A moment of ignorance and a lackluster apology

Earlier this week, the women of The View managed to offend millions of nurses worldwide. Their comments were offensive and hurtful. It showed a blatant disrespect for a profession that I am extremely proud to be a part of. You don’t become a nurse overnight. It takes years of preparation and a true heart for caring for others. It takes compassion, knowledge and a huge heaping of integrity which is why nurses are consistently chosen as the most ethical profession in the United States. 

When Kelley Johnson, Miss. Colorado, RN, chose to step on that stage wearing her nurse’s uniform and declare to the world that nursing is her talent, she did not do so lightly. She put a lot of thought into that decision and she did so proudly. You see, being a nurse is a talent. It takes a lot of skill, whether that be knowing how to accurately assess a patient, or more clinical skills such as how to place an NG tube so a patient may receive crucial medication and nutrition, or an abundance of critical thinking skills that enable a nurse to notice when a patient has gone into cardiac tamponade and encourage the surgeon to take them down to the OR immediately, or the skill to keep on smiling despite having just used our stethoscopes to listen to a patient’s final beat of their heart. We start our days and our nights by donning our scrubs, strapping on our comfortable shoes, wrapping our stethoscopes around our necks and mentally prepare ourselves to care for your loved ones for the next 12 hours or so. In a 12 hour shift, we go through a myriad of emotions as we celebrate our patients triumphs and secretly cry in the supply room over their failures. We walk over 10 miles a shift, assessing and reassessing, making decisions on what medications to give and keep you out of harms way. We call doctors and explain what we are seeing in our patients and make recommendations based on what we are seeing so we can keep our patients safe. We provide dignity and respect to those who have lost their sense of independence. We laugh with you, we cry with you, we pray for you and we care for each and every one of you. We are skilled at compartmentalizing our feelings. We are skilled at analyzing medications, double and triple checking and often finding errors that a physician and pharmacist may have missed. Need a bladder irrigated? No problem. Suspect a chest tube has an air leak? On it. Need someone to hold your hand and listen to you as you share your life stories so that you may be heard just one last time? It’s an honor. Nursing is our talent. To say it isn’t means that you, hosts of The View, truly don’t know what all it is that a nurse does or what it means to be a nurse. Nurses are known for being highly observant and being able to quickly and accurately determine what is being said so to say we misheard or did not understand you is just you further demeaning us. 

The View’s Mea Culpa To Nurses
So, here is where I think The View went wrong in their so called apology. 

This was not an apology. This was a deflection. When you apologize, you accept responsibility for your actions. To say you love nurses, adore nurses, respect us and then continue to deface and devalue us is not an apology nor does it fix things. You do not say to 3 million nurses, oh you misheard, if only you actually listened, if only you were paying attention… You own up to your mistakes, take accountability and say I’m sorry and learn. Nothing was learned here except they just lost millions of viewers. We heard you all loud and clear. You, the hosts of The View, don’t see nursing as a talent. We, however, respectfully disagree. I will continue to don my scrubs and stethoscope proudly. My talent is being a nurse and it just so happens to also be my career. A career I am honored to be a part of.

how to survive clinical 101

Clinical was my favorite part of nursing school. Finally, some real life patient care! It can be fun but also very stressful so here is my 10 point advice on how to survive clinical.

1. Come prepared. This means your care plans should be done, your uniform should be on (including your pen, penlight, stethoscope, sharpee  and a notebook), and your meds reviewed. 

2. Ask questions. This is your time to learn! No question is a bad one. If you don’t know something ask. It’s better to ask and learn than to never ask and end up hurting someone. 

3. Seek out opportunities. Let the nurses know that you want to observe or participate in any skills they might be doing! No skill is beneath you. Bathing a patient and learning to transfer them safely is just as important as tracheostomy care or placing a foley! Soak it all up! 

4. Get some sleep! Have you ever pulled an all nighter to study and then realized “omg… I’m not retaining anything”… The same goes for clinical. If you’re not well rested, you’re not going to retain all the cool stuff you’re learning. So catch some zzz’s. Your memory will thank you

5. Eat breakfast and bring snacks. Low blood sugar is a distraction and can make you hangry. Eat a protein filled breakfast and carry some easy to consume snacks in your scrub pockets. Trust me, no one likes a hangry nursing student and you don’t want to wake up on the floor from low blood sugar. 

6. Watch and learn during report. This is the best time to learn not only about your patient and what we are looking out, the goals, etc for but also, to learn how to give a good report. Be respectful and listen up. When they are done, then ask your questions. Disrupting them ruins their flow and can make key things be missed. 

7. Never act like you know the answer or how to do something if you don’t. This is a red flag that you aren’t safe. If you don’t know how to do something or the answer to a question, just be honest. It doesn’t mean you’re not smart, in fact, just the opposite! 

8. Time management is your best friend. Cluster your care. Think about your priorities. Always visit your most critical patient first and most chatty patient last. Have all of your supplies, medications, etc ready before you enter a room. Follow around the most efficient nurse and do what they do! Time management is key!

9.  Be nice to everyone but don’t butt kiss. Be nice to your classmates, the patients, the patient’s family, the nurses, environmental staff, and everyone else you come in contact with. You will see all of these people over and over again. The nursey world is a small world and people never forget how you make them feel. 

10. Think things through. Think about the how, the why, the reasoning behind things and why certain medications work best. This is when you get to apply what you’ve learned in class. Brain storm answers with your classmates. Think about your priorities. Ask clarifying questions. You got this!
Have any more clinical recommendations? I’d love to hear them. Comment below with your suggestions! 
Love and Scrubs!

What to Give a Nurse for Christmas

For all you last minute shoppers still looking for a gift for the nurse in your life look no further.

1) Starbucks (or their coffee shop of choice) gift cards. Nurses thrive off caffeine. If you really love her (or him), set it up to automatically refill the card when it gets too low. Unlimited Starbucks… A girl can only dream

2) cute socks… Most hospital nurses these days have very limited choices in what we can wear to work. Socks not only let us show off our amazing personalities but let us have a little bit of fun with our uniform (and bend a few rules too).

3) A stethoscope… One of the most essential tools as a nurse (besides our ginormous brains and big ol’ hearts) is a stethoscope. Do a little research here…

4) stethoscope bling… If the nurse in your life already has a top of the line stethoscope, bedazzle it. CharMed makes adorable stethoscope charms that are fun and antimicrobial

5) for the new nurse in your life consider at RN pocket guide. This can be extremely useful when trying to master the nursing basics. If a book seems too bulky… A white coat clipboard for nurses might just do the trick

6) Wine, gin, vodka, bourbon… Whatever can help erase the memory of the code browns we dealt with all night. The more, the merrier. If the nurse in your life doesn’t drink… This can be substituted with chocolate, cookie dough, French fries, donuts, ice cream… You get the drift. Just don’t put your fingers near their mouth or you might lose one

7) New scrubs… Every nurse has their own favorite brand. Go sneak a peak a some of the tags and you’re golden or try something new. I’m a big fan of Grey’s Anatomy (the show and the scrubs), Med Couture, Blue Sky and Healing Hands. What’s better than wearing pajamas to work? Wearing super soft, stretchy, make your butt look good pajamas

8) a nice set of trauma shears and hemostats. Preferably rust resistant and in a fun color (my color preference is pink if anyone’s asking)

9) a new scrub jacket… White is usually better because it can go with more. Bonus points: get it monogrammed (maybe match it to the new stethoscope and trauma shears you got them)

10) a spa day… A mani/pedi or massage or full out spa day. Nurses are on their feet the majority of the day. Burning rubber running back and forth between rooms trying to keep everyone happy and alive. It’s exhausting and our poor feet and backs could use a little TLC. Don’t even get me started on our poor, cracked hands from the abuse we subject them to just doing our jobs.

11) a super nice, super yummy smelling, super long lasting lotion… Nurses wash their hands constantly (see above). Pamper your favorite nurse with an amazing hand lotion and they’ll love you forever. If you’re buying for a male nurse… You might want to skip the smelly kind and go for a more neutral scent

12) A day of rest… For all the nurses who also happen to be blessed with parenthood… Give them a day off. A real day off. Let them stay in their real Jammie’s all day, spread out on the couch and be judged by netflix for watching too long. Everyone deserves a day to just recharge their batteries.

13) and finally, if you really want to go the extra mile and look super awesome while doing it. Show up on Christmas Eve or Day with a hot meal for all of the nurses to enjoy. Nurses give up their holidays to take care of everyone else’s loved ones with little thanks or complaints. They deserve to be remembered and thanked too for just doing what we do best…

Now get out there and spoil the nurses in your life. If any of y’all have any thing you’d like to add to the list, leave a comment below. I’d love to hear them! Merry Christmas, Happy Holidays and a very blessed New Year to all!

EKG Basics

heart beart

There are three basic parts to an EKG:

  1. P wave: this is the wave that shows what is going on in the atria of the heart aka atrial contraction
  2. QRS: think ventricles, if there’s an abnormal QRS the problem is almost always in the ventricles
    1. If the QRS is narrow: the problem is above the ventricles (think atria)
    2. If the QRS is wide: the problem is ventricular
  3. T wave: the heart is resetting to beat again aka ventricular repolarization

5 things to look at:

  1. Heart rate: To calculate heart rate: count the number of R waves in 6 seconds (six large blocks) and multiply by 10. Normal is 60-100 beats per minute (bpm)
  2. rhythm: is it regular or not?
  3. Is there a P wave before each QRS?
  4. What is the PR interval? normal is 0.12-0.2 seconds (or 3-5 little boxes, each little box is 0.04 seconds, there are 5 little boxes per big box)
  5. Is the QRS narrow? normal is 0.06-0.12 seconds (or 1.5-3 little boxes)

If the heart rate is 60-100 bpms, the rhythm is regular (happens at an even interval), there’s a P wave before each QRS, the PR interval is normal and the QRS is normal than it’s Normal Sinus Rhythm.

sinus brady

Bradycardia:

This means the heart is beating <60 bpm AND The rhythm is regular.There’s a P wave before each QRS.The PR interval is normal. The QRS is narrow.

  • Tx: ABC: Atropine treats BradyCardia…
  • usually you only treat if the patient is symptomatic or drops below a specific bpm (the doctor will determine the parameters)

sinus tach

Sinus Tachycardia:

This is when the heart is beating >100 bpm AND The rhythm is regular.There’s a P wave before each QRS.The PR interval is normal. The QRS is narrow.

  • Tx: Calcium Channel Blockers: usually cardizem
  • what to look for: chest pain (priority), decreased BP, check pulse

Abnormal rhythms:

a fib

Atrial Fibrillation:

if there are no P waves and the QRS is narrow, think a. fib.

  • what’s happening: the atria is basically quivering, this means blood isn’t being pumped effectively from the atria into the ventricles. This causes blood to pool in the atria which means clots can form. A patient will be started on an anticoagulant to help prevent clots from forming. If a clot is thrown, it could go bad very fast.
  • Treatment: The patient will probably first be started on medication to try to convert them out of a. fib into a normal sinus rhythm (NSR). If this doesn’t work the next course of action is to cardiovert the patient. The last resort is an ablation. Some patient’s never convert and are controlled with a PO medication as well as an anticoagulant at home
  • if >100 bpm, considered uncontrolled

a flutter

Atrial flutter:

“saw toothed” p waves

  • priorities: check BP, assess level of consciousness and mental status
  • what’s happening: ineffective atrial contractions
  • tx: cardioversion

PVC

PVC (preventricular contraction):

wide and bizarre QRS (>0.12 seconds)

  • usually benign
  • causes: hypoxia, low K+, caffeine, stress, etc
  • what to look for: check O2 saturation then K+, low BP, low HR, decreased LOC
nonsustained vtach
Nonsustained V Tach
sustained vtach
Sustained V Tach

Ventricular tachycardia:

if the QRS is wide and fast, think V tach (looks like 4 or more PVCs in a row)

  • sustained: v. tach is continuing without converting back to NSR by itself
  • nonsustained: this is bursts of v tach where the patient converts back to a different rhythm without any interventions
  • why you should be concerned? v tach can quickly turn into v fib or worse. This is a critical rhythm that needs attention right away
  • treatment:
    • V tach and awake, meds he must take (patient has a pulse)
      • 1st try vagal maneuvers, this sometimes can convert a patient without any medications
      • give meds: usually amiodarone
    • V tach and nap, ZAP ZAP ZAP  (patient is passed out and/or pulseless)
      • the patient will be cardioverted

v fib

V. fib:

if no P’s and no QRS’s, think V fib

  • Tx: V fib, you defib … go get the defibrillator, crank it up and zap that rhythm back to normal
    • Remember to check for a pulse!

asystole

Asystole:

this is when the patient flatlines.

  • tx: epinephrine and a pacemaker, defibrillation will not work. Start CPR immediately.

Pacemaker Spikes: if the patient has pacemaker, you will see a pacemaker spike (it literally looks like a spike). Where the spike occurs depends on the type of pacemaker.

A Paced

Atrial Paced ( A paced):

The pacer spike occurs in place of the p wave. This is taking place of the SA nodes action of firing. If there is no QRS after the spike, this means there is failure to capture

V paced 2

Ventricular Paced (V Paced):

The pacer spike occurs directly in front of the QRS causing a wide QRS. Again, if there is no QRS after the spike, it has failed to capture.

AV paced

Atrial Ventricular Paced (AV Paced):

A spike occurs before the P wave and again in front the QRS. This is considered AV paced.

heart block

Heart Blocks

I’m a big fan of the heart block poem, it comes in handy whenever I’m trying to figure out what type of block a patient has!

If R is far from P, you have a first degree.

Longer, longer, drop! You have a Wenkebach!

If some P’s don’t get through, then you have a Mobitz II.

If Ps and Qs don’t agree, then you have third degree.

1st degree
First Degree Block

First degree: the PR interval is >0.20 (usually benign, monitor for possible new arrhythmias)… Remember to measure those PR intervals!

2nd Degree:

There are two types: type 1 aka Wenckebach or Mobitz I and type 2 or Mobitz II

weinkebach best

weinkebach

Wenckebach (Mobitz I): the PR interval increases more and more with each beat until there’s a P wave without a QRS (aka the PR interval gets longer and longer and then there’s a drop). This  usually occurs in a pattern. Tx is usually atropine first followed by a pacemaker

type II block mobitz iiMobitz II: P waves continue to march out as usual and then all of a sudden you’ll have a dropped QRS. (Measure the distance between the P waves to see if they are occurring regularly). This can happen in a pattern either a 2:1 or 3:1. A 2:1 is there are 2 P waves for every QRS. A 3:1 is when there are 3 Ps per QRS. Tx is a pacemaker

third degree

3rd degree: This is very bad and considered a complete heart block. There is basically no communication between the atria and the ventricles. There are more P waves than QRS waves and the P waves are inconsistent. Tx begins usually with a dopamine drip followed by a pacemaker.

AND there you have it! The nitty gritty need to know basics for EKG interpretation. Now that you’re ready, go practice your new skills! A great website to use is http://www.skillstat.com. If you have any questions, spot any errors or see any rhythms I left out, please let me know and GOOD LUCK!

Stress Kills

There is going to come a time, probably multiple times, where being a nurse gets to you. While it’s a great thing we do taking care of those that are sick and in need, it can be challenging, physically demanding, emotionally taxing and downright exhausting. Nursing burnout is a real thing so it’s important to take care of yourself both of the body, mind and spirit (whatever that means to you). It can be hardest to do after those really rough days especially if something traumatic has occurred or a patient has passed. So what can you do to help destress/detox after those days?

First, you need to already be taking care of yourself. If you’re already overly stressed out, it makes handling tough situations even harder. Think of yourself like a balloon. The more you fill yourself up with stress, the more likely you are to pop. You become overwhelmed quickly, easily emotional and are stretched to the limit. The more you pile on, the more stressed you feel because you haven’t released some of that building pressure. Then BAM, you can’t take anymore. This is how burnout happens. This is why it’s so important to start taking care of yourself immediately.

Second, start thinking about things that calm you. I love crafting and if it involves banging nails into a board or using a staple gun or ripping something up even better. It helps get out built up stress and aggression and brings me back to a zen like state. I also like working out. I hate it (and myself) while doing it but afterwards I always feel accomplished, proud and even, happy. My favorite thing to do to destress though is to treat myself. I treat myself to a fancy mask, light some candles, through on some music and soak in the tub at least once a week. I get pedicures and manicures when I have the time or do them myself. I love a good massage and treat myself often. I usually get groupon or living social deals to make it more affordable because let’s be serious, I’m a nurse and definitely not made of money. Whatever it takes to make you feel all woozah with the world, do that and do that often. Make an appointment with yourself at least once a week and keep it. You deserve it.

Third, cry. I’m serious. I know we have this tendency to want to be strong and tough even on the exterior but it’s ok to cry, just save it for home. The work place is not the place to break down. If I have had an especially hard day I come home, pour a bottle of wine into my Olivia Pope glass, bust out the good chocolate and throw on a chick flick and bawl my eyes out. Sure I might look like a hot mess but who cares? I do some dang hard work and I deserve to let it out sometimes. When I lose a patient and have finally left work, I get in my car, pick up some French Fries from McD’s (my ultimate comfort food), call my mama and bawl my eyes out to her. She doesn’t say much, she just listens and at the end she always says, “Baby, you are giving a piece of yourself to each of your patients. It’s ok to grieve them.” So, I do but then I wash my face, go to bed and get ready to go back the next day because that’s what we do. I can’t say it gets easier because it doesn’t but you’ll learn how to handle it better with each passing day and it starts with taking care of yourself.

So tell me, how do you like to destress? Are you feeling the nursing burn out? Leave a comment below!

Nursing Love And Mine,

Scrubsandpearls

(Please pardon any errors. I wrote this on my iPhone and have fat thumbs.)

Top Ten Things You Need To Survive Nursing School

There are so many things I wish I had known before I started nursing school that would have made life so much easier. At the beginning, I studied every little detail and focused on memorizing rather than understanding. I had always crammed for tests and then seemed to forget everything the moment the test was over but in nursing school you can’t do that. You have to focus on the big picture and understanding the concepts. This is going to be your career, it’s not just another general education class which, let’s be serious, are just a waste of valuable study time. So below are my top 10 things you need to survive nursing school.

1) A comprehensive review book… If you stopped here and didn’t look any further, you would be fine. I’m serious! This is the hands down best investment you can make in nursing school. It really highlights what the need to know and even some of the nice to know things are so you can truly grasp what you’re studying without getting bogged down by all the extra fluff.

My favorite: Saunder’s Comprehensive Review for the NCLEX-RN examination

You can find it here…
http://www.amazon.com/gp/aw/d/1455727555?pc_redir=1407684546&robot_redir=1

2) A class specific review book that has nclex style questions. While the comprehensive review book is great to study with, it doesn’t go into all the details that a class specific review book does. Bonus: It’s a great way to learn what an NCLEX question is like and how to answer them. There are usually 2 or more right answers in each question but there is always one that is the priority (hint, hint: pick the most right answer). If you can learn to prioritize early on, you’re set for the rest of your nursing school career!
Favorites:
The Davis Success Series
Pearson’s Reviews and Rationales Series
Prentice Hall’s Reviews and Rationales

All of these are great! I started with the Davis Success Series but later switched to Pearson’s and Prentice Hall

3) If you’re a visual learner, The Memory Notebook of Nursing is amazing! If you want to save some money, go in on the CD version with some classmates and print them out as you need them.

I’m also a huge fan of Mosby’s Memory Notecards especially pharmacology
and Fluids and Electrolytes These are little spiral bound books the size of flash cards so they’re great for throwing into your purse or book bag.

4) You definitely need a nursing diagnosis book! I don’t have a specific favorite but this is a huge lifesaver when it comes to care plans!

5) Another great care plan resource is an actual care plan book. It doesn’t include every disease ever but it includes the most common and will help you start thinking about priorities when it comes to your care plans.

6) A great planner. Personally, I’m a fan of the Lilly Pulitzer agenda or Erin Condren life planners but this is one of those things you can totally make your own! Just pick what works for you. I personally like to color code my planners. Big events in red, social in pink, meetings in blue, etc. that way I can take one look at my calendar and know exactly what I need to be focusing on.

7) Study Tools… I personally like blank sheets of printer paper so I can condense my notes down as much as possible. By the end of nursing school, I was able to condense my notes to 3-4 pages per exam which usually meant only 20 pages to study for the final. Notecards are great for memorizing but they also can be used to help piece things together. I love being able to have study tools I can just throw into my bag and pull out whenever I have down time. It’s not about studying harder, just smarter so figure out what works for you.

8) A digital recorder… Always check with your teacher before recording a lecture but this is a great way to figure out what you missed BONUS: plug it into your car and you can study on the go

9) A great drug book! You’re school will have one they want you to use but you can always get one that suits you better if that doesn’t work for you

10) Lastly, but int opinion most importantly, An Amazing Study Group
I cannot begin to even describe how much I loved my study group because not only were they there for those late nights and to remind you about big due dates but they become such an amazing group of friends who can support you through nursing school like no one else can. They get your freak outs and need to stress eat and are there to celebrate with you after each test with yummy margaritas or pick you up if you have a really awful clinical day. You teach each other, grow together and succeed together. Nothing bonds you together like nursing school.

11) So you know all of the text books they make you get, spend time to actually read them and do it before you go to lecture. Why? Because instead of seeing a subject for the first time in lecture, you’ll only have to fill in the holes that you missed and can focus on what the teacher is trying to point out is important.

Don’t feel pressured to spend a ton on study aids. LOTS of people survive without them but they definitely make life easier. Again, if you were to get only one, I would suggest a comprehensive review book. Remember to share your resources with your classmates!

I hope this helps! If y’all have any questions or want to add to this, post a comment below or email me at scrubsandpearlsofficial@gmail.com

Top 10 Items Every Nursing Student Needs for Clinical

I can’t even begin to explain how important it is to be prepared for clinical. Not only will you feel less frazzled when asked for something but you’ll also look more competent when you have all the tools you need. Below are my top 10 must have items for clinical.

1. Stethoscope… Buy the best one you can afford. If you get quality, it’ll last longer and you’ll be able to hear better. You can find them on eBay even! Just remember to swap out the earpieces! Hellooooo bargain!

Brand of choice: Littman

2. Pulse oximeter… Most units have their own but keep in mind that the nurses, techs and CNAs are all using them at the same time you’ll need them. Just keep it in your pocket with all of your other essentials. I can’t tell you how many times I’ve needed to spot check a patient and was glad I had one handy. Plus they are way less bulky than the ones the hospital usually supplies. You can get ones for about $10 from Walgreens or CVS or Amazon!

3. A pen light. I prefer the ones that have the millimeter size on the side so I have a more accurate way to measure instead of just guessing! Super essential for those neuro assessments.

4. Black pens! Black pens! Black pens! The funkier the better! That way when someone “borrows” it, you’ll know exactly which one is yours.

5. Trauma shears… So handy for cutting tubing, gauze, packaging, etc, etc.

6. A note pad. Preferably one where the outside can be wiped down. Getrms are no joke. Write down vitals, when meds are due, times, intake, output, etc and don’t forget to chart it!

7. Super comfy shoes! Protect your back and your feet. Nurses use their bodies as well as their brains as tools. Protect those assets.

Brand of choice: Dansko pros or Allegria… Both are super comfy and durable. Consider it an investment in yourself!

8. A couple of pairs of cheap scrubs. Let’s be serious… You can buy your adorable, soft, comfy scrubs when you have a job in the colors you want rather than waste money on scrubs you’ll on wear for clinicals… And then burn them when you graduate. Or better yet, pass them on to younger students who may not be able to afford them.

Cheap brand of choice: butter soft by UA, Cherokee, barco, wonder wink
Pricier Brand of choice: Grey’s anatomy, healing hands purple label, med couture, blue sky

9. Compression socks. Protect those sexy legs. No body wants spider veins or DVTs and bonus: your legs will hurt way less at the end of each clinical

10. Watch. Go for cute, cheap and durable. I like to sterilize mine often and prefer one with a strap rather than links so it’s easier to clean.

Bonus:

11. A sharpie… You can outline drainage on bandages, bruising and redness on skin as well as date your dressings and IV tubing and bags and dry erase marker

12. A dry erase marker for updating those whiteboards

13. Snacks you can fit in your pocket and water to wash it down

Don’t forget your badge! Or you will be sent home especially if you have that one clinical instructor who is extra hard on her students. (If she asks for you to have your scrubs ironed and hair pulled back, do it. Resistance is futile)

Stay tuned for a post on my top 10 supplies you need to survive nursing school.

Nursing love and mine,
Scrubs and Pearls