Blog entries

What Should I Bring on the First Day of Nursing Clinicals?

Don’t be like me.  A long time ago in an ICU far, far away I showed up for my first day of work with a cable-guy sized storage clipboard and a 5-pound double-belled stethoscope slung over my neck.  I whipped out my brick-sized PDA and licked my stylus (I know) just as I looked around and realized how cool I wasn’t.

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Have you seen my stylus?

Choosing the right tactical equipment for your first day of nursing is a little overwhelming.  I know that I was sweating like a gypsy with a mortgage the night before, stuffing my clipboard with unneeded items.  In America’s online economy of instant gratification, some people wind up with “paralysis by analysis”.  This is when you become deluged with consumer choices.  Throw in a little paranoia about your first day at the hospital and you’ve got a recipe for an overdrawn Amazon account.

Let’s talk about the actual tools necessary to get the job done efficiently, intelligently, and comfortably.  Coming prepared is essential as nurses can quickly become swamped with screeching call lights and overdue order sets.  There are certain pieces of equipment necessary to get the job done, so let’s review a list of things to consider bringing on your first day!

  • The right pen

This is an area of deep obsession and constant modification.  One’s pen is a tool of the trade and a weapon in the arsenal of nursing that is so personal I hesitate to give advice.  I look for retractable, fine point, black pens that are reliable.  Given that this device will be used constantly throughout your shift, affordability takes a backseat.  I recommend the Pilot G2 Retractable Gel Roller Extra Fine Point 0.38mm in black.  This bad boy makes its mark every time, fits into the tiniest of vital sign boxes, and won’t leak on your scrubs.  Make sure you always have backups and order at least 5 at a time.  Or take your chances and lend it to someone, “For just a second, maaaan.”

  • Stethoscopes

This piece of equipment is like a calling card around your neck.  It is the most visible piece of equipment you will own and introduces your level of proficiency before you even open your mouth.  If you’re like me, and you show up with a 5-pound Fisher Price monstrosity, savvy clinicians will notice.  Don’t go crazy and purchase the Littmann Cardiac III right out of the gate ($300).  Start with something manageable and affordable.  I suggest the 3M Littmann Lightweight II S.E.  At first, my only criteria was if the scope was long enough to reach the patient.  Upon further investigation, I approached my next stethoscope with 3 criteria in mind. 1. Value:  This scope is pretty much the same quality as the Classic at a lesser price. 2. Weight: A few ounces can make all the difference, especially over a long shift.  Avoid the anchor-like scopes if you can.  3. Sound: If you want to be able to detect lung, bowel, and S1/S2 heart sounds when the unit clerk is telling her favorite knock-knock joke or the dementia patient is screaming from across the hall, then get this one.  It’s an all-around beast and you won’t freak out if it grows legs and walks (see: taken by an unscrupulous co-worker).

Boy, I wish these were more ubiquitous when I started nursing.  As I mentioned, my PDA with complimentary stylus was super-lame even in my day.  Don’t be that guy.  There are a several apps out there for the resourceful nurses of today.  In the interest of full-disclosure, I’m going to plug two projects that I have created.

Nurse Notes is a powerful iTunes app that sends you audible & visual reminders about patient care and scheduled tasks during your shift.  Since the app also stores data and acts as a “brain sheet”, it helps you chart & assists during report.  With this app you can avoid writing everything down by easily programming the app at the start of your shift.  Take a few minutes at the beginning of your shift to plugin essential, patient specific reminders or simply and quickly select from dozens of distinct choices within the main drop-down lists.

Homepage Nursenotes

75 Nurse Cheat Sheets is a portable eBook instantly accessible on your mobile phone and is one of the largest collections of nursing labs, medications, assessments, procedures, acronyms, diagrams, mnemonics, equations, conversions, scales, graphs, pictures, medical abbreviations, and Spanish translations. This enormous reference can replace all of the expensive and bulky laminated clinical sheets that most nurses mistakenly buy for $5 a pop.  It also includes detailed tables, diagrams, algorithms, and charting tools.

LungvolumesOvsR

Lungvolumedescriptions

 

  • Hemostats & Shears
multitool

Reflex hammer and amputation multitool awaiting patent.

Good news.  Hemostats are cheap so you should get whatever’s affordable.  A $2 Kelly will grip just as well as the $20 surgical version.  It might wear out a bit faster, but does it matter?  Long before it breaks it will only get lost, stolen, or accidentally dropped into the sharps box anyway.  Hemostats can be used to unscrew a luer lock that is coagulated with smegma or stop an artery from bleeding at the scene of an accident by the side of the road.  Versatile and worth having around!  I recommend Kelly Forceps.

As for shears, quality is a little more important.  The cheap ones will bend if you try to cut anything tough, like leather.  Still, a good pair can be had for less than $10.  I suggest a set of Prestige Medical Fluoride Scissors.  Extra points if you buy the black ones and look like a rogue EMT!

  • Compression stockings vs. Sweat wicking athletic socks

The debate rages on.  Not really.  This one comes down to personal preference, or biology.  If you’re like me, you’re double screwed.  My parents have varicose veins, which I’m doomed to inherit, and my wife says my feet stink.  I’m partial to sweat wicking athletic socks as a person who is obsessively self-conscious about my hygiene.  In fact, I tried wearing compression stockings but with my hairy man legs and sensitive follicles (I can’t wear hats either for this reason) the stockings practically gave me dermatitis and claustrophobia at the same time.  You will be on your feet for brutally-long periods of time, so if compression stockings help your circulation then go for it.  But if you’re gonna wear them, do it in style without looking like an old diabetic lady feeding birds at the park with these Nabee Socks.   I prefer the Drymax sport sock, though.  They wont’ save your feet from a foley spill but they’ll help reduce the sweat, prevent fungus, and cut down on blisters.

  • Snacks

Do your part… Prevent hypoglycemia in nurses.  Really, though.  I’ve gotten so hungry you could hear my stomach during report.  It’s important to fuel up whenever you can as a busy nurse.  Most units don’t allow food but I’m gonna suggest some ninja workarounds.  I like to stash low-glycemic index foods, high in fiber, that won’t make me thirsty, or make my breath reek when I’m going in for breath sounds on my patient.  I prefer plain almonds and, my guilty pleasure, 5-Hour Energy.  There are those times when you just need a pick-me-up and coffee won’t do.  Just be careful not to take it in anticipation of being tired or you’ll be pacing around the unit like a coked-out patient from the ER trying to convince people to fund your new KickStarter campaign.

  • Fanny packs

No.

  • Sharpies!

Yes.  The need for sharpies will always endure.  Make your mark with a nice fine-tipped Sharpie permanent marker.  Get the multi-pack with clips for convenience and visual variety.  You can date your IV bag, label your lines, or scrawl a love letter to that nurse you fancy in the neuro unit.  I go with the Mini Sharpies because I’ve got enough junk in my pockets and these babies, much like hemostats or pens, will get lost or stolen before actually drying out.

  • 2 week’s worth of scrubs (6 sets)

Layered and worn all at the same time for that androgynous yet buff look.  Actually, you’ll thank me when you’re butt is dragging out of bed for your last of 3 shifts of the week and you’ve got a nice clean pair waiting for you.  The last thing you want to do after a long shift is go home and do laundry for your next shift.  Have 3 pair for each week and alternate!  I recommend… whatever you want.  My only real suggestion is that you have plenty of them.

  • Vick’s or tincture of peppermint
oops

Yes, yes you did. Hand me the Vick’s.

On my first day at the hospital I couldn’t have ventured a guess as to what this would be used for.  You’re first code brown, though, will reveal the necessity of this odor-squashing lifesaver.  The smell of poo can be tougher than woodpecker lips to eliminate.  So why not just cover it up until you clean it up?  Spread a little of either of these potions on the outside of a preformed mask then layer another mask on top of that.  You’ll be whistling dixie and hot-trotting around the room oblivious to the wretched stench.

This is far from a comprehensive list, but you get the idea.  A nurse is always refining their tool box.  For instance, I won’t even touch on the lifelong odyssey of finding the right pair of shoes.  It takes a while to get into your groove and get comfortable with the tools of the trade.  Everything about a nurse’s practice continues to evolve so keep your eyes open, learn from your mistakes, and don’t buy that fanny pack.

 

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New “Nurse Notes” App ready to hit iTunes

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Access an overview of all your patients, their tasks, and demographics.

After much anticipation “Nurse Notes”, a new app created by Nurse Mastery, is ready to hit the iTunes store in November.  Nurse Notes is an innovative iPhone application developed by a team of nurses and programmers designed to help organize the daily tasks of nurses from all specialties.  This powerful tool will send you audible & visual reminders about patient care and scheduled tasks during your shift, as well as help you chart & assist during report.

View your patient related tasks.

View your scheduled tasks.

Do you rely on a piece of scratch paper to remember when & what to do throughout your shift? Stop writing everything down when you can easily program this app at the start of your shift. Take 5 minutes to plugin essential, patient specific reminders or quickly select from dozens of distinct choices within the following drop-down lists:

 

 

  • Assessments
  • Medications
  • Treatments
  • Procedures
  • Discharges
  • Dressings
  • Activities
  • Hygiene
  • Turning
  • Voiding
  • Studies
  • Orders
  • Fluids
  • Vitals
  • Labs
  • Diet
  • I/O
  • BG
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Dial out directly from the app.

This comprehensive app can act as your brain sheet, sending you alerts throughout the day. “Complete” or “Delay” the alert to revisit it later. Set a task to “Repeat” for duties that recur throughout the day.  “Clock-out” at the end of your shift to pause all alerts.   “Clock-in” again to retain info and resume tasks for the patients you had during the previous shift. Easily view an organized task list of “Upcoming” duties and then slide them over to the “Completed” list for reporting later.  Use the “Notes” section to write important occurrences you wish to handoff to the next nurse. Compile that long list of phone numbers and store all your information in one place:

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Enter new tasks from drop down lists.

 

 

 

 

  • Phone, beeper, & room codes (simply tap to call within the app)
  • Patient notes for report
  • Room Number
  • Code Status
  • Allergies
  • Weight
  • Gender
  • Diet
  • Age

 

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Refer to your notes during report.

 

 

 

 

Nurse Notes is sure to make an impact on the industry as a comprehensive organizational app for nurses has been lacking since cell phone technology has become so ubiquitous in US hospitals.  The release date has yet to be announced but the buzz is building.  Check back for more details and a direct link to the app in the iTunes store.

Murse on the Run: A 3-Day Guide to Yosemite

yos

This summer, my wife and I sat down to plan an epic running vacation.  We had heard of people taking trips where the main activity centered around running.  Although a grueling and pointless activity to some, running has always held a special appeal for us.  We each have extensive backgrounds in endurance sports and a love for racing.  My wife, Kristin, has qualified for the Boston Marathon 3 times and I have been just a few minutes shy on 3 of my 10 marathons.  Running has contained an element of competition for us for a long time but this summer we wanted to see what it would be like to let go of timing chips and race bibs and just run like Forrest.  Even with the best of intentions and a history of long-distance racing, nothing could have prepared us for thousands of feet of elevation gain and loss through the Yosemite Valley and up El Capitan, Half Dome, and Glacier Point.

curry

The logistics of such a large endeavor were daunting.  We wanted to experience the intoxicating nature of Yosemite while staying relatively comfortable after each day’s run.  We decided to stay at Curry Village, a collection of tent cabins at the base of Glacier point equipped with common showers, electricity, and a provisional store.  The rustic feel of the un-air-conditioned canvas cabins and the untamed surroundings, hinted at by individual bear-bins to keep out the wildlife, were just what we were looking for.  After renting a car in San Francisco and driving 4 hours to the the heart of Yosemite we unpacked, inventoried our supplies, and basked in the grandeur of the surrounding peaks.

Day One: Glacier Point

This was by far the most beautiful run of them all.

We took off at 0700 heading southwest along a bike path paralleling the main road to Curry Village.   After two miles we hit the trail head for Four Mile Trail.  The trail immediately soars into repeated switchbacks, winding its way up lung-busting grades, revealing more jaw-droppingly gorgeous views of the valley.  El Capitan can be seen looming to the west, while Half Dome casts a shadow to the north.  We were greeted repeatedly by friendly foreigners, vacationing in the iconic valley to get a sample of the beauty of America’s national park system.

glacier

After soaking in a few more views along the way we hit the 7214 foot Glacier Point.  Although accessibility is what keeps parks like these alive, it was a little anti-climactic being greeted at the top after our arduous run by a white-haired grandma with a walker, fresh off the tour bus that drove up the paved backside of the mountain.  The panoramic scene from the top is breathtaking, especially looking down the face of the granite monolith.  Curry Village can be viewed from this height by looking straight down the 90 degree flat wall that shoots downward in a perfect line.

We wound up running down the backside of the mountain to get away from the crowds via the Panorama Trail.   This trail rapidly descends for a couple of miles to a bridge above Illilouette Falls.  At this point, the trail ascended again, making us wander just what we had gotten ourselves into.

descent

The trail reconnects with the John Muir Trail at Nevada Falls.  The final four miles back down to Curry Village were a little congested, as this portion connects with Happy Isles Trail, the most popular starting point for the Half Dome hike.  The entire route spanned 17 miles of ups and downs, taking us approximately 8 hours to devour.  We slunk back to our cabin feeling weary and tentative about our commitment to run two more challenging peaks before weeks end.

Day Two: El Capitan

Our earlier drive past El Capitan on the way into the valley was a humbling experience.  We stopped to peak through a set of telescopes set up by local climbers.  Through them you can view the various climbers in different stages of elevation along their multi-day ascents.  Our little running adventure didn’t seem as extreme after seeing this!

We hopped in our rental and drove 45 minutes to Tamarack Flat campground, three miles past the Crane Flat intersection.  The trail begins along an old logging road.  We were immediately aware of how much more isolated this trail was than the others.  Kristin made sure I was sporting my bear bell to warn any potential predators of our approach.  It turns out I didn’t need the bear bell as I promptly tripped over the trailhead sign, bringing the entire metal apparatus crashing to the ground.  Seeing as it was 0600 and a campground was situated right at the trailhead, I was a little embarrassed to have probably woken up the entire site with my noisy exploit.

el cap

The trail starts with a two-mile drop to Cascade Creek.  We learned quickly that the quadriceps muscles are much more prone to fatigue, especially on downhill sections.  We were tired from the day before but also filled with reverence for the enormous sequoia trees that loomed large above us.  After crossing Cascade Creek we went left onto a single track trail.  The gradually climbing trail is marked with cairns, or small rocks stacked to mark the way.  Before opening up to reveal  the face of El Capitan, the trail winds through mossy areas filled with hanging branches giving it an eery feel.  It’s difficult to appreciate the peak of El Capitan because, unlike Glacier Point, it slopes gradually without providing a definitive drop off point over which you can ogle in amazement.  The clearest view of El Capitan is about a mile before reaching it, as the tip of the face comes into view above the valley below.

This run was much more isolated, methodical, and reflective.  Without photo-ops every half mile and fellow hikers eliminating the need for a selfies, the trail takes on a more meditative nature.  Viewing Half Dome and Glacier Point across the valley is an overwhelming sight well worth the long haul to the top.  The run back to our car was swift and uneventful, save for the overwhelming amount of mosquitoes.  We eventually snapped off a couple small pine tree branches to use as bug swatters.  The entire run took us 7 hours.  Throughout the entire 17.5 miles we saw only one other hiker.

Day Three: Half Dome

We saved the beast for last.  Half Dome is a legendary hike and climb combination that draws enthusiasts from all over.  Most people hike half-way up, and with a back country permit, camp out overnight to get an early crack at the last section the following morning.  The lucky few, like us, entered a lottery and won a permit to climb the last portion.  The final 1000 feet is a greater than 45 degree angle scramble along a set of wooden foot holds and cables set up by park officials.  There are piles of rubberized gloves discarded by previous climbers that are free for the taking at the base of the cables to enhance grip.  However, no rangers or park personnel are present beyond this point to regulate hiker activity, for better or worse.

Since arriving early is essential to get up and down the cables without a bottle-neck effect, we woke up at 0430, boiled the water for our oatmeal, and strapped on our headlamps before setting off.  We ran one mile from Curry Village to the Happy Isles trailhead.  The paved portion up to Vernal Fall Bridge is quite steep and has restrooms available before it splits between the Mist and John Muir Trail.  We ran up the Mist trail as pitch darkness and stunning views of the stars gave way to sunrise.  Unfortunately, the California drought has depleted the once mighty falls that used to emit a vivid spray, lightly coating hikers along the path.  What remains is but a trickle.  In any case, the scenery was still amazing as we  climbed 4000 feet to Nevada Fall.

trickle

Beyond the falls, the Mist Trail turns back into the John Muir Trail.  Entering Little Yosemite Valley, the path opens up creating a nice flat stretch for easy running.  This brief interlude is quickly interrupted by more steep switchbacks.  The soft dirt that was so forgiving on our mileage-addled joints disappeared and was replaced with pure granite.

half

After being fooled by a false summit we finally reached the base of the monolith.  As the first hikers/runners to reach the base, we had first choice of second-hand gloves, slipping into the best fitting ones that we could find and setting off up the horizontally placed foot boards while gripping the cables on either side.  After about 1000 feet of terror-inducing climb, we finally reached the top.  We basked in the view of the valley below and reflected on our long run while being harassed by partially domesticated marmots vying for our trail mix.  After eating a little lunch we headed back down.  Several astonished hikers asked if we’d already been to the top.  We would briefly stop and give a trail report before resuming our slow jog back down the mountain, reveling in our bad-assery.  Half Dome was a formidable foe, taking 8.5 hours over 18 miles.

climb

Before leaving Yosemite we made sure to take a leisure day that ironically involved belaying one another with a guide as we crack climbed in our harnesses suspended over 800 feet in the air.  So much for a relaxing day off!  Looking back on the adventure, most people would doubt that it had anything to do with nursing.  I believe that it is a testament to how hard work, persistence, a belief in oneself, and the support of a loving wife and friends can get any nurse to the top of the world.

 

 

 

 

10 Nursing Hacks – Ain’t Nobody Got No Time for That!

Nurses are always trying to keep the plates spinning, as the saying goes.  Maybe in our case it’s bedpans, full of “output”, while paging a doctor, and getting the family member a cup of hot tea.

What exactly is a “nursing hack”?  It’s any simple tip that a nurse might stumble upon that changes the work routine and saves precious time and energy.  It’s basically a trick that will help make work easier.  Nursing hacks aren’t easy to come by and often surface at the most unexpected moments, like an “AHA” moment while inserting a foley catheter.  I’ve rounded up some of my favorites from your submissions, and even created a few of my own. They just might change the way you practice nursing.

  1. The Ring: Use an oxygen mask elastic strap to remove rings, eliminating the need to cut them off.  This technique acts as both a tourniquet and an anchoring technique.  I can’t really do it justice with an explanation so just watch the video below…

2. You only need 1 secondary IV tubing set: When it’s time to hang a new one, just lower and invert the existing secondary bag.  Gravity will force the fluid into the old bag and flush it out.  About 50 ml’s worth should do the trick, then re-spike a new secondary.  If you’re changing from one medication to another that’s not compatible, then change the tubing to avoid crystallization.

3.  Immaculate shaving cream:  If you have a patient covered in BM and it’s stuck in their body hair, lather the affected area with shaving cream, then wipe it off with a wet washcloth. It will come right out.  Be sure to avoid sensitive areas like mucous membranes.

4. Toothpaste sandwich: Next time you have a heinous code brown, take 2 preformed masks, spread a little toothpaste on one and sandwich the other on top.  When you wear it you will be impervious to stench.

5. Bedpan maintenance: To prevent splashing onto the bed while your female patient is on the bedpan, place a sanitary wipe or disposable washcloth between patient’s legs.  Also, place powder along the bedpan before you put in under the patient.   It makes for easier extraction and is ideal for heavier patients.

6. Tiny bubbles: If you are priming new IV tubing, clamp the tubing first, then spike the bag and slightly fill the chamber before you commence priming.  This will prevent annoying air bubbles from being distributed all throughout the tubing.  Also, when you’re priming a pressure bag and tubing for an arterial line,  inflate the pressure bag with the fluid upside down.  This will force all remaining air out of the saline bag first, followed by the fluid, preventing more bubbles.

7. Phlebostatic axis: When you’re patient has an arterial line, ensure that the pressure reading is always accurate by locking the bed height.  This will ensure that the transducer remains at the level of the heart.

8. Climate control: Want to keep your elderly, demented patient exactly where you last placed them?  Turn down the temperature in the room and cover them with nice, cozy blankets.  They will not want to get out of bed and wander around if they’re super comfy and it’s cold outside of the sheets. They might even sleep!

9. TED talk:  Place the plastic wrapper that the TED hose comes in over the patient’s foot when applying the stockings.  This prevents sticking and helps them to slide right up.  This is especially helpful with edematous legs.

10. Helicopter family:  If the patient’s family is hovering like crazy, especially during a procedure, give them a task to perform.  If it’s an IV start or something painful, offer them the job of holding the patient’s hand.

These are just a few of the nursing hacks that save time and make a hectic shift more tolerable.  There are lots more out there so feel free to visit the Contact page or leave a comment below to let us know about your favorite tips, tricks, and hacks…