Awww. *gush*

I've been taking care of a particular family for 4 nights now, and they've been through a lot (mainly jaundice/bili lights hell).

Last night they bought ice cream for the unit. Really sweet of them. I am a sucker for ice cream. It's always cool when patients give us snacky-things.

But tonight was the first time I've had a letter written to me. The dad handed it to me, in an envelope made of a sheet of printer paper held together with paper tape lol.

Dear PurpleRN,

Thanks for all the care, support and guidance that you extended during the most anxious and memorable time. We truly appreciate your dedication

- [family]


I'm feeling super good right now. It's a nice thought to fall asleep to.

Gah. Circumcision rant again.

So I had this unfortunate baby yesterday that was born by vacuum-assisted C-section after a failed vacuum-assisted vaginal delivery. Apparently he got good and stuck.

After a vacuum delivery, it's pretty common for the baby to have a good-sized circle of bruise on the head (like a giant hickey) where the suction cup was placed.

This poor kid had actual scabbing and exudate (ie, "goo) on his head around the edges of the bruise. I'm guessing they tried too hard with the vacuum and broke the skin.

So naturally, the kid is kinda grumpy and fussy. His head hurts.

Then the parents decide to get him circ'd. This poor baby was inconsolable. I would be two if I was hurting from both ends. I wish someone would've tried to convince them to at least wait until his head was healed up a bit.

I ended up calling the NICU on-call doc to beg for a tylenol order for the kid. He was finally able to sleep for a whole hour and a half at least. That's all the sleep he got during my 8 hour shift. And they only gave a one-time order :(


Then I had some parents last night who asked about getting their son snipped and when they should do it. My brain immediately went "Never!" but I told them that if they can wait 24 hours until he has a chance to improve breastfeeding, it'd go better for them. Mom's a c-section, she'll be here a couple days. No skin off their back.

And then I go to change the kid's diaper. Poor thing has a mostly-buried penis. I think if they get him snipped, there won't be much of anything left! We'll see how things are when I go back tonight, if they've done it or not yet.... Mom seemed a little on the fence about it. Fingers crossed for them.

According to the latest data, only ~35% of West Coast babies are circ'd now ( http://www.cirp.org/library/statistics/USA/ ). It'd be nice if we could get it a little lower...

50 Things Your Nurse Won't Tell You....

I was contacted recently by a writer for Reader's Digest who was putting together one of their famous "50 things" lists. She found me through a comment I posted to one of Head Nurse's blogs ( http://head-nurse.blogspot.com/2011/04/last-minute-request-for-minions.html ) back in April.

Apparently she liked my quip, "I may not decide whether or not you need an injection, but I do decide the gauge of the needle involved..." and decided to ask for some more ideas for the project.

I won't share any of them here, of course. That would ruin the article.

But the request got me thinking. It was actually really hard to come up with good "sound bites" within the topic, because, as a nurse, I live for telling my patients things.

Nurses are educators and advocates, and one of the keys to our job is keeping our patients well-informed. Communication skills are right up there with "how to take vital signs" in the list of important things we need to do.

So I answered the topic more along the lines of "Things Your Nurse Wishes You Knew" or "Things Your Nurse Wishes She Could Tell You" with a bit of a twist in the wording.

I'm very curious to see how the article comes out.

Also curious what my readers (all 4 of you lol) would write for this topic? Anything you really wish your patients knew? Or that you'd never tell them?

A short happy :)

This happened a couple weeks ago, but I just remembered it and it made me smile.

[Setting - almost end of shift]

Patient: Will my next nurse be as nice and helpful as you?
Me: [laugh and grin] Nope. I'm the best one here! All the others are terrible!
Patient: You really are the best one here. I hope you're coming back again tomorrow.


Makes a girl feel good at the end of the day....



[I would *never* actually downsell my colleagues. I work with an amazing bunch of nurses! It's really nice that we have each others' backs, and we always try to upsell the oncoming shift when we do handoff in the room]

A short rant about communication skills.

In a hospital setting, good communication is crucial. It can literally be a life or death issue. And even in the cases where it is not, a lack of communication can seriously Fuck Up Your Night.

Last night I was assigned to work in the Overflow Unit, a section of rooms in Pediatrics where we put the Moms that don't fit on the main unit.

I was originally assigned 3 patients, but one of them was halfway out the door. I just had to finish the last of the discharge paperwork and snip off the baby's security tag. Okay, cool. Down to two.

The Break Relief nurse told me to get Room X ready, because I was going to get the next admission. Didn't tell me the name, or when she delivered. I had to do some sleuthing and guess-work to figure out who was the next likely candidate. Okay, fine. It happens.

Then I get a call from L&D asking if Room Y was clean for my new admission. I explained that X was clean and ready, because that's what I'd been told to set up. She said "Right, pt A is going into room X, but she's not ready yet. Pt B is going into room Y." Huh? Who is pt B? "Also, make sure room Z is clean as well." (apparently for the other nurse on overflow with me).

So we scramble to get Y ready, and call housekeeping to clean Z (where I'd DC'd my other patient from). I'm trying to read up on my incoming patients when all of a sudden I see the room number for incoming-patient-B switch from L&D to the Main Floor, not Overflow as expected. Huh?

Apparently one that *they* were expecting was not doing well, and being kept in L&D longer, so they decided to move my patient to the main unit and give me the next one that came along.

It's 0445 when Patient A shows up, strangely lacking her baby. Apparently he was cold and they kept him under the warmers for a bit? Her husband was strange, maybe Asperger's? Obsessed with taking photos ("the lighting in here is terrible, and the white sheets are washing out the picture") while mom was clearly exhausted. Got her settled (the other nurse's patient came in while this was happening) and finally got to go on my break at 0520.

Back from break at 0550, got a 10-minute head's up, and then my New Patient B came to the floor. Did I mention I had 6am meds to give on practically everyone? Got B settled, managed to pass my meds mostly on time and waited for the Day Shift to arrive and rescue me.

And not *once* did my Charge call us to let us know what was going on. I had to call her. I understand what it's like to be busy as Charge. I used to do it on Tele. It sucks when you've got admits on all sides. But I made *sure* to call my nurses and let them know "You've got Mr Smith coming in, he's going into room 1234" as soon as I figured it out. There is nothing more unsettling to me than getting a call from the other unit going "Is the room ready?" and you having to ask "Which room and for what patient?"

I cannot handle not being kept in the loop. And I know that the Charge Nurse knows that this stuff is going on; she's the one making the decisions about who goes where. She changes the information on the L&D "Chalkboard" on the computer, but I am not sitting in front of that screen all shift waiting for information to pop up.

It is *not* that hard to call me and say "Miss Jones delivered at 0100, she'll be going into room 4321" It takes 30 seconds, and makes my night run sooooo much smoother. I know it's doable.

Apparently word got to the Charge that I was not happy, and at the end of shift I got an apology/excuse but no reassurance that it won't happen again.


Looking at what I've just wrote, I realize this is not a short rant. It is a long rant, and for that I am sorry. I just value thorough communication :)

An overheard conversation....

As a fix for our staffing problems, the management has decided to cross-train L&D nurses to float to Mom/Baby if we are short. One of those L&D RNs was having her first orientation day on the unit. Our scene finds us sitting at the station; they are discussing the pertinent info for shift report, and I am charting about 10 feet away.

[a muffled scream filters down the hallway]

L&D RN: Um, what was that?
MB RN: Sounds like a natural childbirth to me. *grins*
L&D: You guys can hear that all the way down here....?
MB: Yep. Especially if it's one of the rooms at the end of our hallway here.
L&D: [looks concerned] We had no idea you guys could hear things over here. I'll make sure to close the doors next time I have a mom without an epidural.

I dunno why but this brief exchange made me giggle like crazy.

I may have a problem....

Ok, so this might be kind of stupid.... I'm watching through all of Xena right now on Netflix, and I'm on the last episode of season one. One of the side characters is in labor, spending most of her time sitting off on the sidelines while the main action is occurring.

Cut to her lying on her back with her legs bent, and another character is telling her that the baby "hasn't come down at all" and I'm thinking, "Dammit, woman! You're an Amazon! Get off your back! You're better than this!" (also, since when did ancient greek warlords know anything about childbirth?)

And then they determine that the baby (apparently a half-centaur!) is breech and she has to have a C-section using candle-related hypnosis as a method of anaesthesia and the baby that comes out could *not* have fit inside that woman and then I realized I need to stop taking things so seriously.....