November, 2006 Archive

November 20, 2006, 6:05 pm

It’s An Emergiblog Review!

oshu

This gorgeous facility is the Oregon Health and Science University Medical Center.

No, I didn’t move to Oregon although Portland is beautiful .

They also have fantastic health care facilities.

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Emergiblog is a blogger participant at ReviewMe.com.

As a member, I receive requests from websites to do an objective review of their online information/layout and write about my findings here on Emergiblog.

I select only the offers I choose to select and I am paid by the sites reviewed whether the review is favorable or unfavorable (an important distinction). My goal is to review sites that I feel nurses would be interested in exploring.

Emergiblog has been asked to review the OHSU Nursing Retention and Recruitment site.

All I can say is: Wow!

Let’s look at the details.

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Are you a nurse thinking about moving to the Pacific Northwest?

You need to check out the OHSU site.

Are you a nurse and want to check out a premier place to work? Want to see how the places that are “doing” it right are actually doing it?

It is imperative that you check out this site.

*****

I was no stranger to the Oregon Health Sciences University name. It’s an amazing teaching and research facility.

And they believe in the power of nurses.

This particular area of the massive inter-linking site is the go-to place for nurses looking for employment. If you weren’t thinking OHSU, you will be when you are done.

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The main page of the site contains the basic information. Location, address and telephone numbers; it also notes that OHSU is looking for critical care nurses at this particular time.

So far, so good.

The meat of the site is found on the sidebars.

To the right are links that will give you information on the nursing philosophy of the facility. Read them!

We’re not talking dry, boring nursing-tome stuff here. OHSU is truly committed to excellent nursing practice. Each link is readable, clear and specific to the topic.

I even found their Nursing Organizational Chart interesting and easy to read. Yes, I am a geek, what can I say?

To the left are links that give a general overview of the nursing departments, units (size and special info) and specialties that are offered to nurses.

Look at this link specifically. There are nursing specialties there I didn’t even know existed. If you are a new nurse, your eyes will bug out. If you are an experienced RN, the selection will make your mouth water. Internships are available!

If you can’t find a niche at OHSU, you probably aren’t a nurse!

Note that OHSU is working on the Magnet Recognition Program. Find out what that entails.

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Need an Oregon license? There is a link straight to the Oregon Board of Registered Nursing.

Want to further your degree? You can link right to the nursing school and download the nursing publications.

  • This link could be more user friendly.
  • There are a lot of requirements listed but I found myself thinking, “Okay, I want to sign up NOW so where would I go.” I found it daunting and I have looked at numerous online BSN programs.
  • For comparison, the University of Wisconsin BSN/LINC site is much more appealing to those looking for online programs, as is the site for Thomas Edison State University in New Jersey.
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I tested the site by looking for an emergency department job. There were no staff nurse positions available, but they are looking for a nursing manager.

As of today, the entire OHSU lists 141 nursing positions that run the gamut of the specialties. That’s not a lot of openings for a teaching facility this size.

You can tell a lot about a facility by the number of nursing positions open, and this is a positive sign to me that there is not a lot of turnover. A stable nursing staff is a good nursing staff.

I notice a lot of nurses needed for the critical care float pool and PACU has a few more openings than other departments. Considering the number of surgeries/procedures performed there, I’m not surprised.

*****

In summation, the site is easy to use, the links are self-explanatory and you can always find “home” base – you won’t get lost on this site.

Good explanation of benefits, but no salary scales are listed. Differentials are listed.

You come out of the experience with the distinct impression that OHSU values their nursing staff and offers an unbelievable amount of support and education for their nurses.

I get the impression nurses are able to give exceptional care through OHSU.

Nice site.

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November 19, 2006, 9:03 pm

The Sacrifices A Parent has To Make..I’m Tellin’ Ya

nd

Sometimes a parent just has to put their children ahead of their love for all things Notre Dame.

It’s a fact of life that they don’t tell you as you hold that tiny baby in your arms.

It is for this reason that I was unable to watch the steamrolling Irish squish the Army.

Now I have every respect for those in the service acadamies. We have the best Army in the world. They just can’t play football very well.

That’s okay, guys. You concentrate on protecting the country; sometimes a bit of perspective is needed.

Meaning I won’t gloat.

I’ll save ALL my gloating for the tiny trojans of usc. I won’t even capitalize the letters.

So, next week I’ll be firmly ensconsed in front of the TV for the ND VS. usc game.

The scream that will pierce the atmosphere, and you WILL hear it, will be me.

WHEN Notre Dame wins, think of the wonderful Fighting Irish. Then think of me.

I don’t drink. But I will drink next Saturday, and it will be beer. I hate beer.

But anything for the Irish.

Cheer, cheer for Old Notre Dame
Wake up the echoes cheering her name,
Send the volley cheer on high,
Shake down the thunder from the sky,
What though the odds be great or small
Old Notre Dame will win over all,
While her loyal sons are marching
Onward to Victory!

I need a Bowl game. I can’t face the fact the season is ending.

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The reason I missed the ND/Army game was that I was busy watching my daughter and her cross-country team take second place in Division IV at the NCS finals.

This means she and her team have qualified for the state championships in Fresno next week. All I’ve heard for a year is “We’re going to State, We’re going to State!”

And next Saturday she’ll be running in the State Championship.

I’ll be there. In Green and Gold.

And then I’ll be home for the ND game.

In Blue and Gold.

Life doesn’t get any better than this!

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11:59 am

The Yearly Visitor

flowers

(Update: I first posted this story last November. It’s time for me to post it again in remembrance. She has come back to visit.)

I often find myself with writer’s block, especially when I stop to think that people are actually reading what I write.

I have to remind myself that blogging is not a performance art, it is a (hopefully) creative outlet for emotions, opinions and commentary.

I often find myself blocked from adressing a specific topic because I’m only minimally anonymous on this blog, if at all.

Sometimes it’s easy to change the sex, age and chief complaint of a patient and not affect the story or its outcome.

But what happens when you can’t do that; when the details ARE the story?

How can I describe what was the most tragic, gut-wrenching shift of my career with a patient I can’t forget….. because she returns every Fall?

I have decided to tell this story in the form of a letter to my patient, covering up the details to the best of my ability. Who knows, I may just delete the whole thing when I’m done, but it is Fall again, and she does come around.

“Dear Melissa,

It’s been many, many years since our meeting in the emergency department late that holiday night. The evening you told your mom that you would join the family over at Grandpa’s as soon as your headache improved.

You didn’t show, and your mom came home later to find you unresponsive on the den couch. She called 911. We met around midnight.

The paramedics gave you some medication en route and you responded to one of those medications. By the time you arrived, to have called you agitated would have been an understatement. This was a different kind of agitation.

Your eyes were open but they did not see. You thrashed and writhed but not because of any particular stimuli. You screamed a scream we could not understand but could not seem to hear when we tried to speak. You looked right through us. I’d never seen that stare before. I will never forget it.

We noticed that you were oozing blood from a nasal airway attempt en route. And you were dripping from both IV attempts the medics made. The entire department and half the hosptial met the ambulance that brought you to us and many things were occuring simulaneously.

The nurses inserted a foley that returned red urine. Every place you hit while thrashing turned ecchymotic. You leaked around the IV insertion sites we put in. Somehow the ED doc managed to do an ENT evaluation. Blood behind both tympanic membranes.

Disseminated Intravascular Coagulation (DIC). All I knew at the time was that it was 60% fatal. The lab confirmed it. The question was why?

The specialists started arriving. Internal Medicine. Hematology. Respiratory. An ABG was done; pressure was held. You didn’t stop bleeding. Blood cultures done. More bleeding. You continued to thrash against the barriers we had put up. We tried sedating you but nothing worked; your respirations remained sixty and deep for hours.

Your mother stayed in the room with you after the majority of the procedures had been done.

I stayed calm and conversant even though I knew you were critically sick. I told your mom to try and talk to you because you could probably hear her. I told her you were the same age as my daughter. I learned you were taking college classes and happy with a part-time-job. I learned you had a recent break-up but seemed to be getting over it. I learned you had sisters.

Your mom wondered if she should have your father called and get your sisters to the hospital.

I said yes.

The rest of the hours are a blur after so many years. No time to chart so I kept grabbing paper towels and putting my notes on them. By now, the other two nurses had to go back to taking care of the other patients in the totally full ER. You were nowhere near stable enough to transfer to ICU, although we had had the room for awhile now. I ran with IVs and medications and clotting factors and FFP and blood and reinforcing dressings and a million other things that needed to be done.

Then it got very quiet. I looked over to find that you had laid back down on the pillow. You became unresponsive except to painful stimuli. It happened that fast. I told the ER doctor that your breathing had suddenly dropped to 20 per minute and that you were no longer thrashing.

He intubated you without any response except a ET tube full of blood. An NG tube also was passed. No response. More blood.

The family came back in, this time it was your dad and your sisters. I explained what each tube was for, what we were waiting for. Your dad asked if this was bad.

I said yes. It was very serious.

More hours flew as I worked with you with your family at the bedside. By now we knew that your tox screen showed the presence of some pain medications and that your acetaminophen level was normal. Mom remembered some complaints of an upset stomach during the week.

I wish I could remember all the details and technicalities that went into my non-stop 7 hours of caring for you, but my memory is fading where the technical stuff is concerned. It has never faded where you are concerned.

At 0700, you were stable enough to go for a CT scan of your head. It looked like a pristine scan. No bleed. No swelling. Your mom joked about telling you she saw your brain.

After the scan we went up to ICU where the new nurses took over and settled you into their unit. I heard them say to start Dopamine. I said good-bye to your parents and to you and returned to the ER.

I had seven-and-one-half hours of nursing care to account for when I sat down with a cup of coffee to do your chart. And I’m obsessive with my charting so it was a little after 0930 when I went back up to the ICU to give them the missing nurse’s notes.

I walked in just in time to see your agonal rhythm on the monitor. My heart sank. I was told they had decided to take you off the ventilator.

You were no longer breathing. I saw your heart stop beating. Your father fell into my arms, sobbing. Your mother cried and hugged me and thanked me. I touched your hand and said good-bye and held myself together as best I could.

Until I got to the ER, where I made it into the bathroom, shut the door. The sobs came. Hard. I leaned up against the cold tile wall in a fetal position sobbing so hard I ached. Half-an-hour I did that. I pulled myself together enough to get in the car where it started again. All I could say was “Oh God, Melissa, I’m so sorry” over and over. I couldn’t come back to work the next night.

Or the next night.

They said you died of an overdose of acetaminophen. Only you know the whole story.

I’m so sorry Melissa. I’m so sorry we couldn’t save you. I will always wonder if there was something more I could have done. Something I missed. Something that would have stopped that cascade of death that overpowered us all that night.

Sometimes, as we tug-of-war with God over a patient he lets us win. He won that night and Heaven is richer for it. We are the poorer.

I think of you often, but mostly this time of year. I wonder how your family is doing, I think of how old you would be now. And every time my family bows their head to say grace over Thanksgiving dinner, I say a prayer for you and your family. Put in a good word for us, too, okay?

Thanks for visiting me again this year, Melissa.
See you next November.

Your Nurse,
Kim

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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