Two days ago we received 2 cards in the mail. They come every year at this time. They are never late and there is always a personal note included.

My sons are 12 years old today. These cards, which have come every year for the past 11 years, are not from their grandparents or aunts or uncles. They are not from their friends or my friends. These cards are from one of the nurses who cared for them in the Neonatal Intensive Care Unit (NICU) after they were born prematurely.

So I write this to recognize the continued feelings of gratitude and awe that I have for one special nurse. How can I thank her for caring for my children when I wasn’t able? How can I thank her for showing my boys love and compassion when I couldn’t be there? How can I thank her for helping us through our most difficult days, weeks, and months?

My boys are grateful to receive these cards each year and to be remembered on their birthday; however I’m not sure they grasp how much the cards are appreciated by me and my husband. This day of celebration for our kids still brings mixed emotions to us, feelings which are understood by this special NICU nurse who reaches out to us each year.

As a nurse, I have not had a continued relationship with any patient after discharge, although I can think of several that I wish I had. How about you?

I’m drawn to articles that offer tips, top ten lists, mnemonics, and quick-reads to make our days and lives as nurses run smoother. That’s why I’m happy to share that we’ve just added a new article to our Recommended Reading list with not one, but two handy mnemonic devices! Plus, the topic is ECG interpretation and you may recall that one of my most memorable days as a nurse began with analysis of a Six-Second Strip. 

Please allow me to share one of these clever mnemonics with you here (you can click through to the article to learn the other – enjoy free online access while it’s on our recommended reading list). 

So, what are the H’s and T’s referred to in the title of this post? They are the reversible causes of cardiac arrest, which include:

* Hypovolemia

* Hypoxia

* Hydrogen ion (acidosis)

* Hypo- or hyperkalemia

* Hypothermia

* Tension pneumothorax

* Tamponade, cardiac

* Toxins

* Thrombosis, pulmonary

* Thrombosis, coronary

Do you have any similar mnemonic devices to share? Let’s help one another to remember all that is nursing and healthcare!

Reference:

Craig, K., (2013). Heart Beats: Rhythm self-quiz: Fast and deadly. Nursing2013 Critical Care, 8(1).

Hi again! Here’s part 2 of my mnemonics list. These tips need a little more explanation, but they worked for me, so perhaps you’ll find some value in them as well.

To remember the types of white blood cells and their descending proportion in a blood sample…
“Never Let Monkeys Eat Bananas” = Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils

To remember where lymphocytes mature…
B cells mature in the Bone marrow; T cells mature in the Thymus

To remember the cranial nerves…
“On Old Olympus Towering Tops, A Finn And German Viewed Some Hops” = Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glassopharyngeal, Vagus, Spinal Accessory, Hypoglossal

And to remember the functions of the cranial nerves (sensory [S], motor [M], or both sensory and motor [B])…"Some Say Marry Money But My Brother Says Bad Business Marry Money."

To remember the location of the adrenal glands…
Think ADD RENAL; they're "added" to the renal organs, the kidneys.

That’s all for now! Here’s R-E-M-E-M-B-E-R (Part 1) in case you missed it!

As you can imagine, I do a lot of reading about nursing. Journals, books, newsletters, blogs - you name it and pretty much I’m reading it! I think I’ve mentioned before how some titles really hook me. I love lists, so when I come across anything that starts with “Top 10” or “Tips for” or “List of” chances are that I will open to that page or click that link. Another one of my favorite things are mnemonics, or easy tricks for remembering complex things, which in nursing school and in practice, are very helpful!

Here are some of my favorites:

To help organize your day…
IMAGE: Introduce yourself, Medications, Assessment, Goal, Explain & Educate

To evaluate a symptom…
PQRST: Provocative/Palliative (what makes it better/worse), Quality/Quantity, Region/Radiation, Severity, Timing

To assess skin lesions…
ABCDE: Asymmetry, Border, Color/Configuration, Diameter/Drainage, Evolving

To assess pupils…
PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation

To include in your documentation…
PIE:  Problem, Intervention, Evaluation

More to come soon...do you recall the one for remembering all the cranial nerves?

Have you made any adjustments in your career goals or education plans based on the RWJF and IOM Report , The Future of Nursing: Leading Change, Advancing Health, released last October?

I have been away from clinical nursing since 2001. I can’t believe that it has been 10 years. I’ve always believed that someday I would go “back to the bedside” and I really do miss taking care of patients. It’s been a little more noticeable to me lately just how much I miss the clinical side of nursing. I’m not sure if it’s because the fact that it’s been 10 years overwhelms me or because I am excited about the direction in which our profession is headed. Perhaps it’s a little of both.

The question that really gets to me is where do I want to be? Critical care was my home for most of my clinical career.  I loved the thrill of caring for acutely ill patients and their families. Titrating vasoactive drugs, assisting with invasive procedures, using the latest technologies - all so cool! Admissions from the ER, “road trips” to diagnostic tests, end-of-life discussions, and the list goes on…

However, my “other list” is quite impressive to me also. As a women’s health NP, it was so fulfilling to be in the community and make a difference educating women about preventive care. Also, contraceptive counseling, prenatal care and teaching, helping someone find some relief from her symptoms of menopause, and so on…. Primary care practitioners have so much to offer and the need is so great.

The very first key message from the IOM report states “Nurses should practice to the full extent of their education and training.” Does this mean that it is my duty to practice as an NP because I have the degree and license? Would I be disregarding this message by returning to staff nursing in the ICU? I sure hope not. Then again, I could always pursue another degree…critical care NP might be the answer. Now there’s something for me to think about!

Perhaps as we prepare for the future of our profession, we should all take this time to look at our individual goals as well. What is your future in nursing?

Sometimes no words are needed 
Just a nod may be all that is necessary 
A look of understanding 
One hand over another 
A friendly smile 
A shrug of the shoulders 
Someone sitting close by 
Not saying anything 
Just being there 
Sometimes that’s all we can do 
Sometimes that’s all that someone needs 
Sometimes that’s all that we need 
Running in circles to find an answer when no answer exists 
Can be frustrating 
We must learn to accept this 
Be there for one another 
Listen 
Feel 
Support 
Care 
Sometimes no words are needed 

My most memorable mentor has to be my first preceptor after I graduated from nursing school. As a new nurse in the medical intensive care unit, I was pretty nervous and overwhelmed. I had worked in the unit for about a year and a half as a nursing assistant, but I knew how different my role would be as a new RN. 

This nurse was literally always teaching. And not just me… anyone who she came in contact with learned from her. She was an expert and I honestly can’t remember a time when she didn’t know something. She sought out new experiences for me and encouraged me to be on the lookout for new experiences throughout my career.

Amazingly, she was able to see patient care from my standpoint as a novice. She started with the basics and was able to help me build upon my knowledge and skills in a way that made sense to me. Later, as I became more confident and comfortable, she would begin her questions to me with “What would you do…” or “How would you know…”

One important quality that stood out about this nurse was her respect for everyone - patients, family members, nurse colleagues, and other members of the healthcare team. She was a good listener, had amazing clinical skills, and a knowledge base that boggled my mind!

This nurse was more than my preceptor, she was a mentor and friend to me. I feel so fortunate to have been mentored by such a wonderful role model. Who is your most memorable mentor?