My Most Wonderful Pulmonary Team

Wednesday, December 16, 2009 by Matthew S. Starr, MSN, RN, CNA-BC, Asst. Clinical Dir.
As a manager of a pediatric hospital there are many things that warm my heart. This past week my heart was warmed by my most wonderful pulmonary team that decided instead of adopting a Christmas family they would adopt the families of Riley Hospital and serve them two meals in our Ronald McDonald House. They served over 80 families lasagna, pie, garlic bread, and salad. These items were donated from all members of the pulmonary team who performed a most fabulous job.

It brings to mind that teamwork and togetherness on units is essential to patient care and creating a caring environment. There was one father that even began crying as the staff made his plate, covered it in foil, and assisted him back to where his child was sick, so he could eat with his wife and child. He could not believe that the healthcare workers that do so much for them already would go above and beyond to do more for them in their time of need. I have to say, I am so blessed to have an amazing team here at Riley and this is yet another example of what it means to work for Clarian and Riley, and to be the best nurse you can be.

Matt

To be a registered nurse at Clarian, visit Registered Nursing Opportunities Indiana.


Get to Know Someone on a More Personal Level

Wednesday, December 16, 2009 by Matthew S. Starr, MSN, RN, CNA-BC, Asst. Clinical Dir.
People often ask me what is at the core of a great team. I have thought about this a lot. It seems to take a lot of things to make a great team: hiring the right people, having enough equipment, good patient ratios, and collaborative MDs. Though at the core of all of this, what rises higher than any other is relationships. It is truly the job of the manager to aid in bringing a group of people together to form a relationship between their co-workers.

When staff have a vested personal interest in each other they enjoy helping one another as well. Recently I pulled my 100 member team of pulmonary staff together for a team building workshop. Over and over I kept hearing of how much they cared for one another. They have an amazing team and this seemed to be the common theme for all of them and why they had such a great team. Relationships with each other and their manager - what a great concept.

Thinking through the Studer initiatives that Clarian has been undergoing gets a lot of flack about prescriptive questions. At the core of these questions and themes for leaders to use, you can see it is developing a relationship with the staff and getting to know them on a more personal level. This is also what aids patient satisfaction. It is not always about being the best staff member, but it is the lasting relationship you leave with your patients. At times we focus so much on the clinical side we forget to establish the relationship with each other and our patients. If everyone could take away to get to know someone on a more personal level every day, what a preeminent organization we would become.

Matt

To be a registered nurse at Clarian, visit Registered Nurse Job Opportunities.


I Miss Your Mustache

Wednesday, December 9, 2009 by Sherry Holden, BSN, RN, Associate Partner
I find people very interesting. The big dichotomy of humanity is that we are all very different and very much the same. All one has to do to prove that theory is watch and listen. It will not require a government grant to collect a large amount of data nor a team of experts to publish the results. A few days on 4-Medicine at IU will suffice. Last week I had two fun encounters that have swirled in my head regarding people and how we relate to one another.

I had a patient who was quite ill and had no definitive diagnosis. We finally decided to put her in respiratory isolation for a few days until some things had been ruled out, or in, whatever your preference. I was in her room when she called her husband to inform him not to visit that evening for safety reasons. Her closing comment to him was, “I love you and I miss your mustache!” The other situation involved a man who was admitted for twenty-four hours with chest pain. When his wife came to take him home, her parting comment to me was, “I’m glad he is coming home. I miss his noise.”

So the question is, "What do we like about one another enough to miss?" I have been thinking about many people in this context: family, friends, colleagues, and acquaintances. I love my children and grandchildren dearly, but what is there that I really like about each of them? I have friends that I went to kindergarten with fifty years ago. Why have we maintained a life long connection? I enjoy the people I work with every day. Why? When I arrive, why am I glad to see the people of the night and always happy to work with the people of the day? I especially like the banter in the med room. Uncensored! When I gave report yesterday I told my replacement, “You will really like this patient.” What was there about that person that I liked enough to feel confident that someone else would like them too? Do I just like people who are like me or do I like people who are really different than I am? In order to answer that question, I have to know what I like about me.

The reality is this: there are many people that I genuinely like; more and more I am discerning why. And, that adds a richness to my life. However, at this moment, I am not sure what I think about mustaches and noise.

Sherry

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.


Team Work

Tuesday, December 8, 2009 by Teresa Weller Sundine, BSN, RN
One of the things I love about working on Neuro Critical Care at Methodist is our TEAM WORK. My co-workers are always there to help out and especially in a pinch. A few weeks ago I was asked to take a patient that had just come in that day. It was my first day back after being off for a few days and sometimes you just want to have a nice “even keel” night. Well this patient starting having high heart rates then high blood pressures and finally a change in their neuro status.

Luckily for me one of the attending ICU docs was just outside the room. I was able to get him in there quickly and from there it all went “full speed ahead.” We decided to intubate the patient, put in a central line and an arterial line besides slamming in blood products... and this was happening ALL AT THE SAME TIME! Thank goodness for all my teammates because they were all in there helping and if they weren’t they were checking on my other patient.

Even with 22 years experience you can feel like a fish flopping on dry land when these things happen. Team work and a good working relationship with your co-workers are some of the most important aspects of nursing. I love my co-workers... Thank God for them all.

Happy Nursing

Teri

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.


Nurse on the Phone: Hot Topics!

Tuesday, December 8, 2009 by Gwenn Christianson, MSN, RN, CSPI
At Indiana Poison Center our staff are called Specialists in Poison Information, conveniently abbreviated as SPIs. Sometimes I think our Registered Nurse jobs should actually be known as real Spies, since we spend so much time digging out hidden information ...

Indiana Poison Center, this is Gwenn RN, how may I help you?

“This is Kate, the school nurse from Happy Valley Elementary. Several of our parents have seen this e-mail that is circulating about alcohol based hand sanitizer and the dangers involved if children should lick the hand sanitizer off of their hands. The parents want us to switch to alcohol-free hand sanitizer. Can you tell me anything about this?”

Well, I can tell you that as long as your students weigh more than 30 pounds and are licking less than a teaspoon of hand sanitizer from their hands, they are going to be perfectly fine. Ethanol based hand sanitizers typically contain 62% ethanol, and ingestion of a teaspoon or less in a 2 year old, 30 pound child is not enough to be a problem. If you have kindergarten aged children and above, they should weigh more than 30 pounds, so they should be fine. I’d be glad to e-mail you our news release on hand sanitizer – you’re not the only school nurse being besieged by parents who have read this mis-information and are worried about it!

“Hi, this is Dr House from Memorial Community ER. I have a guy here who says he shot up heroin, but he sure doesn’t act like it. He’s agitated, tachycardic and hypertensive. I remember seeing something about heroin that was contaminated ... Can you fill me in on that?”

Sure, Epi-X had an alert out on heroin that is contaminated with clenbuterol. It resulted in symptoms like you describe – agitation, tremors, hypertension, tachycardia – plus hypokalemia and hyperglycemia. Treatment is basically symptomatic and supportive care – benzodiazepines and temperature control, plus correction of the electrolytes. Would you like me to fax you the alert?”

A weeping mom: “I just gave my baby some Motrin and some cold medicine - Then my sister-in-law told me that ibuprofen and cold meds could kill him! She saw it on the internet! Should I take him to the Emergency Room?”

No, ma’am, you don’t need to take him to the hospital, he’s going to be perfectly fine. I’ve seen that internet entry too and it’s not true at all. It’s what we call an urban legend, or what they used to call an old wives’ tale. Ibuprofen, which is what’s in Motrin, and Dextromethorphan, which is the cough ingredient they’re concerned about, are not toxic together. Both are safe when used as directed, together or separately. I’ve checked several drug interaction sites and they have no drug interactions, and I’ve also checked some reputable web-sites that investigate web rumors like this and they say there’s no support for this one.

Gwenn

To be a registered nurse at Clarian, visit Nursing Jobs Indianapolis.

Girl Power!

Sunday, November 22, 2009 by Tracy Davis, BSN, RN, CCRN, Pediatric Critical Care
How much fun was it to be a part of Girl Power last weekend?! Clarian sponsors this high-energy, fun event. It is aimed at giving young girls ages 7-14 a sense of empowerment, improved self-esteem, and just a better sense of what it means to be a strong, independent young woman. That alone is worth the effort to go and work all day. About 1000 girls were there enjoying the many things the day had to offer. Such things as a cooking demonstration, fencing, dancing galore with Radio Disney, hula hoop contests, building birdhouses, listening to Tamika Catchings of the Fever, jump rope demonstrations that defied gravity, and then there was my station.

We had a close up and personal look at germs…cooties…bugs…call them what you will, but it was all about hand hygiene. At first the kids were ever so slightly grossed out when I told them we were going to put on a special lotion that would fluoresce their hand germs when we looked at them under a special light. Then they couldn’t help but smile, and wanted to see what we could find. I loved it. After that we washed with alcohol-based hand sanitizer and looked again at the difference. It was a small but powerful science experiment, especially at the height of cold and flu season. I figure anything I can do to contribute to knowledge, empowerment, and a smile about cooties is a day well-spent. I am glad to be a part of a team that values this unique opportunity to care for children in a very different, diverse way.

Tracy

To be a registered nurse at Clarian, visit Jobs for Registered Nurses.


Policy and Ethics in Brief: Privileged to Visit

Sunday, November 22, 2009 by Lucia D. Wocial, PhD, RN, CCNS, Clarian Nurse Ethicist
It was not that long ago that Clarian endorsed an open visitor policy. As an organization we recognized how family presence contributed to the well-being of our patients. I often hear nurses express concerns about the fairness of the visitation policy. Patients aren’t prisoners, so who are we to tell them who can and cannot visit?

We value family centered care, but that does not mean families may do anything they want. The Clarian policy on visitation provides a lot of latitude to customize visitor guidelines to meet the needs of the patients on individual nursing units.

The flexibility may lead to questions of fairness. One way to decide if the guidelines are applied fairly to different patients is to ask “are we meeting the needs of the patient?” If the visitor is meeting a patient need, aren’t we obliged to meet that need? Most would say yes. So when is it ethical to deny a patient something they need?

Sometimes our duty to protect patients from harm means we have to give up something that might be beneficial. This can happen under normal circumstances when a family becomes disruptive or when visitors pose a potential risk, as is true now with the H1N1 virus.

The policy on visitation places the responsibility and the authority to determine what is in a patient’s best interest squarely on the nursing staff. Not all nurses are alike however, so again, how do we make sure the implementation of the policy is fair?

When nurses decide to make an exception to the visitation policy, they must communicate the reasons not just with patients and families, but with other members of the team. When exceptions are made the criteria used must be transparent for all to see so that a reassessment can occur as the situation warrants.

Consider what is relevant, the need being met, the benefit to be gained and the harm to be avoided. Fair can mean different. When fair is different, we have an obligation to be transparent about the criteria we use to enforce a policy differently.

Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.


An Hour in the Life (with a few exceptions for repetitions)

Sunday, November 22, 2009 by Gwenn Christianson, MSN, RN, CSPI
Indiana Poison Center, this is Gwenn RN, how may I help you?

8:00 am “My 20 month old, 19 pound daughter just took the medicine we had laid out for my 12 year old son. That’s Concerta® 36 mg, 2 tablets. Will she be OK?”

“Well, she’s going to need to come into the Emergency Room and be monitored for awhile. This is a pretty strong medication and it can affect her heart and her neurological status. But I think with appropriate care she’ll be just fine. What hospital will you take her to?”

08:05 am I called report to Community Memorial ER about the child who ingested the Concerta®. Talked to Kylie RN and suggested Activated Charcoal PO, EKG monitor, benzodiazepines if symptomatic, monitor for at least 6-8 hours for this SR product.

08:07 am “My 2 year old son just drank some cologne! He’s spitting and carrying on something awful! What should I do?”

Cologne has a lot of alcohol in it and it tastes horrible. However, a little bit of it’s not going to harm him. Wipe his mouth out with a clean wet cloth and start him on some juice or Koolaid, then bring the bottle back to the phone …

08:32 am I’m 79 years old and I do NOT have dementia. But I think I just took a double dose of my Tylenol Arthritis Extra Strength. I usually take 2 tablets 3 times a day, at 7 am, 3 pm, and 11 pm. But I got up early this am and took my Tylenol at 7 am and I think I took it again just now!”

One time a double dose of Tylenol®, even Tylenol Arthritis Extra Strength®, should not harm you. But you will need to restrict the total amount of Tylenol® that you take for the day, so you don’t take too much for the 24 hour period. I suggest you skip your 3 pm dose and resume your dose at 11pm, OK? Or you can check with your Doctor’s office and see what they say.

08:44 am This is Officer Mitch Jones calling from Happyvale Police Dept. and I want to identify a pill confiscated at a traffic stop. There has been no exposure. It’s a round yellow tablet with the imprint TL 177.

This is cyclobenzaprine, common name Flexeril; it is a prescription but not a Scheduled drug.

0851 am This is Deb RN calling from Memorial General ER. These parents just brought in a 7 month old who chewed on a paint brush that had been dipped in oil based paint, wrapped in tin foil, and stored in the refrigerator. He is coughing and spitting. He seems to be oxygenating OK, as his color is good and his biox is 98% on RA.

OK, oil based paint is a concern because it is a Hydrocarbon and if even a few drops are aspirated into the lungs, it can cause a nasty hydrocarbon pneumonitis. Treatment is basically symptomatic – O2, RT treatments, CXR, biox, ABGs – the usual. Real rarely these kids will require mechanical ventilation. Antibiotics only if there are signs of a secondary infection and no need for steroids…

Gwenn

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.


Nurses Should Dress Professionally

Sunday, November 22, 2009 by Laurie Barth, BSN, RN
I was visiting my niece in the hospital a few weeks ago. She was at another facility in Indy, had her own private room and received very good care. However, as I was sitting in her room and visiting, her nurse came in to check on her. (Now watch out, I am going to get on a soap box.) I truly believe that nursing is a profession. We, as nurses, have a tremendous amount of knowledge in our heads. Our patients expect us to know our stuff and to manage their care appropriately and efficiently while they are in our care. Why wouldn’t we want to dress the part of a professional? The nurse that came in and checked on my niece had on nursing scrubs. Appropriate, right? But what wasn’t appropriate was that when she bent over to read the measurement on the pleurovac, I could see her underwear and half of her bare bottom!

Now wait. I don’t consider myself a prude by any means. But I do care what people think of nurses as a whole. Think about it. How do you want to be viewed when you are at work? Think of those men and women who you consider professional. How often do you see a lawyer or physician walk into a room with their clothes wrinkled and stained? Or the shoes scruffy? Or too much skin showing with tattoos and piercings blatantly glaring at you? Think about it. Aren’t you a professional nurse with critical thinking skills tasked with the utmost care of another human being? Be proud. Demand respect. Dress the part.

Laurie

To be a registered nurse at Clarian, visit Registered Nursing Opportunities Indiana.

When the Power Goes Out, We are Empowered

Monday, November 16, 2009 by Sherry Holden, BSN, RN, Associate Partner

Instantly, the power is gone. Darkness prevails. If you think about it, most of us are not comfortable with darkness – we are hard-wired for light. Twenty-three hours of darkness at IU Hospital this week was an interesting challenge. I’m sure debriefings have run the gamut of every department within the system. I’d like to add my two cents with a few observations from my perch on 4South.

There is a plan. Disaster drills are such a nuisance – especially when you are in charge and the day is horrendous. So are fire drills when it is 0705. And, code drills. Nonetheless, they are all the foundation of preparedness. I suppose the people who are responsible for all of this stuff are going over the details with a fine-tooth comb. From my vantage point: It’s a good plan, and it worked.

People become very resourceful and depend on one another when it is dark. Night shift people can verify this in particular. I understand morning blood draws were more than interesting. So once again we revert to what we learned in kindergarten: “Hold hands and stick together.” Teamwork is a great force.

4South had the benefit of a few working computers. We had to share. It worked well. By and large, people do not want to PAPER CHART. I even found myself being one of them – imagine that!

Patients are very resilient. Given the appropriate information they respond in kind. From the moment a patient is admitted to the hospital, they become dependent. I find it amazing how people respond in that state when given “appropriate information.” I also find it interesting how communication and relationships change when we are all in the same boat: We bond quickly.

Management was right there with us. They were visible, available, resourceful, dependable and appreciative – working for the common good. Why is it that we don’t always see them in that light? I even had a few personal minutes with the Chief of Staff. How special was that!? What he offered was encouragement.

During the day, the unit was quiet. We had limited light, fewer people using our space and a slower pace. It was nice.

We will all have stories to tell. Over the years I have endured many situations without power – some of them lasting for several days; most of them weather-related. We will have fun remembering.

Without electricity, how would we function? Think about that for a minute. And then, think about this: When the power goes out, we are empowered, and the power of the individual is endless.

Sherry

To be a registered nurse at Clarian, visit Registered Nurse Job Opportunities.
 

Who Doesn’t Like to Play Cashier?

Wednesday, November 4, 2009 by Tracy Davis, BSN, RN, CCRN, Pediatric Critical Care
It seems as though there is always something new to learn here. This past week, we integrated a new, safer way to care for our patients using barcode technology when administering medications. More than a few staff said it made them feel like a cashier scanning items at a checkout, and it was a piece of technology that was fun to learn to use.

I like the fact that while there is always a human involved in the process of giving a patient fluids and medications, this little whiz-bang can help us bring more safety to our care process. There is a learning curve in every new change. It is one more item to work into an already established routine. But one of the many things I love about this PICU staff is how well they embrace technology and run with it. Not only are they not troubled by it, but also they seem to find ways to improve it and make it work better for them and our patients.

Whenever there is an event where we are introducing new gadgets, charting, etc., into our workflow, we have extra staff around to assist and troubleshoot. Most units call these people “Super Users.” We have always affectionately referred to them as “Super Losers.” They know this is said in the most loving way possible and is truly a term of endearment. It is a true spirit of teamwork. It is so reassuring to know that when we have something new come into our world, it will be a smooth, seamless transition. That is a testament to the dedication of this fine group of skilled clinicians. I’m just glad to be one of the “cashiers.”

Tracy

To be a registered nurse at Clarian, visit Jobs for Registered Nurses.

Nursing Recruitment Lesson: Don't Take Vacation When Hiring Student Nurse Externs

Tuesday, November 3, 2009 by The Clarian Health Nurse Recruitment Team
The past month has been one of the most challenging times for me since I started working in Nurse Recruitment at Clarian nearly a year ago. I’ve been given a new and amazing support specialist; and I took on responsibility for recruiting Student Nurse Externs (SNEs) in addition to Critical Care nurses, LifeLine nurses and ER or emergency nurses.

I put out a “call” for those who had been on the student nurse waiting list since Feb/Mar and contacted our Clarian nursing scholarship recipients to measure interest for 29 positions that I was asked to fill. Wow! The response was tremendous, and the candidates had to compile and provide a portfolio of four documents before we determined their availability for interview.

I took a week’s vacation while deep in the throes of this work and came back to the most stressful week I’ve had in Nurse Recruitment! Getting everything organized, setting up over 50 interviews (for student nurses alone! This did not count the RN positions!), catching up on an e-mail in box that was to its limit and voice mails that filled my box to capacity literally gave me a headache that lasted for three days!

After eight days of catching up and a couple of extra long work days that required some work at home, I finally did it! I caught up! What a sense of accomplishment as well as what fun getting to meet and help place these eager SNEs into their very first nursing positions.

Lesson learned: NO vacation during the peek SNE hiring months!! Tee hee (of course my vacation was planned well in advance of my taking on this responsibility). After six years spent as a nursing manager, I have learned to just accept that it is always hard to get away and always hard when you come back. From the recruitment perspective though, it was much more challenging because my job is customer service and many things just waited on me to return and pick up where I left off!

Julie

Julie Ruschhaupt, BS, RN, Clarian Health Nurse Recruiter
JRuschhaupt@clarian.org
317-278-7082

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.

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Medical-Surgical Nurses Make a World of Difference

Tuesday, November 3, 2009 by Sherry Holden, BSN, RN, Associate Partner

November 1-7 is designated Medical-Surgical Nurses Week. This is a time set aside to celebrate and appreciate Med-Surg nurses. When I first became involved in the Academy of Medical Surgical Nurses and became aware of this week, I wondered why we needed another week in addition to Nurses Week in the spring. Over time I have grown to appreciate the difference.

During Nurses Week, I set aside a bit of time to reflect on why I became a nurse. During this period of time, I think about why I am a medicine nurse. Why did I choose this specialty, and why in the world have I stayed with it for forty-two years?!? Medical nursing is never really a comfort zone. Just when you think you know something, it changes. There are many specialties that are more glamorous than medicine. And there are many places in the system where people don’t have to work at such a crazy pace or have an odd appreciation for chaos.

Over the years I have done many interesting things within the framework of medical nursing, and I have had opportunities to do numerous things in other areas, but have never made the leap. Four years ago, after my round with cancer, I was sure I would never be able to keep up with 4-medicine again. I interviewed several places and was offered a couple of very interesting jobs, but I couldn’t make the move; just couldn’t imagine myself without liver patients!

Medicine is always a challenge. It is about critical thinking, honing one’s senses and developing keen assessment skills. It’s about team-work at its finest. Many years ago I referred to medicine as the “theater of dependency.” We like to think of ourselves as very independent practitioners, but in reality we rely on each other constantly. Medicine nurses have very distinctive personalities - need I say more? Let’s just consider IU 4-medicine for a brief moment... (How wild and whacky was that?!?) I guess medical nursing gets in your blood. Over the years, I have had three criteria for staying the course in any position I have held: am I learning, am I having fun, and am I making a difference. If all of those things are operational, I am pretty content. Medical nursing has been a place of satisfaction for me.

I was pleased with the slogan for this year: "Medical-Surgical Nurses: Making a World of Difference." Medicine Nurses share an umbrella with Surgical Nurses. Somewhere along the line, I have made a distinction because I am pretty much a pure medical nurse. I hope I haven’t slighted any surgical nurses in this blog, because I can tell you right now, I have a great appreciation for what you do. Actually, I pretty amazed at what you do! I think you know that as truth because when I float to your areas a lot of hand holding occurs to get me through. For some reason it is hard for me to wrap my brain around all that cutting and pasting! So, to all of my colleagues in Medical-Surgical Nursing, enjoy the week, share your stories. re-commit to your specialty and never doubt for one moment that you indeed “make a world of difference.”

And, if you are out there as an “undecided,” consider Medical-Surgical Nursing, because it could make a world of difference in your life, too.

Sherry

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.
 

Technicalities

Saturday, October 31, 2009 by Gwenn Christianson, MSN, RN, CSPI
Vicky, a school nurse called. A special-needs student, a little boy aged 8, had eaten a good portion of a toy. “Well, not the toy itself. It’s this special kind of “Real-Life Reptile” and he chewed a hole in the tail and ate a bunch of these little white beads …. what we want to know is if those beads are toxic or not?”

First I established that the little boy, Ricky, was generally healthy and having no obvious problems at this time. He had been given a glass of water to drink and was doing so without problem. They estimated the amount of beads he had ingested as ¼ cup….

"Do you have the original packaging on the toy, and does it say non-toxic?"

"Oh no, we never keep all that stuff."

"Then do you know the manufacturer’s name or number?"

"Only what it says on the tag..."

Turned out the tag said the product was a "Real-Life Reptile" made by Boinky Ball Toys (all names changed to protect the innocent), but nothing more. The particular reptile he had ingested was a "Fast & Friendly Gecko," blue-green with bulging orange eyes and red toes.

I did a quick search on our Poisindex© system – neither the toy nor the manufacturer was listed.

Then I did a quick Google© search – and voila! Boinky Ball Toys was listed, and so was our little reptile friend... unfortunately there was no information on the contents and their potential risks if ingested.

I advised Vicky that I doubted this was a toxic exposure, as toys are generally made with non-toxic components, because kids do tend to nibble on them. I suggested that I take her number, and that I would call the company and track down the actual ingredients, just to be sure. Meanwhile she would closely monitor little Ricky. She was agreeable with that approach.

I called Boinky Ball Toys and spoke to Tiffany in their Customer Service department. Eventually I got her to understand that I wasn’t interested in placing an order but I needed to speak with someone in charge of product development, to find out what the product was made of. Then I spoke to Shelly, who said I needed to talk to Dave, "but he’s in a meeting right now, may I have him call you?" I explained, yet again, that we had a child that had EATEN their toy and we needed to know sooner, rather than later, what the toy was composed of. Shelly promised to interrupt Dave’s meeting.

A few minutes later, Dave called back. He had obtained the MSDS on the toy and was pleased to report that the white pellets were vulcanized plastic and totally non-toxic. I thanked him for his time and called Vicky back.

"Good news, it’s just plastic, completely non-toxic," I told her. "The only risk would be a concern for obstruction, but that’s unlikely since the format that Ricky swallowed was all tiny pellets." Still I recommended that he be fed a high fiber, high fluid diet for a few days and that he be watched for any signs of an acute abdomen. Of course, if he developed any symptoms, he should be checked by his FMD and that the physician needed to be informed of this exposure.

When Indiana Poison Center opened it’s doors, in 1977, nurses used a microfiche to look up general topics and made a general guess as to their contents. When I joined IPC in 1988, they had recently moved to a computerized database, Poisindex©, which tries to list every possible substance and it’s ingredients, with general directions on managing each. Since the early 2000s, with the advent of the internet, we’ve turned more and more to Google© and other search engines to help us find things that have yet to hit the database. But often technology is still not enough and it comes down to basic research and personal interaction to find the information that we need.

Was all that necessary? Well, I could have slept pretty well that night, knowing that the chance was 99.9% that Ricky’s ingestion was non-toxic... but I’d rather take the extra time, make the extra calls, and make 100% certain there was NO risk – treating that child like my child. So that’s what I did.

Gwenn

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

Moral Distress Survey Says...

Friday, October 30, 2009 by Lucia D. Wocial, PhD, RN, CCNS, Clarian Nurse Ethicist

The results are in from a June survey about moral distress... but before “the big reveal,” it’s important to highlight a few key points.

Moral distress occurs when you believe you know the correct thing to do, but something or someone restricts your ability to pursue the right course of action. It doesn’t mean you have weak morals or that you are acting unethically. It is about a sense that you are not fulfilling your moral obligations, your core values are violated and your moral integrity is at risk because your “ethical” actions are restrained.

Moral distress can affect nurses’ physical and emotional well-being, as well as have an impact on their professional practice. When nurses are affected, patient care also may be affected by nurses distancing themselves from patients, resulting in patients receiving less attentive physical care. Moral distress also contributes to nurse turnover.

More than 1,000 nurses responded to the June survey, allowing us to evaluate a new tool for moral distress called the Moral Distress Thermometer (MDT). The MDT works a lot like a pain rating scale. It’s easy to understand and takes less time to complete than a 38-item survey that until now has been the standard tool for detecting moral distress in nurses. While the MDT is sensitive to detect moral distress in nurses, it cannot identify what may be causing the distress; that data has yet to be analyzed.

Clarian nurses surveyed in June were more likely to have a Bachelor’s degree or beyond, to be certified, and to work in critical care areas. Overall, the moral distress of respondents was 3 on a 1-10 scale. Perhaps the most significant finding of the project was that nurses who answered “yes” to the question “have you considered quitting a job because of moral distress?” scored higher on the MDT. In fact, 30 of our survey respondents had scores high enough that we can say they may be at risk for leaving their current job because of moral distress.

Here’s your challenge: We know through other research and our own experience with Unit-Based Ethics Conversations that having the opportunity to discuss ethically challenging situations is helpful. If you think your moral distress score is high, talk to someone.

Vicky Lachman put it this way, “The space between knowing and acting is bridged by moral courage.” Moral courage is the willingness to take a risk to protect your core values. What are you waiting for?

Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist

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Nursing Patients and Patience

Tuesday, October 27, 2009 by Teresa Weller Sundine, BSN, RN
As nurses we have patients, but we also need to have PATIENCE! In our world everything is needed NOW or 10 minutes ago. Our work environment many times seems to be in crisis and we get frustrated.

Some examples are July of any year we get new... I mean brand spanking new residents that to us seem completely incompetent because we forget that they are just like us. They are just starting to find their way in the medical world. We forgot that WE were once brand new too and although we THOUGHT we were smart ( like our teenagers) and knew everything, we realized quickly that we have a long way to go to know everything. We must help the residents along just like we help our fellow nurses along.

Each year, actually several times a year, we get the new nursing graduates. They have 12 weeks of orientation and then several weeks of mentoring and we let them fly. What we need to realize is they are still fragile and need to be handled with care. We need to get to know them... see what makes them tick and help them to grow stronger and more knowledgeable. This is where the patience comes in because many times our personalities clash or WE are frustrated with life or work so we LOSE our patience. It may have nothing to even do with that person, but we let our own personal lives run our work emotions. We must all remember back to when we first got out of school and entered our first job. I know it was scary and sometimes it still is. I thank all the nurses that were patient with me and helped me to grow and I hope I show my fellow employees the same thing.

Nursing is a very rewarding profession not only monetarily but emotionally, intellectually, and friendship-wise. I love the people I work with and I am very glad they are there with patience for me too.

Happy Nursing

Teri Weller Sundine BSN, RN

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Expecting the Unexpected

Saturday, October 24, 2009 by Tracy Davis, BSN, RN, CCRN, Pediatric Critical Care
In our line of work, life does literally change in a moment... a blink of an eye... a turn of the head... sometimes forever. Our nursing staff prides itself in rising to the challenge of helping families deal with these moments. Moments where the floor falls out from underneath the feet of parents. Where their breath leaves their body. Where their stomach feels as though it has been punched by Evander Holyfield. It is definitely not the kind of nursing everyone gravitates towards. But as for me and my family in the Pediatric Critical Care Unit, we love it. In the past week, that notion has been strongly reinforced. There is just nothing like helping a parent through that time of crisis. Though we can not possibly know how they truly feel, we can surely give them all of the emotional support we have. It is a simple concept: treat people the way you would like to be treated. Parents never forget their time with us, the entire memory of an event that will last their lifetime. It is clear our actions and words have the power to make those memories better or worse. I would like to think we make connections with our families that endear us to them for a lifetime. I know that long after they leave, we certainly never forget them. It is a gift to guide them through unexpected events and show them a path to navigate the chaos. No wonder I wouldn’t do anything else.
 
Tracy
 
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This Is My Job, This Is What I Do

Monday, October 19, 2009 by Gwenn Christianson, MSN, RN, CSPI
All morning long the phone has been ringing and everyone I’ve spoken to has apologized for calling me. “I’m sorry for bothering you.” “I’m sure this is nothing, but … ” “This is a stupid question.” “I feel really silly bothering you with this …”

And all morning long my response has been some version of “There are no stupid questions,” “It’s no bother at all,” “I’m here to help you,” or “That’s why we’re here.”

It reminds me of an old song, but I can’t for the life of me remember what it is ...

Click for Indiana Poison CenterOne of the major challenges in working at Indiana Poison Center is persuading the public to call us right away, and not to wait for symptoms to develop. Despite all of our attempts at educating the public, a great majority of callers still worries about “bothering” us with trivial calls. So we go on attempting to educate, one at a time, that there are NO trivial calls and we welcome ALL calls. The best policy when it comes to poison control is better safe than sorry.

I don’t expect the average parent to be able to recognize or determine when a toxic exposure has occurred. I do expect them to realize when a non-food substance has been ingested, sprayed into the eyes, inhaled, or spilled on the skin, and to call for help right away. MY job is to help you determine how serious it is.

I don’t expect a parent to know which will be a problem: ear drops or eye drops (it's eye drops), Advil infant drops or Tylenol infant drops (Tylenol), Grandma’s beta-blocker or her ACE-I (BB), or pansies or petunias (neither). Figuring out what is toxic is a complicated process. It involves more than just the substance, but also includes the patient’s age, weight, PMH, current condition and other pertinent factors.

So, our conversation continues. Most of the time the exposure turns out to be a trivial event. Occasionally it is a serious situation and we send that child to the nearest ER. But even the calls that are not emergencies are important – they give me a chance to interact with the parent, to do some teaching regarding normal childhood development and poison proofing, to discuss when it is appropriate to call the PCC (always!) and to send them some educational literature about the PCC.

So the moral of the story is – ALWAYS CALL US. We’re here to help!

And thanks to Google, I found the song I was thinking of. It’s by Conway Twitty and the words are:
     That’s my job
     That’s what I do
     Everything I do is because of you
     To keep you safe, you see ……
     That’s my job.

Gwenn

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Have Fun, But Get Your Mandatories Done First

Thursday, October 15, 2009 by Sherry Holden, BSN, RN, Associate Partner
Sometimes you look back over the past month and say to yourself, “What just happened?” You discover that you have compacted time and squeezed every minute to its limit. Instead of taking a breath and enjoying a bit of fall, you ratchet it up a notch and say “what’s next?” I’m doing spin-off lists now so I can basically keep track of who I am, what I’m doing and where I’m going. Maybe I need a blueberry!
 
I’ve been trying to complete my MANDATORIES. I can never seem to get them done during patient care time, so I have to wander in at strange times on my days off. I consider mandatories a necessary nuisance, especially now that I have to go in to do them. I liked the good ole days when I could do them from home in my pajamas on a Saturday night at midnight. I am one of those people who actually read every word and often take notes on things that are new. I also find interesting stuff at times that I might have known at some point in time and have totally forgotten or find that it really is new and I either like it or I mull it over in wonderment. I’ll not expound on the latter but can give you a prime example of the former. Did you know that the brain is 2% of the total body weight, uses 20% of cardiac output at rest, utilizes 500ml of oxygen and 75-100mg of glucose/min and requires optimal perfusion of 50ml of blood/100gms of brain tissue /min.? No one thinks about this stuff until October; unless, of course, your world is neurology.
 
My world is not neurology. I spent last week working in Video Seizure. I find it all very fascinating but I am not comfortable with it. I am getting better but I can tell you that Nik & Marz are pretty impressive with the whole scene. They are finite in reading the monitors and responding accordingly. It is the one great thing I like about the nursing profession, we all seem to find a niche over time and have the ability to excel in that arena. I even have trouble answering the phone in seizure! Try this a few times: "Video Seizure, this is Sherry." That must do something odd to brain waves!
 
I also managed to go to Reno this month for a long weekend to visit my college roommate and a grade school friend. What a great interlude! You can’t beat spending time with people you have known for 46 and 55 years. We went to Tahoe, Virginia City, Carson City and the unexplainable Harrah Auto Museum. Couple that with airplane snafus and every weather pattern imaginable, and there are great stories to be told.
 
I am a great believer in managing time to allow for fun as often as possible. We clog our lives with so much it is imperative we find time to make a few memories. As my sister would say, “We all need marker days”.
 
(Good rates to Florida - temp is 90; check it out! But, get your mandatories done first!)
 
Sherry
 
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Boom Boom... Pow!

Saturday, October 10, 2009 by Tracy Davis, BSN, RN, CCRN, Pediatric Critical Care
With all due respect to the Black Eyed Peas, that is kind of what life has felt like for me lately! My life as an Interim Clinical Manager is quite busy. As I think about it though, it is not like my previous roles left a lot of down time. This is just a very different kind of busy. I love rounding on our families. It is when I get to see all of the kids and parents at once, hear their stories, and really get to know them. It is a compelling time. Even if it is a child with a short length of stay, I know I can learn something from their story. It is what I truly love. I know that I can answer questions that will help fill in the gaps, or maybe just repeat the same information so it sinks in a little better. Each interaction means something to both of us. I think if I feel that, surely a parent does, too. I have a different role with my staff now. I would like to think it is helpful to them that someone who knows how important responsiveness is, will be “taking care of them.” They know I take the responsibility seriously. So as more things, more responsibilities come at me like they are shot out of a cannon, (hence the “boom boom pow”), I say... bring it.

Tracy

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