNR/DNI because staff didn’t want to participate in a code; it was a matter of the patient being under serious trauma and probably wouldn’t survive CPR alone, let alone intubation for the prolonged future. Media often portrays a false sense of CPR effectiveness and does not consider the trauma that comes along with compressions, defibrillation, and subsequent ventilation. In-hospital CPR survival- discharge rates on average are roughly 25% according to the NIH. The patient was dying, but her prognosis was originally set for several more months and the family kept repeating that “she had more time.” They held on to this hope in the midst of the patient’s rapid decline.

Speaking to patients about advanced directives before they are in these situations is so important. It was heartbreaking following this case for weeks with no progress and false hopes.

Until next shift,

Shania

The rise of Delta: not the airlines.

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Due to a high number of unvaccinated individuals and anti maskers, hospitals are now hit with a second covid-19 surge. I, as well as many other nurses, have experienced the nightmares of covid returning as beds are full, patients are sick, and staffing is strained.

The Delta variant is now the major strain in the US. It is about 2x more contagious and transmissible than the original covid-19, meaning that one infected person can infect upwards to 5 other people. Those who are unvaccinated including children are most at risk for infection and hospitalization.

Loss of taste and smell are less common with this variant and typical signs are symptoms resemble that of the flu including headache, sore throat, runny nose, and congestion.

Even with the variant, vaccination prevents 88% of people from having symptoms and 96% of people from ending up in the hospital.

Take home points:

Get vaccinated!

Wear a mask in public places.

Prevent the spread and help the strain on the hospital system.

Until next shift,

Shania

Time, Talent, Treasure

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From a young age, I always valued the concepts of time, talent, and treasure. These three qualities make or break a person’s life and I evaluated them within my own life in order to be successful and to be in a continuous state of growth.

  1. Time is such a valuable resource in the sense that you cannot get it back; it only keeps moving forward. Where you invest your time determines your future. I stated before in previous posts that my biggest fear is wasting my time on things that are unnecessary. Therefore, I make an effort to use my time for productive things, whether that is learning, growing my business, calling my grandmother, going to the gym, cooking a meal, or even watching a show I enjoy.. anything in moderation. I often make a to do list for every day and this helps me stay productive and make sure that I am making the most out of the time I have during the day. Atul Gawande wrote a great book on this topic, The Checklist Manifesto. I highly recommend!
  2. Talent. Talent is tricky because this is where your life purpose or passions come in. It is amazing to me how many people just settle because they don’t want to go out of their comfort zones, experience new things, and find why they are actually here on Earth. A talent isn’t just some child prodigy who wins America’s Got Talent. Talents are the unique qualities and interests that each person has. I enjoy people and helping people live healthier lives, therefore, I became a nurse. The stress and anxiety that comes with working in the hospital allows me to realize that I am not meant to stay in the hospital forever, at least not as my sole income. I also know that I have always loved acting and I am at a point in my life where I can actually pursue it professionally, alongside my nursing job. Talent is what keeps me motivated and reaching for me. As Ronnie Doss says, the comfort zone is the danger zone. It is dangerous to remain stagnant in life and never reaching for more.
  3. Treasure. Where your treasure is, there your heart will be. Look at your bank statements. Other than bills and living expenses, where do you spend the majority of your money? This reveals what your priorities are. Many times this money goes to food, alcohol, coffee, or toys. What about if much of it was invested, donated, given to others? It is important to be conscious where the excess is going and to monitor the outflow. Money is not inherently bad. So many great things can be done with proper funding. It is how money is used that can lead to trouble.

Where are you investing your time, talent, and treasure?

Until next shift,

Shania

RN Residency

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What did nursing school actually teach you? Are you ready to start caring for patients right out of school? Did the NCLEX really prepare you to be a bedside nurse? Probably not. Most nurses right out of school feel like they did not learn anything and have no idea what true nursing actually is. It is always so surprising that such a rigorous 2-4 year nursing program is so textbook-focused with such a small percentage of time actually at the bedside. Other careers actually prepare students to begin working right out of school- Doctors have a residency and fellowship for years, physical therapists have months of clinical experience before graduation, etc. Many nursing programs only have one clinical per week with the rest in nursing labs or lectures in the classroom. I definitely did not feel prepared after graduation to actually be a nurse. I had such a great knowledge base, but struggled to put all that knowledge into practice at the bedside.

One of the most important factors into considering what to look for in a first job is a residency program. Residency programs involve all of the new graduate nurses and equip those nurses to be confident and competent at the bedside. The program I completed 4 years ago was recently re-accredited by the ANA and I was so thankful for it. I will detail the aspects that was presented within my residency program:

  • one year in total; 1 session/month
  • Skills day- the first session was all about learning and relearning the specific nursing skills required for the job in your unit utilizing the specific hospital’s policy and supplies
  • Disease processes- relearning the different core measures and refreshing on different patient diagnosis
  • Mentorships- Experienced nurses have the opportunity to mentor the new grads
  • Evidence based practice- complete an EBP project on a topic of our choosing and present it at a hospital-wide EBP fair

These are just the highlights of my residency program, but it is so worth the extra time and effort to know how to be a great nurse.

Until next shift,

Shania

(W)holistic Care: One day at a time.

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When patients arrive to the ER, they present with a “chief complaint”, or the reason that they came to the hospital. We, of course, identify the problem and treat the diagnosis based on evidence based practice. But, we don’t just stop at the diagnosis, nurses identify other needs and even warning signs. We ask about a safe home environment, access to medications, assess health literacy, and even screen for suicidal ideation. This is called holistic care, or treating the whole person rather than just their chief complaint.

Holistic care involves ensuring each patient has the capability to understand their medical history and have access to the resources they need to stay healthy. It is easy to document that the patient refused or is noncompliant, but often their reasoning is quite innocent. Asking questions, and more importantly listening to our patients provides so much more useful information that helps to tie up their story. Doctors are often in and out of a patient room within 15 minutes (if that). I have seen doctors simply ask the nurse how the patient is doing without even laying eyes on them theirselves. Nurses have the opportunity to thoroughly identify each patient need and educational level.

Holistic care can be overwhelming if the patient requires many resources or additional time for teaching. I often remind my patients to take it one step and one day at a time. It is too much to think about everything that needs to be fixed or mended. Start with day one and one change then gradually add in additional disciplines. It all starts somewhere.

Until next shift,

Shania

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615-856-8181
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