July 6, 2011, 12:56 pm

Who’s The Grown-Up Here?

Get great prices on nursing scrubs every day.

Ah, the benefits of sand therapy!

Time for little Bettina’s daily afternoon face plant!

Not only does it appear my colleague is about to lose her grip on her patient, I’m concerned about her choice of body mechanics.

I predict a lumbar strain in 3…2…1……

(This photo is from the Library of Congress collection.)

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Call for submission: I am putting together a July issue of Change of Shift. I have a few submissions in the books, if you have a nursing blog, or have a nurse-related blog post on a non-commercial site and would like to have a submission included, please click the “Contact” button up top and send it on in!

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I love my pediatric patients. While it is hard to see children feeling sick, they can be bright spots in occasionally hellacious shifts.

I’ve blogged before on my observation that the kids seem to be the adults in the some families.

  • They don’t want to undress for an exam, so they fight the parents who are helpless in the face of taking a shirt off a three-year-old.
  • They have to be restrained so they don’t run rampant in the ER, and they slap their parent across the face. The parent doesn’t respond.
  • They are told they need to cooperate with a procedure and they answer their parent with a loud, clear, “F*** YOU!” At the age of five. The parent retreats.

Interestingly, I see it in families at all economic levels, in a variety of ethnic groups and cultures, and in families where the parents are both younger (teens, twenties) and older (forties).

Unfortunately, it is becoming less rare.

Part of me wants to go into a rant on the lack of discipline of the younger generation (….and get off my lawn while I’m at it!)

But this is serious.

These kids are my patients.

And this lack of parental assertiveness, this fear of standing up to their children, is affecting their health.

*****

“She doesn’t want it.”

“He wouldn’t take it.”

“He just wasn’t up to taking any medicine.”

This is the response of many parents when asked if their children received any medication for their fevers.

Parents who are sitting in the emergency department with a sick, febrile child are allowing said children, ages 18 months to 5 years old, to decide whether or not they will take medication for fever!

But it gets better/worse…they take the same stance with their antibiotics.

*****

And this makes me seethe.

Parents, are you out of your minds?

A child is dependent on you to protect them and to do the right thing to keep them from harm. When it comes to illness, that means making the child take their medication.

  • That’s right. Make them take it.
  • As in force them to take it.
  • As in hold them down, restrain their movements, ignore their screaming, administer the medication and don’t stop until it has been swallowed.

I don’t care if they don’t want it.

I don’t care if they don’t like it.

I don’t care if they aren’t “up to it”.

They do not have a choice. They are children.

They will cry, and get over it.

They will scream, and get over it.

They will kick, and get over it.

They will be mad at you, and you will get over it.

*****

If you choose to allow your child to intimidate you, slap you or cuss you out without discipline, that is your perogative.

Good luck when they are adolescents, you (and society) will reap what you have sown.

But that child cannot make decisions for himself and you had better damn well step up to the plate as a parent and take responsibility for making sure that child takes the medication he needs.

Not medicating your child because they don’t want it or don’t like it is flat out abdicating your parental responsibility.

Someone needs to be the grown-up in this situation.

That needs to be you.

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The technique of giving medication to a little one who tends to gag, throw up or (as they get a bit older) spit can be tricky. I have a way of administering oral medication that seems to stop that in its tracks.

Disclaimer – this is NOT medical advice, it just worked for my kids. I use a medication syringe and place a tiny amount of medication inside the cheek. A tiny amount. That way, it doesn’t go to the back of the throat and cause gagging and it isn’t on the tongue so they can’t spit it out. When they swallow (and they will, even if they are screaming, they will reflexively swallow eventually) I repeat.

It takes a little longer to give the medication this way, but it works with all ages (until they are able/willing to drink from a med cup) and it gets the medication down. No gagging, no vomiting, no spitting! : )

June 15, 2011, 5:00 am

CEN – That’s Me!

Be careful what you wish for.

When I said I wished I could wear my nursing cap, this was not what I had in mind!

Behold the latest in Respiratory Isolation fashion – to be worn when your patient is undergoing an aerosolized treatment. First, you put on a cap to cover your hair. Then, you zip a disposable lining into the white hard hat. A motor blows cool filtered air in your face.

You can hear yourself breathe like Dave in 2001: A Space Odyssey.

Nursing is not for the vain – you should have seen my hair when I took this contraption off. The N95 respirators take care of any make-up I might wear. So much for my cover model image : / Guess the folks at Glamour will have to wait.

Funny, I feel a strange connection to this fellow…..

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Be sure to check out Dr. Val’s new radio show, Healthy Vision with Dr. Val Jones! It’s available on iTunes, and can also be heard on Better Health by clicking the widget to the far right on the sidebar. Listen in as she interviews experts on regular eye exams, contact lenses and UV protection for eyes (something I wasn’t aware of until recently!)

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Well, I went and did it!

I took, and passed, the CEN exam!

Which is a little ironic, given how I was so sure that my career in emergency nursing was coming to a close last month.

And it might have, had “Thrive” Permanente seen any potential in an RN with 33 years of experience for their dermatology clinic.

(In addition, I was passed over for someone with, and I quote, “a higher level of experience” for their chronic disease clinic, too. Seriously. That nurse must have trained with Flo Nightingale, herself! Mind you, this was all via computer. No one ever talked to me. I’m starting to get a complex…)

And so I remain firmly ensconced in the ER milieu, surrounded by the infarcting, the exsanguinating, and the lacerated; the migraining, the febrile, and the vomiting; the sprained, the concussed and the drug seeking.

My people.

***

I’m proud of this CEN.

Didn’t change my work status. Didn’t change my paycheck.

But it does mean that I meet the core knowledge requirements for emergency nursing as established by the Emergency Nursing Association.

It feels good to have that verified.

I did get a new name tag with three new letters after my name.

I figure when the newness wears off, I’ll stop looking at it every ten minutes.

I did the same thing after my BSN.

***

I’d like to say I worked my butt off for the certification. And I did.

But I also walked my butt off for it, too!

The testing station was in San Francisco, about 1.5 miles from the BART station; I figured I would walk. Could have taken the MUNI, but the level of intimacy required due to the number of persons aboard was more than I was willing to share.

I started up Van Ness Avenue. Which is uphill. You don’t think it is, but it is. Trust me.

By the time I got to the location, I was sweating, out of breath and dying for water.

(Actually, I was dying for a margarita – I had passed two bars and a Chevy’s on the way…)

This turned out to be a blessing in disguise. When I sat down to take the test, I had zero anxiety. None. All that exercise must have cleared my head and left me with endorphins, because I hit the keyboard running and did 175 questions in a little over an hour (about 75 minutes).

Passed with a 90%. You find out immediately.

*****

Decided on a Grande Caramel Frappucino with Extra Caramel and an Add-Shot from Starbucks on the way home instead of a margarita. Given that the temperature had dropped twenty degrees while I was taking the test I was sorry I had not gotten an extra-hot latte.

But San Francisco never looked as beautiful as it did on that walk back.

Guess I’ll be hanging out in the ER for awhile…

 

May 31, 2011, 9:44 am

Change of Shift – May, 2011

Welcome to the latest edition of Change of Shift, the nursing blog carnival!

Submissions to CoS are now accepted on a continuous basis, simply click the “Contact” button at the top of the page whenever you have a post you would like to submit.

I’m dropping the BlogCarnival submission route due the gargantuan amount of spam submissions it engenders. There may be a time and a place for the “Top Ten Uses for Tea Bags in Healthcare Reform”, but this isn’t it!

Let’s get started!

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Sue Hassmiller is the Robert Wood Johnson Foundation Senior Advisor for Nursing. She is also a volunteer with the Red Cross. Abandonment Guilt, her final blog post from tornado-ravaged Alabama, can be found at AJN’s Off the Charts.

Best. Post. EVER! From BabyRNDeb at Life and Times of an L&D Nurse. What a difference One Year can make!

Over at oncRN, “the silence needs to be listened to and honored.”

*****

Gina at Code Blog continues her interview series with Cardiac Cath Lab Nurse Amy Sellers (who happens to blog at Nursing Influence).

Just pulled my head out of the sand long enough to notice that Emily at crzegrl.net has morphed into Emily at FlightEMS.com! For those who did not read her story, here is After Seven And A Half Years, crzegrl.net Becomes FlightEMS.com. This gal has been blogging since 2003. Yes. You read that correctly!

Nurse Teeny has segued from hospital to the the community and finds the nurse/patient connection just as strong. So strong, in fact, she wonders Can You Care Too Much? Where do you draw the line? Posted at The Makings of a Nurse.

*****

Psychologist Romeo Vitelli has written a wonderful two-part history of the life of Florence Nightingale. There are details here I had not known before! The Bedridden Activist (Part 1) is posted at Providentia. Part 2 can be found at the link at the bottom of Part 1.

Running Wildly likens members of her code team to the pieces of a Jigsaw Puzzle in a poignant post at Running Wildly, and muses on varied chief complaints of the ER population in Save the World.

From back in January, Shrtstormtrooper (a) invents a cuss word and (b) eats a foreign object, but it’s The Cost of Night Shift, at New Nurse Insanity: Fundus Chop. Been there, done that!

*****

We all take BCLS/ACLS. We are required to do so. But IsntSheLovlei asks, Are You Ready to Save a Life? Really ready? Posted at The Dog Ate My Care Plan….

Over at The Nurse Practioner’s Place, some advice for the Frustrations of a Nurse Practitioner Student. Can’t agree with the commenter that all students cheat, though.

Okay, this is hilarious. In the “old days” there was the CCU and the ICU. The CCU nurses thought the ICU was all dirty and septic and (ewww) GI and the ICU thought the CCU was all high-brow, didn’t want to get their hands dirty and spent all their time hovering over monitor strips. Check out the Caffeine and Xanax post Scared of the SICU. Some things never change!

*****

At Your Cervix writes I Know I’m at Work Too Much When… And I thought I had crazy dreams!

Wanderer can’t believe It’s Been 5 Years? of nursing at Lost on the Floor.

Mrs. Nurse notes that An Eventful Day is Usually Not a Good Day at Tales of a School Zoned Nurse.

Elle Bieling pens an thoughtful essay on pain and emotions in The Mystery of Phantom Pain posted at The Body Window.

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So, my plan for Change of Shift is to put up an edition at least once a month, towards the end of the month. Submissions received during the month will all be posted in that edition.

I’ll also be perusing the nursing blogosphere and “collecting” posts to feature in the carnival throughout the month, so don’t be surprised if you find yourself not remembering that you submitted! : )

Thanks for reading, and keep blogging!

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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