Just my opinion…

So today an older patient came with his grandson who was translating for him. As the grandson sat in my waiting area while his grandfather was getting his test I witnessed an awkward convo, involving another person it sounded like this:

“He looks Indian!” (referring to the patient)

“Yeah I can see that, we are from Bangladesh.”

“How do you like America?”

“😐…oh I was born here 😑. I’m 21 so America is what I know, but I like it.”

Now, the person asking about where he was from (because he just couldn’t be from here) was an older person. I know that they tend to have a very narrow view of the world. I get that. However, I really hate it when people assume that people of foreign descent weren’t born here. He literally had no accent from any other country. He spoke English as well as any “red blooded American” I have ever met. It’s a bit backwards to me to think that because someone doesn’t look “Caucasian ” or “African American” they just have to be from some other country. We are a country with a multitude of nationalities, that’s what makes things so interesting. I just wish people would maybe think before they speak.

Alpha-gal syndrome

I learn about new disorders all the time here in MRI. Normally I’ve at least heard the name of the disease or disorder before, or I know a teeny bit about it.

I have never heard of alpha-gal. At least, I’ve never heard the name.

Turns out, I have heard of the disorder before. I had a patient once tell me he was allergic to pork because of a tick bite.

Alpha-gal is a “sugar molecule found in most mammals (except in people, apes, and monkeys)” (CDC.gov, 2019). Turns out there is a tick (lone star tick) that can transmit the molecule in blood from the animal to humans. We humans don’t normally make the molecule but apparently we can make an immune response to it. If we develop an allergy then we can no longer eat meat from cow, pork, rabbit, deer, lamb, essentially the animals work hooves! The odd thing about it, and what makes it kind of hard to diagnose, is the fact that the reaction tends to take place 3-6 hours after the ingestion of meat. It’s hard for a lot of people to make the association between meat and their allergic reactions.

I found a good podcast about the disorder. Lots of information about how it works and the ongoing research around it.

One of the things I realized while looking further into the disease is how important it is to ask your patient about allergies. Alpha-gal is uncommon, however, patients with it can’t have certain medications. Heparin is typically derived from pork. Some insulin is derived from pigs and cows as well. There are quite a few medications that have porcine or bovine derivatives. A nurse would have to make sure to take this into account for their patient with this particular allergy.

Then again, when is the nurse not taking safety into account, right?

Safety first

I feel like safety may be starting to take a back seat to profit and productivity. Nursing is increasingly being pressured to move patients from ICU to the floor quicker. Discharge the patient quicker so that another patient can be admitted. Get patients to this scan or that scan faster. It’s not safe.

As a former ICU nurse, I have witnessed patients being moved to the step-down or the floor before they are really ready. Two days later they were back in the ICU do to a decline in the patient’s status. Typically they were in worse condition than they were when we moved them out. As a former floor nurse, I have seen discharges be rushed because they needed the bed for the next admission. Patient education was minimal at best. As a radiology nurse, I am seeing patients come down to MRI that are in no condition to be inside a scanner for an hour. There is a constant rush to get the outpatients on and off the table.

I understand hospitals need to make a profit to continue providing care. I get that we need to treat as many patients as possible. However, when you rush your medical personnel you open the door for mistakes and safety events. I became a nurse to provide the best care I can provide. I don’t see my patients as just a medical record number and a hospital bill. I see people that are here for our help. I see people that are bracing themselves for a potentially devastating diagnosis. I see people that need my care. I don’t like feeling like I have to rush this person through the process.

What happened to the so-called “culture of safety”? When did safety take a backseat to speed? I refuse to place anything before the safety of my patient. So, continue to look at your numbers, your productivity charts, your profit margins. I will continue to take care of my patients as I was taught and give each patient the time they need.

No days off

Have you ever encountered this particular situation,

Them: “Hey, when are you off again?”

You: “Well I am off tomorrow but I…”

Them: “Oh good because I need you to…”

Or my other personal favorite,

Them: “How are you doing?”

You: “Whew, I am worn out! It’s been a long week!”

Them: “How are you always tired, you only work three days a week!!!” 

Seriously? SERIOUSLY?!?!?!?!

Let’s start with the fact that nurses work with people every day we are at work. PEOPLE. Like, human beings… HAVE YOU SEEN OUR SPECIES??? We deal with emotional outbursts, insults, violence, unrealistic expectations, death, etc. ON A DAILY BASIS! It’s not just 3 days, or 4 days, or 5 days, or whatever schedule that we work. It’s the emotional baggage we deal with on days off. It’s wondering if you could have saved that patient if you had done one thing differently. It’s trying to figure out why this one nurse hates you. It’s sitting at home thinking about the child abuse victim that you know will be given back to their parents. It’s thinking about the insults the doctor hurled at you because you weren’t moving fast enough. It’s class assignments due at midnight. It’s the kids having soccer, baseball, and basketball practice the couple of days you have off. It’s 3 weeks of laundry that still needs to be done. It’s a house that desperately needs cleaning because you haven’t had time. It’s never having an inkling of downtime.

It’s constantly feeling like you are walking on a razor-thin edge between success and insanity.

It’s stressful.

The last thing we need is to be made to feel guilty because we are too tired to hang out or because we don’t have time to be someone’s personal errand-runner.

Your days off belong to you. Every single one of them. You deserve to power down. You deserve to do NOTHING if that is what you want to do. You aren’t being “lazy”. You are trying to maintain your sanity. You are not wrong for turning down a night out on the town. You are not wrong for telling someone “no” when they start to come up with your schedule for your day(s) off for you. You are not wrong for shutting out the world temporarily if you need to. You take care of so many people, you deserve to take care of yourself. Nurse yourself back to health. Take your days off and do whatever the hell you want with them.

A nurse that doesn’t take care of themselves can’t effectively take care of others.

 

 

Pacemakers?

My hospital is one of the few in our area that will perform an MRI on patients with pacemakers.

It makes me nervous.

I KNOW it’s supposed to be considered “safe” now. The newer pacers and defibrillators are being made to be compatible with MRI scanners.

It still makes me nervous.

I just don’t feel I should be throwing a person, with a magnet sensitive device, into a giant magnet. I feel like it’s a risk everytime I do it. Is an MRI of the wrist really necessary on this 79 year old man with a pacemaker/defibrillator combo? Like, is this life or death? Are you going to do surgery?

No?

Then why are we taking this risk?

I just don’t like it.

Do any of your facilities perform MRI’s on patients with pacemakers or defibrillators?

“Exceeds expectations”

So, it’s evaluation season. Doing my own eval is uncomfortable for me. It feels like I am tooting my own horn, so to speak. I don’t like talking about myself. I don’t want to sit down and tell you about the great things I’ve done over the past year.

So, I sit down for my eval with my manager… As we start going over each section she tells me the ratings she has given me.

They were all “exceeds expectations”!

What?

I have been a nurse nine years. Every eval I have gotten was rated “fully meets”. I was always content with that. However, for the first time I exceed. My manager started mentioning all the things I’ve done that’s she’s noticed. She gave me compliment after complement for the care I deliver. I honestly didn’t know she paid that much attention. She manages over 100 nurses, she’s always on the move. However, she makes it a point to stop by our department and check in on us. She is always available. To be honest, she’s the best manager I have worked for. To know that with all she is doing, she still noticed my hard work, it felt great.

My actions are not so that I can be noticed. I just do what’s right for the patient. Ultimately, that who we are here for. I never thought I was going “above and beyond”.

It was a great feeling.

I’m in the right place. I’m definitely in the right place…

Does nursing education need an update?

I am going to share my thought on nursing education:

The way nursing teaches feels like it’s 20 years behind.

There, I said it.

What we are teaching our students and how we are teaching them is outdated.

I graduated with my Associates in nursing almost 10 years ago. Why in God’s name did I have to calculate drip rates? Not once in my almost decade of being a nurse have I EVER had to calculate a drip rate! In fact, most hospitals prefer meds to be given through the IV pump to help avoid mistakes in how fast an IV medication is given. Another thing I learned in school that is absolutely obsolete is how to give the “perfect” nursing bath. Let me just tell you that the bath you are taught and the bath you will be given are not the same. No one has the time to give this elaborate bath and many facilities are moving away from basin baths and moving towards the chlorohexidine wipes. However, those are mminor things that need to be updated.

What I really am appalled by is how nursing school made me feel like I would be all on my own. I spent so long trying to memorize every medication my poor brain could store because I was made to feel like I had to know them all. I tried to memorize all the side effects. I wanted to know contraindications, interactions, dosages…

I needed to know it all because I alone am responsible.

Yeah, no.

I have always had a wonderful relationship with pharmacy. I have no problem with calling pharmacy and asking about a dosage, an interaction, how often it can be given, etc. As a nurse you are actually not alone. If all else fails, there are several apps that can be downloaded to your phone that can provide a wealth of medication information (think Epocrates, Medscape, and so on).

And that is my next gripe, technology.

Why are nursing programs not incorporating the wealth of technology into their nursing programs? Just about eveyone has a phone now with access to Google. This idea that we have to memorize everything because we have no one to turn to is very obsolete. There is literally a wealth of information at our fingertips. We are in the information age and it’s time nursing realizes that.

But nothing, and I mean nothing, is probably more obsolete than those damn careplans! Hours and hours spent writing thorough nursing plans, while thumbing through the nursing diagnosis books and for what? Most careplans are now documented in the online charting systems (Epic, Cerner and such). Furthermore, NO ONE looks at them but the TJC when they come to visit!

Something is wrong with nursing education. Many Associates prepared nurses are coming out of school with plenty of knowledge on how to complete tasks. A lot of ADN programs teach tasks with no real time spent going over critical thinking. There are Bachelors prepared nurses have all the knowledge of theory and delegation but no real idea on how to apply that knowledge in the real world.

This is a problem. We are hammering nurses with knowledge and theory but not showing nurses how to apply what they have learned with REAL patients. Don’t get me wrong, as individuals providing health care we need the knowledge we are given. However, we need to learn how to teach nurses to apply what they have learned. We need to learn how to teach nurses how to reflect and resolve when problems do arise. This idea that nurses have to do it all and be perfect needs to die. Quickly.

Our future nurses deserve better.

Li-Fraumeni Syndrome

Every now and then you all know that I like to share some of the things that I encounter. This week I encountered a disorder that I had never even heard of:

Li-Fraumeni Syndrome

If you are scratching your head at the name don’t worry, so was I! This is something I have never come across. You know me, when I don’t know… I am all over the internet until I do know.

I will say I had no idea such a brutal disorder existed.

Let’s get to the gist of what this syndrome is. The disease was first recognized back in 1969. Drs. Frederick  Li and Joseph Fraumeni were studying familial cancers and this study focused around four families that suffered with multiple cases of young adult and childhood cancers. It turned out that a mutation in a gene, TP53 to be exact, made them predisposed to cancers. Oh, while we are talking about the gene, it’s a tumor suppressing gene (figured I would throw that at you so it makes a little more sense). As if that wasn’t enough, it made the carriers more susceptible to rare cancers. We are talking cancers of the “soft-tissue, bone sarcomas, breast cancer, brain tumors, adrenocortical carcinoma and acute leukemia. Other cancers seen in LFS patients include gastrointestinal cancers and cancers of the lung, kidney, thyroid, and skin, as well as in gonadal organs (ovarian, testicular, and prostate.)”(lfsassociation.org)  This article gives a lot of info

Li-Fraumeni Syndrome is an asshole.

It was the statistics surrounding the genetic mutation that shocked me the most. According to the LFS association, individuals with the mutation have nearly a 50% chance of developing cancer by the age of 40. It gets worse. The risk goes up to nearly 90% by age 60. However, hold on for this one, women have a nearly 100% chance of developing some type of cancer within their lifetime (much higher risk for breast cancer)!

Yeah, I was NOT ready for that particular statistic.

Like I said, Li-Fraumeni Syndrome is an asshole.

What should trigger oncologists to test for this mutation is family history. If a patient has a strong family history of the cancers listed above, especially if family members tend to get cancer at a young age (40 or younger), LFS should be looked at.

So, what made me do some research on LFS? A patient. I came across a young patient coming for a radiological study that had a tumor, while one of their parents was battling cancer as well. Yes, parent and child were both going through chemotherapy at the same time.

Once again, Li-Freumani is an asshole.

I happened to be a part of the care and saw some prior scans of the patient and had never really seen such a large tumor. Someone from the patient’s medical team happened to be down here with us and they were able to tell me the name of this syndrome.

I can’t even imagine what it would be like knowing that I carry such a genetic mutation. Would I ever want to have children? If I decided to have children, would I feel guilty if I passed it on to them? I had this discussion with some of my coworkers and we all had differing views. So bloggaverse, I ask you two things:

1. Have you ever heard of LFS?
2. Would you ever have children if you knew you carried the mutation?

April 1st

It’s coming.

April 1st.

No, I am not worried about April Fools Day.

I start graduate school. I make that first step towards my Master’s degree. I take that big leap back into school.

I. Am. Terrified. I don’t know why. I feel like I’m not ready. I feel like I have gotten myself in over my head. I feel like I am not good enough for this. I know this is my anxiety talking. This isn’t my first time dealing with the panic and self doubt that comes with anxiety. Anxiety stopped me from going back to school before now. Anxiety almost stopped me from taking the job I have now. Anxiety has awoken me from my sleep with my heart racing for absolutely no reason. True anxiety is no joke. It’s not easy for me to admit that I deal with depression and anxiety. I am the nurse that has it all together. I am the nurse that other nurses vent to. I am the nurse running a blog giving advise to other nurses. I am the nurse that has mental health issues.

I am not going to let anxiety win though. Yeah, I am scared sh*tless, I won’t lie. I feel like I might have made a mistake. However, I am still going to log into my student portal on April 1st and begin looking over my first assignment. I am the nurse that is going to have her Master’s in two years because I am the nurse that refuses to give up.

Unnecessary

I almost lost my temper.

One of the anesthesiologist does NOT know how to talk to people.

It feels like she is being condescending at all times. I get it, you’re a doctor. I respect that. However, it’s totally unnecessary to speak to people in that manner. I am a nurse. If you talk to me instead of at me you would know I have plenty of nursing experience. I know quite a bit more than you give me credit for. I am fully capable of the tasks that are required of me during this anesthesia case. I can do whatever you need if you just ask. Contrary to popular belief, nurses don’t read minds.

I’ll say this, she has one more time to speak in her condescending tone. One more. While I am going to be professional and respectful, I’m going to put her in her place. I’ve had to do it with plenty of residents and a few attendings. This isn’t new for me, I know how to get my point across. She needs to be knocked off the pedestal she placed herself on… I’m just the one to do it.