Hold My Hand

Have you ever given someone a bath?  Not just a child, but a grown adult, an elder, a person that can no longer care for their body but still is valuable, still has breath and heart and thoughts and a worthy soul...these are the bodies that need bathing as well.  

I remember once I bathed a woman in her nineties who had been particularly difficult to get along with.  She was in the hospital (obviously) and was battling a gut disease that was taking over her life.  I gathered the necessary supplies, dipped the wash cloth into warm water and began to bathe her.  I washed her face first, then shoulders, arms, legs.  Slowly, as I bathed her, she began to relax and settle, her eyes closing.  I helped her roll onto her side and began to wash her back.  I thought about the life she had led that required this particular back.  A once-strong back that had served a still-strong lady. A back that washed clothes and cooked meals and supported the births of five children.  I dried her off and got her comfortable again in bed with fresh linens and a new outfit.  I combed her hair and braided it gently.  And then I left.  

I wish I could tell you that we had a magical bond after that and she became suddenly pleasant and nice.  I wish I could tell you that my bath healed her stomach and she left the hospital skipping the next day.  The truth is that she was sick before her bath and she was sick after the bath.  But I realized something then, that perhaps I had known all along.  

I truly believe that the purpose of life is to help others. I know for sure that my God takes joy in the helping hands that reach out, the kisses given, the hugs received.  I know for sure that I made her life better, even if just for an hour or so.  Everyone is beautiful.  Everyone belongs.  They may not always be thankful, but we do it anyway.  There are things much, much more important than your makeup or your outfit or your car or your phone.  I fall into the trap of materialism sometimes, and honestly, I'm never very happy when I'm worrying about those sorts of things.   

I wish that I always had a humble heart.  I wish that I always looked out for others above myself. But I believe in second and third and fourth chances.  

Part of what I miss about being a nursing student as opposed to being an actual nurse is just that quality time that I was able to spend with patients.  As a nurse, I'm busy.  I don't get to bathe people or talk to them or sit and listen to their stories.  Maybe if we looked at souls as a holistic part of healthcare, we would be more successful on a biological level.  It's so easy so see six patients and six med passes and six bedrooms instead of six beating hearts that have thoughts and souls and lives.  I hope I never harden.  I hope I always cry after one of my patients dies.  I hope I always have a hard time explaining a terminal disease diagnosis to someone.  

Mother Theresa:

Being unwanted, unloved, uncared for, forgotten by everybody, I think that is a much greater hunger, a much greater poverty than the person who has nothing to eat.

If we have no peace, it is because we have forgotten that we belong to each other.

Even the rich are hungry for love, for being cared for, for being wanted, for having someone to call their own.

The hunger for love is much more difficult to remove than the hunger for bread.

One of the greatest diseases is to be nobody to anybody.

All Purpose Skin Salve

This is hands down my favorite salve to make, and the one that my friends all go crazy for.  I usually don't have any left for myself!  It's simple, really, after making the herbal oil.  To make a salve, follow these more detailed instructions here: (Click me!)

All Purpose Skin Salve

Lavender Flowers

Calendula Flowers

Rose Buds

Lemon Balm

Comfrey

Carrier oil like almond oil or extra virgin olive oil 

1 ounce of beeswax

Lavender essential oil

Containers to pour the salve into

Instructions: Create your herbal oil and let it infuse for six weeks in a sunny window.  Then combine one cup of the strained oil with one ounce of beeswax.  Add ten drops of lavender essential oil and pour into your desired containers.  This salve is magical for cuts, scrapes, bruises, bug bites, stings, rashes, itchy skin, dry skin, eczema, psoriasis, sunburns, and other skin-related issues.  I use it for my lips, too.  

Moments in Nursing/Keeping It Real

Nursing is taking care of an adult with stage four cancer and his (very) elderly father coming to you and asking, with tears, in his eyes if his son will ever leave the hospital. 

Nursing is having the son in law of a dying man ask you why the strongest man he knows is so weak now as he punches a wall. 

Nursing is holding a sobbing woman in your arms after her husband was just diagnosed with cancer.

Nursing is getting an unsatisfactory customer report because you didn't bring antacid medication quickly enough.  They don’t know that one of your patients ripped out his IV in a confused fit at the same time and another was running a fatal heart rhythm.  And you can’t tell them. 

Nursing is being spat on, cussed at, kicked at, bitten, yelled at, misunderstood, and abused by patients, but more often, the patient’s families. 

Nursing is realizing an ordered antibiotic will cause an anaphylactic reaction in you patient, and getting yelled at by the doctor when you call to tell him he needs to prescribe something else.   

But nursing is also an amazing gift.  And sometimes patients say thank you.  Sometimes they let you hug them or tell you about their lives.  I never feel ashamed to tell people what I do.  I’m a nurse.  I belong to a vast group of others that also care and there are always, always nurses working at hospitals around the world.  We know your history, your medications, personalities and quirks.  We provide the care that is prescribes, and more often than not, suggest what should be prescribed.  Because we know you best.  I am your advocate and I’m happy to serve.

Also I get paid.  That doesn't hurt.  Although it is definitely not as much as people think. Just keepin it real.   

Insert obligatory Nurse cartoon here ;)

Herbal Flowers: Lavender

I have a special love for lavender as it was the first herb I ever used with a medicinal intention.  And can you blame me?  It smells amazing, is beautiful to look at as a plant, and gives an overall sensation of pleasure, courage, strength, and euphoria when smelled.  Lavender is capable and powerful as an herb while being calm and gentle at the same time.  The essential oil is relaxing to the mind and can alleviate insomnia, stress, tense life spells, and melancholy.  Internally, the flowers can be drank as a tea or made into a tincture to treat stomach distress and spasms like those associated with indigestion or Irritable Bowel Syndrome.  Topically in oil form or a salve, lavender is antibacterial, anti fungal, and antiseptic.  I often apply it to bug bites, bee stings, or small wounds (cuts, scrapes) to alleviate pain and speed up healing while preventing infection.  Rosemary Gladstar has been reported to use it to wipe down doorknobs or the rims of drinking glasses where diseases are particularly bad.  The essential oil is often called a first aid kit in a bottle, and it can be found quite easily now days.  Think of lavender as your super supportive best friend: calming, uplifting, brave, strong, and ready to go to battle for you. 

I have personally used it with success to treat dermatitis, heat rash, headaches, and melancholy.  I also like to toss it in food whenever apt to foster a peaceful life. ;)

Suggestions for use:

Tea: 2 Tb. in 8 oz water for stomach cramps or spasms

Bath: Essential oil dropped into the water for stress, sadness, headaches or insomnia

Topically: Oil or salve applied as often as remembered for small skin issues like dermatitis, bug bites or stings, cuts, scrapes, rashes, or even sunburns.  

Songs To Motivate You

If I'm being completely honest, I don't love my job.  It sometimes takes a little work for me to get pumped up to go at 6pm and know that I'll be there until 8am.  It definately is not something I want to be doing the rest of my life, but I try to stay positive and realize that I'm exactly where I need to be for a reason.  God has a plan for me and I pray every shift that I can touch the patient's I have in some way and remain tender, kind, and compassionate.  Anyway, these songs help me stay motivated:

One Step at a Time by Jordin Sparks
"It's gonna happen when it's supposed to happen and we find the reasons why one step at a time." 

Stronger by Kanye West
"Work it harder, make it better, do it faster, makes us stronger." 

It's My Life by Bon Jovi
"It's my life and it's now or never.  I ain't gonna live forever."

Beautiful Day by U2
"It's a beautiful day, don't let it get away." 

Stand By Me by Ben E. King
"When the night has come and the land is dark and the moon is the only light we see...No I won't be afraid, Oh I won't be afraid...Just as long as you'll stand by me." 

Eye of the Tiger by Survivor
"Rising up, straight to the top.  Has the guts, got the glory."

Champion by Kanye West
"Did you realize that you are a champion?"

All the Above by Maino
"See me come up from nothing to be living my dreams"

Number One by Nelly
"I am number one!" 

White Willow Bark Vs. Aspirin

White willow bark is a great alternative to aspirin and can provide gentle but still powerful pain relief.  Hippocrates recommended that his patients chew the bark for fever and inflammation as early as 400 B.C.  In 1829 Europe, scientist found that salicin was the active ingredient in White Willow Bark, or the ingredient that causes the pain relieving properties.  However, extracting salicin from White Willow Bark was difficult and time consuming. In 1852 a synthetic form was created called salicylic acid.  The body converts salicin to salicylic acid after being metabolized in the stomach.  This is why some believe that White Willow Bark is more gentle on the gastrointestinal system, because the acidic property of salicylic acid never was meant to be actually present in the stomach.  This acid can cause stomach ulcers and bleeding.  Then, later, Bayer, a German company, called salicylic acidacetylsalicylic acid, or ASA and marketed it as the aspirin we know today. 

I personally take White Willow Bark in the dry leaf form as a tea.  I brew 1 to 2 teaspoons in a cup of hot water for 10 to 15 minutes.  I take around 3 to 4 cups a day as needed.  

I buy my white willow bark in bulk, at about $7 per pound.  I usually buy $1 worth and it lasts me six months or so.  I am lucky enough to have a great chain shop that sells bulk dried herbs, but it you don't this website is well respected and ethical for sourcing your herby needs.  

White Willow Bark

Uses: Pain relief, especially pain caused by inflammation. 

Form: Tea

Dosage: 1-2 tsp. in 1 cup hot water for 10-15 minutes.  3-4 cups per day as needed. 

Things to consider: Do not take if you have bleeding tendencies, as it can thin the blood. 

My herbalism disclaimer: While I have been studying herbs for five years now and am a Registered Nurse with a bachelor's degree in allopathic medicine, I do not know you.  I do not know your special body quirks or how you react to certain compounds.  Please do not use my words as concrete fact and realize that these herbs have traditional uses that work for most.  

Night Nursing, Part 2

Here we go, night nursing, part two! 

Every patient must be checked on every two hours, and charted on.  It is ok to back chart in my facility, so I typically just carry paper and pen with me to note things that I might forget, like pain levels and IV pump numbers (Yes we have to enter these in as well).  If a patient is on a PCA, which is a Patient Controlled Analgesic, or the “Pain button”, I have to clear it out and see how much is left in the machine, how many times they have pushed the button, how much has been delivered to them since the day shift nurse cleared it, ect.   These machines are all programmed specifically for each patient per doctor order.  If they run out, I have to set a new one up, which requires going to the charge nurse for the PCA pump keys and having another RN sign off with me.  I document the things I cleared off on a PCA flow sheet that is kept with each patient’s paperwork.  If my patients are on telemetry, or heart monitoring, I need to call down to the telemetry unit once per shift to see what they are running.  If they are running something unsavory, the battery is low, or if a lead is off, the unit will call up to the floor to tell me.  Then I check to see if I have any medications due at that time.  If not, I can perhaps chart a little, depending on the craziness of the night. 

I might need to admit a patient if I have an empty room, which can easily take an hour.  Then their medications have to come through pharmacy into my computer before I can give them.  If one patient is acting crazy I have to address that.  (yelling, cussing, hitting, confused, not breathing right, chest pain, ect). 

 By now it is about 11pm and I have to run down to the cafeteria if I want any food because they close now.  I am usually one of the last people there.  I put my food somewhere on the floor, usually in the break room, and see if my patients need anything.  Remember, any medication I need is in one of two machines on the floor, and needs to be scanned in, so it is a process.  If any IV pumps are beeping or feeding tube pumps, I need to trouble shoot those.  Around midnight I go grab all six of my patients charts and note my orders with a red pen against the computer.  I do a 24-hour check since I am the night shift nurse.  This means I see what is ordered for the patient and see if it matches what is ordered in the computer, or see if I have done it.  For example, if a patient needs labs drawn in the morning, I have to write for that order in the computer so that lab knows to come get their blood.  Or, if they are having a procedure the next day, it is my job to get the paperwork done.  Then I check on all my patients again and give midnight medications.  You can give a medication 30 minutes before it is due to 30 minutes after it is due.  Then I take the charts back to the main nurse’s station, where the charge nurse is, and put them back into their spots.  Then I try and chart.  I really try to have all my head to toe assessments and 2 hour assessments charted by midnight.  This may seem late to some seasoned nurses, but remember, I am new.  As long as I have physically done the assessments on time, I feel like it’s ok. 

After those things are done, I check on the patients every two hours, give medications through the night, and chart.  At four, labs are drawn and chest X-rays are done.  Sometimes I have to draw the labs, sometimes law workers do it. Also at 4, the intake and output records for the last 24 hours are totaled.  A big graphic sheet is printed out for each patient with vitals and intake and outputs listed, included drains and IVs.  I will go and physically put these in the patient's charts for the rounding doctors to look at during the day.  Everything is available on the computer, but some doctors still prefer the paper charting.  Hopefully at some point I've gotten to eat, but that is rare.  I will check the surgery schedule if any of my patients are going to have surgery that day to see if I need to get some pre-surgical vitals on them.

Around six I usually go wake everyone up and see if they need pain or nausea medication, to go to the bathroom, or anything else.  I look to make sure their IV bags are full and their IVs are still working.  This way the day nurse doesn't get left in a mess.  A lot of medications and insulin are due at seven so I'll check blood sugars.  If something is to be done that day like a catheter pull or dressing change, I'll try and do that too.  By this time, the day shift has come on and I give report.  I usually leave around 8am and go home to sleep.  

Life of a Night Nurse, Part One

I am going to have to break this up because it is quite long and in depth. 

This is what a typical night shift looks like for me:

I arrive at the hospital at 6:50 to swipe in and get my nursing assignment.  Around 7:05 or so I go out to find the day nurse that has covered my patients and get report on them.  Report can vary, depending on if it is my first day in that week or not.  If not, then I do not need a full report unless a patient has been admitted during the day while I was sleeping.  A full report consists of the patient diagnosis, doctors, history, what their IV is running at, where their IV is, any complications, if they are in a lot of pain or experiencing a lot of nausea, if they have any upcoming procedures that I need to get consents for, and things of that nature.  Then, after receiving report on all six patients, together I walk around with the day shift nurse and meet them.  Then she or he leaves and I’m on my own.  

The first thing I always do is log onto the computer charting system and document that I have received report from whoever and that I am assuming care.  This covers the hospital in case something should happen.  Then, if when I was meeting one of the patients they tell me they want pain medication or nausea medication, I will go pull that out of the Pyxis.  The Pyxis is our medication system.  It is one of two big machines on the floor.  You go to it, enter your ID, scan your fingerprint, and find the patient.  Then you pull out whatever medication you need.  It pops open one of many drawers and tells you what pocked the medication is in.  Sometimes you have to provide a count of how many are in the drawer to begin with, especially with pain medications.  Then you take the medicine and log out of Pyxis.  If none of my patients specifically requested a medication, I’ll pull up all my patients on the medication system at my computer and look and see who has 8 o’clock or 9 o’clock medications.  I usually start with the patient that is the most acute or that has a procedure coming up.  I will go pull out their medications and go to their room to begin my head to toe assessment.  I listen to their lungs, heart, bowels, feel their feet for equal pulses, roll them over to look at their skin, look in their mouths, touch them, talk to them, and ask things like, “When was your last bowel movement?  Have you been coughing?”  I also check their IV site and fluids running and their dressing site, any incisions, ect. This takes me about 15 minutes.  Then I scan their medications with a barcode scanner. Every pill, every vial is bar-coded.  Then I scan their armband.  Then I can administer medication.  Some medicines are simple pills but a lot are “IV Push”.  This means that I either draw up sterile water into a syringe, inject it into a vial of powder to reconstitute it, mix it around, re-draw it up, and then push it through a port on their IV tubing over a certain amount of time, or draw up a liquid in the syringe, dilute it with sterile water if necessary, and do the same thing.  Also, some medications, specifically antibiotics, are in little bags.  I hang this “IV Piggyback”.  They have a secondary tubing that fits into a port on the IV pump and have to be separately programmed.  This is just like IV push except it takes longer so I have the pump do the work. For example, Piperacillin goes in over 4 hours.  Obviously I can’t stand there and slowly push in 100 mL over 4 hours.  Some medications, like blood pressure medications or pain medications, require me to input a vital sign.  These have been recently taken by a nurse tech and are written on a paper in the room.  If I am giving insulin or heparin or lovenox, I need another nurse to come and cosign with me.  I pull up the labs to show them that the dose I’m giving is ok, and then scan their ID badge.  Also, if I have given them a narcotic, which I usually do, I have to save the remaining medication to waste with another nurse, unless I use the full dose.  The doctor has ordered what does to give.  After medications,  I ask if they need anything, which they usually do (water, blankets, go to the bathroom), address their needs, and wash my hands and leave.  I do this for all six patients.  This takes me a while, usually a few hours.  I try and give all my medications through ten o'clock during this time.  By the time I can sit down and chart, the first patient needs to be checked on or might need something. 

And The Dead Came Round To Listen

I'm trying to get used to staying up late for work and sleeping all day. Tonight is the third night in a row that there has been a big windy thunderstorm roll into the little town that I live in and I have to admit, it has me feeling quite superstitious. Just now, for example, I can hear tree branches blowing and scratching on my metal porch roof.  Very spooky.

Some of the dinner on my tiny table

 Two nights ago I had a little dinner with a few friends and it was super fun. I made herbed chicken with lemon balm, rosemary, sage, lavender, garlic, dill, onion powder, cracked black pepper, and a little lemon juice. I also made chicken that I pounded out very thing and just marinated in Italian dressing. I marinated baby mushrooms in wine and put them on skewers with onions and the herbed chicken. Then I also made Texas toast, fruit salad, and Mexican street corn. Grilling out makes food taste amazing and it so much easier to do in the summer, despite my trying to light the grill with vicks vapor rub in place of lighter fluid. I hate turning on my oven and heating up the house. My friend brought potatoes for a side and I made very sweet tea. The only way I like tea is if it is medicinal and hot or very sweet and iced. I had so many people at my house that I ran out of chairs! After dinner we sat on the front porch and talked until the bugs became too bothersome in the dark. Then we watched the basketball game that was on. It got pretty loud and crazy, but I for sure and certain did not mind. It gets pretty lonely around here. Part of my favorite section of the night was painting with my friend's little 8 year old daughter, despite getting green and purple paint on my face. She even painted me a picture that I hung on my fridge!

It says, "I love Katie"

I have to work the next two nights, which is awesome because I'll get weekend pay as well as night shift pay.  Hopefully I can sustain this odd schedule!

Memorial Day Weekend and a Note on the Future

This past weekend was nice and the calm before the storm, so to speak.  I went to my parent's house about an hour away and had a small cookout with one of my current roommates and an older couple.  We had burgers and veggies straight from the grill.  This current week, I will be going to new employee days, taking a dosage math test, getting drug tested, and signing contracts.  All just to be your friendly neighborhood nurse!  Then, hopefully this weekend I am moving to my very own little blue cottage before I start my first real, adult-y job on Monday.

Today's plan is to pack pack pack.  I recently stole a stack of boxes from behind the local Walmart and I have about five bins I can use.  This would probably be much easier if I were organized.

I've been thinking a lot about change lately.  Those of you that know me know that I have an aversion to change.  This time around though, it feels ok.  I am staying in the same area so even though I'm starting a new job where I could plausibly kill people accidentally and I'm moving residences, I feel kind of excited.  The dread I feel comes from the initialization of it all.  The process of moving.  The first week of work.  Those things make my pulses speed up a bit.

Something I reflect on:

"For God has not given us a spirit of fear, but of power and of love and of a sound mind."
"The Bible.  2 Timothy 1:7

A picture from my recent graduation