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shania@shanialynnvo.com

nursing

How to choose a great facility

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A variety of sources reveal that on average 1 in 5 nurses leave their first job within the first year of nursing. And some of these people leave nursing altogether. How do you know what facility is right for you? How do you know what facility is “good”? Below I reveal my top few green flags for a nursing facility (based on my own experience).

  1. Friendly work environment- Nurses helping nurses, interdisciplinary communication, etc.
  2. Open communication- Management will not hold any information from staff.. this can come in direct communication, emails, posters, etc. Also, have the ability to speak to leaders when a problem/idea arises
  3. Resources- Can you always find/have what you need to perform nursing duties?
  4. Culture of professional development/learning- Ask about tuition reimbursement, certifications, raises, committee involvement, etc.
  5. Benefits
  6. Ability to transfer specialties
  7. Ratios- Med-Surg averages 1 nurse to 5-6 patients
  8. High patient satisfaction ratings- Medicare.gov posts hospital survey statistics
  9. Nursing recognition- How do they represent/honor the so-called “heroes”? Nursing awards, posters, gifts, spotlights, etc.
  10. How do they prevent burnout?
  11. Scheduling- do you have any say? PTO? Overtime

Until next shift,

Shania

Sample Patients in Medical-Surgical Nursing

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**Identifying patient information has been altered to protect patient confidentiality

Patient 1: 68 y/o male with spinal stenosis and resulting functional paraplegia presents to the ER with abdominal dissension, nausea, vomiting, and diarrhea. Pt was found to have a small bowel obstruction. GI order NGT to low-intermittent wall suction (LIWS) for decompression. The patient also has a history of vascular dementia and delusional disorder. He frequently asks for food, water, and repeatedly states that nursing is starving him. Fortunately, pt eventually had several BMs and will get an abdominal X-ray to assess for small bowel obstruction resolve and hopefully NGT removal.

Patient 2: 75 y/o female is brought in with family c/o AMS. Lab work reveals a UTI and acute renal failure. Both BUN and Cr are critical and does not decrease for several days. CT abdomen reveals possible myeloma. Family does not yet know this and nursing must not reveal these results until oncology confirms.

Patient 3: 50 y/o male comes to the ER with abdominal distention, nausea, vomiting, constipation, and failed paracentesis outpatient. GI attempts EGD and colonoscopy, however pt unable to tolerate Golytely and/or enemas. Imaging reveals a colonic volvulus (twisting of the intestine)- a medical emergency. NGT placed for decompression, as patient continues to vomit. Surgery consulted brings pt for immediate colectomy with ostomy placement. Unfortunately was this patient’s h/o CKD and CHF, pt will likely be transferred to CCU post surgery. Family care during this surgery is crucial as they wait to hear how the pt recovers.

Patient 4: 30 y/o female comes to ER with c/o uncontrollable abdominal pain and ascites. Pain management is the main goal for nursing. Balancing IV pain medication for breakthrough with PO medication along with treating the side effects of nausea and pruritus is the challenge. **Patients with liver failure/cirrhosis are difficult cases as all lab work is often abnormal.. critically low H/H, elevated clotting factors, and elevated LFTs must be monitored.

Patient 5: 75 y/o male presents with abdominal pain, N/V/D. Pt is diagnosed with diverticulitis and will be treated with IVF, bowel rest (NPO), and finally diet advancement as pt tolerates.

**All of these cases are in a single shift. Some days are much easier than others and vice versa. Prioritization is key in these situations.. “Who will die first?” Remember the ABCs and include pain as top priorities. Leave charting for later, and keep all patients informed of rounding times, to limit call lights.

Med-Surg is also funny in the sense that you haven’t performed a nursing skill in a while or a certain skill increases anxiety, and the next shift you will have to perform it. This shift was that for me. I was always nervous around NGTs because they are easy to come out, some are hooked up to suction and others are not, placement must be checked frequently (ph), and patients are always anxious to pull them out. After this recent shift, I am comfortable with them!

Until next shift,

Shania

It’s called Chorea

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A man in his 70s with a history of diabetes mellitus and myasthenia gravis presents with severe, involuntary movements of both upper and lower extremities coupled with uncontrollable nausea, vomiting, and diarrhea. It looked like this man was having a never-ending grand-mal seizure while remaining conscious and not foaming from the mouth. He was brought into the ED after sustaining multiple falls while at home, and was treated with increased doses of Mestinon which caused the vomiting and diarrhea.. we tried to fix the movements, while causing fluid volume deficits.

Myasthenia gravis is a neuromuscular disorder that results in easy fatiguability of muscles, whereas this man was having excitability of all muscles. The neurologist coined these involuntary movements as chorea and attempted to treat with Olanzapine (antipsychotic), Keppra (antiseizure), and pyridostigmine/Mestinon (anti-myasthenia gravis) medications. The MD thought the chorea could potentially be caused by hyperglycemia (I have never heard of this as a cause), which was also a problem during this admission.

I do not know what the ultimate cause of the choreic movements was, but after sleep and medication therapy, the patient was discharged from the hospital with vastly reduced movements and was working with physical therapy the next day.

Until next shift,

Shania

A Faith of Thorns

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I recently had a patient encounter with an elderly woman and the conversation is as follows:

“Do you think God is creating this virus to destroy the world like he has done in the past? Like he is wanting us to learn something?”

(Me) “I think God is good and would not create this kind of destruction. He has said after the flood that he would not destroy the earth like that again. He said that he works everything out for good. He did not say that everything will be good. The enemy is present to kill, to steal, and to destroy. I believe this is not God.”

(Patient) “I grew up in the Church of Christ and do love God. I have lived for over 70 years and never in my life has something like this happened. I just can’t wrap my head around why. Where is God in this?”

I didn’t really know what to say at this point, other than to listen and ponder with her. I know God did not send this pandemic, but I will never know why it has occurred in this lifetime. I have tried to focus on only positive thoughts such as having more time to learn a new hobby, catching up on Netflix, spending time at home, and enjoying the presence of immediate family; however, the energy of the world is filled with fear, anxiety, and isolation.

Jesus describes the purpose of parables in Mark 4 by defining three different foundations of faith:

1. Rocky soil= hear the word, accept the word, but have no root and when tribulation comes, the faith falls away.

2. Thorns= hear the word, however the desires of the world overpowers the faith.

3. Good soil= hear the word, accept the word, and spread fruit (joy, faith, success) in multiples.

I would like to think that my faith has a foundation of good soil. I like to think that my optimistic persona will radiate and disperse the fear that is all around me. However, as I write this post, I feel like my faith is grown in thorns. The stresses and worry of current life are drowning my joy and hope I have in Jesus. In the words of my sweet lady, “where is God in this?”

I don’t know, but I do know that I will find out one day. For now, I will hope for the future as I know this too shall pass. I will continue to find joy in the little things. And I will continue to trust that God is with us.

Until next shift,

Shania

“And these are the ones sown on rocky ground: the ones who, when they hear the word, immediately receive it with joy. And they have no root in themselves, but endure for a while; then, when tribulation or persecution arises on account of the word, immediately they fall away. And others are the ones sown among thorns. They are those who hear the word, but the cares of the world and the deceitfulness of riches and the desires for other things enter in and choke the word, and it proves unfruitful. But those that were sown on the good soil are the ones who hear the word and accept it and bear fruit, thirtyfold and sixtyfold and a hundredfold.””
‭‭Mark‬ ‭4:16-20‬ ‭ESV‬‬
https://www.bible.com/59/mrk.4.16-20.esv

Things I’ve Learned in Quarantine- A Personal Retreat (part 1)

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  1. Staying positive doesn’t mean you have to be happy all of the time. It means that on hard days, you know that there are better ones coming.
  2. Take every day to count your blessings. I have a healthy family, a paying job, a home, etc.. Social isolation began about 3 weeks after the Nashville tornadoes. There were families who lost everything and now had to remain inside a stranger’s home until it was safe to rebuild. 340 employees were furloughed at my hospital, I am very fortunate.
  3. Being alone with my thoughts sucks. My anxiety exacerbates when I am isolated. This led to phone calls, video conferencing, among other activities to stay connected without complete social distancing.
  4. Joy and tragedy can coincide. When I run through the neighborhood, I see positive quotes from children written in chalk. Countless videos have been posted about people placing thank you signs around the hospitals for front-line staff. One of the most memorable videos is from a city in Georgia who stood on their balconies and congratulated nurses as they changed shifts at a highly populated hospital. Volunteers have made masks and donated food to essential workers and those in need.
  5. I love Yoga! A friend introduced me to online Yoga videos and I do at least one every day I am off work. It’s a relaxing work out, forces me to stretch, and allows me to be present in the moment.
  6. I love community. Before all of the forced social distancing, I willingly social distanced myself. It is easy to want to stay home and relax alone without having to worry about the schedules of other people. It is easy to text, call, or FaceTime a friend for social interaction. It is easy to choose to be virtually present for a race, meeting, etc rather than physically being present. But now that virtual interaction is the only safe means of connection, I realize that relationships and community are so important for a healthy soul. Being engaged in the lives of your friends, coworkers, church, group hobbies, and family creates a sense of self-worth. I may not be fully willing to go out of my comfort zone and seek connection, however when I do, I always feel so much better after. The conversations that can be had with people with common interests and those in my daily circles improve my life. Connections and experiences are what is remembered for years to come, not what I gift or create myself.
  7. The rise of telemedicine.
  8. Homemade peanut butter cups are easy and delicious. Not to mention they are great with afternoon coffee!
  9. I have grown more in love. This “staycation” with my fiancé has allowed us to do all of the things we enjoy for multiple days in a row.. morning coffee while reading on the couch, yoga, running, netflix marathons, cooking, and just being in each other’s presence. I was worried about our October wedding (we have been planning for 2 years) not happening, but just going on a big adventure together wouldn’t be so bad.
  10. I have revamped my acting career.. more info to come.
  11. I am the 2020 nursing preceptor of the year.
  12. I ran my first half marathon in 2 hours, 14 minutes, and 32 seconds.
  13. I enrolled in a clinical trial to test the use of plaquenil for COVID prevention.

Terminal Agitation

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Terminal agitation. I have never heard of this term before until my last shift. A patient I had a week ago, who was admitted with a fall, died today after being placed on Hospice care. The previous week, the patient was not oriented to person, place, time, or situation, and was very restless. She was able to communicate, however inappropriately. She constantly wanted to get out of the bed, and never went to sleep. She had dementia and I thought this was a progression of her dementia. I found out on this past shift that this agitation was actually her quick decline to the end of her life.

Another nurse on the floor worked in Hospice care for several years and had a hint that this was terminal agitation. The patient was seen to be picking at the air and stated that she was seeing her late husband. I have never encountered these signs before and contributed them to hospital delirium and her baseline dementia. I could not believe that the next shift I had, was this same patient who was now comatose and passed within 24 hours after transitioning into Hospice care.

Until next shift,

Shania

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615-856-8181
shania@shanialynnvo.com