How many times has a patient said “I feel funny” or “I don’t feel right” and then proceeded to code shortly thereafter? That happened to me twice.

How many times have you felt pulled in different directions – between call lights, alarms ringing, medications to be administered, dressings to be changed, patient education to be provided, etc.? For me the answer is TMTC (too many to count!)

How many times has a patient deteriorated quickly or coded without any warning signs? I’d say several.

I wonder if during any of those times a patient was trying to reach out to me to say “I feel funny” or “I don’t feel right” and the opportunity to intervene passed without my knowledge because I was busy with other tasks.

Just thinking…

I wish that we had enough time during our day to just pause and listen. Wouldn’t that be nice?

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).

I’m a bit ashamed to be admitting this to a group of nurses, but I figure that if I shame myself enough maybe I won’t let this happen again. Ok, here it is…I didn’t get a flu shot. There, I said it. No reason, really, I just got busy and it kept getting pushed to the bottom of my to-do list. My husband got his at work, I took the kids for theirs, but mine – I just never got around to it. I am embarrassed and yes, more than a little nervous about getting sick. 

I’ve been reading a ton about this year’s influenza viruses "taking the U.S. by storm." I get emails from the CDC with the latest numbers and maps showing flu activity around the country. Our Nursing News page has links to updates and articles about this year’s virus. Our twitter timeline and facebook newsfeed also contain quite a bit of flu-related news, opinions, and personal stories these days. 

Not only am I “virtually” surrounded by the virus, but my kids come home from school each day with a report of who was absent, or more concerning, who was sick at school. My husband returns from his work as a respiratory therapist with a flu update from the hospital floors. And of course, I’m aware of every sniffle and sneeze around me when I’m out. 

My plan, which has been working well so far, consists of the usual recommended practices: frequent handwashing, not touching my face, getting enough rest and eating well, and doing my best to avoid those who are sick. However, while I’ve dodged illness thus far this flu season, I will surely be calling my nurse practitioner this week to schedule my vaccination! 

Any other advice? 

Happy New Year everyone! Here’s the list of nursing recognition days and months for the beginning of 2013*. I found some new additions for this year’s list – Critical Care Transport Nurses Day and National Nursing Home Week. Please let me know if you know of others.

Be sure to celebrate your hard work and the hard work of your colleagues – Enjoy!

*I will add/update links as they become available.

National Nurse Anesthetists Week
January 20-26, 2013

National IV Nurse Day
January 25, 2013

PeriAnesthesia Nurse Awareness Week
February 4-10, 2013

Critical Care Transport Nurses Day
February 18, 2013

GI Nurses and Associates Day
March 27, 2013

Certified Nurses Day
March 19, 2013

National Radiology Nurses Day
April 12, 2013

National Critical Care Awareness and Recognition Month
May 2013

Oncology Nursing Month
May 2013

National Nurses Week
May 6-12, 2013 (National Nurses Day is May 6)

National Student Nurses Day
May 8, 2013

National School Nurse Day
May 8, 2013

International Nurses Day
May 12, 2013

National Nursing Home Week
May 13-19, 2013

Neuroscience Nurses Week
May 19-25, 2013

I have been trying to limit my watching of the Newtown, Connecticut events on television. I feel guilty about it, as those directly affected by the horrible massacre that occurred December 14th must face the tragedy every minute of every day. Like you, I am experiencing all sorts of feelings of sadness and anxiety and my thoughts and prayers are with the victims, their families, and the first responders.

I have not limited my reading though. I feel that by reading the stories shared by family members, I am getting to know the victims and in some small way, I am honoring them. I am reading the stories shared by the survivors and feeling that in some small way, by doing so I am helping them process the events by “listening.” I am reading the thoughts and feelings of how others are processing what happened, hoping to contribute to the discussion and let our voices be heard so that changes can be made to make our nation a stronger and safer place for ourselves and our children. 

Now I turn to the feelings of “How can I help?” and “What can I do?” I encourage you to see posts from our colleagues at AJN’s Off The Charts and Nursetopia for lists of resources and ways to help. Also, the American Nurses Association has assembled a list of more than 30 nursing organizations joining forces to call for change. 

“The nation’s nurses call on President Obama, Congress, and policymakers at the state and local level to take swift action to address factors that together will help prevent more senseless acts of violence. We call on policymakers to: 

• Restore access to mental health services for individuals and families 

• Increase students’ access to nurses and mental health professionals from the elementary school level through college 

• Ban assault weapons and enact other meaningful gun control reforms to protect society”

Nurses – we are the largest single group of health care professionals. We see the devastation caused by weapons and violence. We care for patients with mental illness and know there is need for improved services and access to treatment. It is time to take action.

“Learning is one of life’s most essential activities.” — Annie Murphy Paul

Enrollment in all types of professional nursing programs increased from 2011 to 2012, according to new survey data from the American Association of Colleges of Nursing. These findings are based on data reported from 664 of the 856 nursing schools in the U.S. with baccalaureate and/or graduate programs.

The survey also saw a 3.5% increase in entry level Bachelor of Science in Nursing programs. The number of students enrolled in RN-to-BSN programs increased by 22.2% from 2011 to 2012, which, according to the AACN, signals a growing interest for baccalaureate-prepared nurses from both nurses and employers.

"AACN is pleased to see across-the-board increases in nursing school enrollments this year, given our commitment to encouraging all nurses to advance their education as a catalyst for improving patient care," said AACN President Jane Kirschling in a press release. "As the national voice for professional nursing education, AACN is committed to working with the education and health care community to create a highly qualified nursing workforce able to meet the expectations and challenges of contemporary nursing practice."

A few other interesting survey findings:

• Enrollment in master’s and doctoral degree programs increased “significantly.”
• Survey data indicated an 8.2% jump in enrollments for nursing schools with master’s programs (432 institutions reported data).
• Doctor of Nursing Practice programs saw a 19.6% enrollment increase (166 schools reported data).
• Baccalaureate nursing graduates are more than twice as likely to have jobs at the time of graduation than those entering the workforce in other fields.
• Graduates from master’s degree programs (MSNs) were most likely to have secured jobs at graduation (73%).

"Momentum is clearly building for advancing nursing education at all levels,” Kirschling said in a press release. “Given the calls for more baccalaureate- and graduate-prepared nurses, federal and private funding for nursing education should be targeted directly to the schools and programs that prepare students at these levels."

"Further, achieving the Institute of Medicine’s recommendations related to education will require strong academic-practice partnerships and a solid commitment among our practice colleagues to encourage and reward registered nurses committed to moving ahead with their education."

This post was written by Erica Moss, who is the community manager for the online masters in nursing programs at Georgetown University.

I’ve seen a lot of patients die. And by a lot, I mean too many to count. Some deaths I remember clearly, perhaps because the patient was alone or had a large number of family and friends at the bedside, perhaps because he or she was close to my age, or perhaps because of religious traditions that took place during or after the death. It’s odd then, that when I think back to last words of patients before they died, I am at a loss. 

It could be because many of our patients followed a similar pattern prior to their death. Many were on mechanical ventilation which was withdrawn after many days, weeks, or months of progresses and setbacks. Most were unresponsive, either due to sedation or their disease process. They may have spoken their last words in my presence, but at the time I may not have realized that they were the last words they would ever speak. 

I do remember the last words of one patient in our unit. She was my grandmother. After a fall with a resultant hip fracture, she was transferred to us several weeks after surgical repair of her hip. Her oxygen requirements were increasing and she was becoming more and more agitated. In our unit she was treated for aspiration pneumonia, given anxiolytics, and supported with more and more supplemental oxygen each day.

We, her family, knew her wishes – she didn’t want to be intubated – and we respected that. I was working night shift, not as her nurse, but would stay much of the morning to help with her am care and to be there for rounds. On one particular morning, she was coughing and vomited. She had a hard time catching her breath. I called out for her nurse to suction her, when my grandmother grabbed my hand and said “No more.” We spoke of what that meant; it was a pretty intense conversation for a young nurse to have with her own grandmother. Then I called the rest of the family to explain our conversation and ask that they come to be with us. 

Everyone arrived throughout the day and we did what we could to keep her comfortable. We all spent time holding her hand and chatting with her when she was able. At one point, my grandmother asked for a grape soda. I found one for her and as she sipped it through a straw, she said to me “Lisa, I won’t be at your wedding.” “I know,” I said, “Grandmom, but you will always be with me.” Her response was “Yes… and grandpop knows what to give you.”

And those were her last words to me. I knew that she was referring to a wedding gift, and I laugh now when I think about it, because that was typical of my grandmother. She was an incredibly generous woman…always fighting over the check at dinner and pushing to pay at any cash register. These final words make me smile and think of who she was, not laying on that hospital bed, but as my grandmother.

What made me think of this was a recent book I just completed. In Looking for Alaska by John Green, the main character has a fascination with last words. He reads countless biographies and has memorized last words, even making it his mission to discover the “Great Perhaps” mentioned in the last words of François Rabelais. It was a good read, definitely thought-provoking, and I thank my niece for recommending it to me.

As nurses, some of us work with dying patients on a daily basis, while others, only rarely or sometimes. Regardless of your experience, do any last words stand out in your memory?

What to say here? I am still in shock by the devastation caused by this hurricane. 

I grew up on Long Island. My parents, my brother and his family, and many childhood friends still live there. Yes, they experienced loss of ‘things’ and remain without power, but they are all safe. As the stories emerge of lives lost, I know how lucky we are. 

The accounts of hospitals closing and patients being evacuated are amazing. I am in awe of those who’ve worked so hard and continue to work so hard to keep patients safe and provide care to those in the hospital as well as out in the community. The evacuation and transfer of patients, especially of NICU babies from NYU Langone Medical Center, is incredible to me. As a mom of 2 NICU graduates, I remember well the challenges of repositioning a sick premature baby in his isolette; I can’t imagine moving across New York City during a hurricane. What more can I say but THANK YOU to our nurse colleagues and the other healthcare professionals who managed this incredible feat. 

To those dealing with loss, I imagine you will never see this post. If, by chance, you do come across this writing someday, know that at this moment, my thoughts and prayers continue for you. I hope that you have rebuilt your home, whether in the same location or somewhere new, and you’ve been comforted and supported in your grief. 

American Journal of Nursing has created a list of helpful resources (open access) to help us cope now and be ready for future emergencies. 

Wishing everyone safety and good health during recovery efforts. 

Thank you to Julianna Paradisi of JParadisi RN's Blog for the Liebster Award nomination! These awards are a way for bloggers to get to know one another better, recognize one another, and share favorite blogs with their audiences. To continue the trend, I must share 11 things about myself, answer 11 questions asked by Julianna, and nominate 11 other bloggers and ask them 11 questions. So, here we go:

Eleven Things About Me
1. I speak Italian. My parents met when my dad was in the Air Force and stationed near my mom’s hometown in northern Italy. They married, had my brother, and then moved to the U.S. I learned the language from visiting our family and studying it in school. 

2. I like wearing glasses. I tried contact lenses but couldn’t get used to them. I own several pairs of glasses at any given time and like to order different styles online.

3. When time and acuity allowed, I thoroughly enjoyed washing patients’ hair, which was not usually an easy task in the Medical Intensive Care Unit. It was time consuming and messy, but I hope that someone will do that for me if I’m ever critically ill. 

4. I always, always wear a watch and am usually early for everything! It drives my family a little bit crazy!

5. I don’t like to style my hair, but if I have to, I usually straighten it, and then curl it. It makes no sense, I know.

6. NICU nurses are my heroes. For 2 months, they were lifesavers and caregivers to my twin sons who were born at 29 weeks.

7. I enjoy gardening. I find weeding relaxing and I don’t mind cutting the lawn or trimming shrubs. The best part, of course, is having fresh vegetables and herbs on hand all summer!

8. I still have many of my books from nursing school. They have been updated with new editions and even with all the information that is now available online, I still can’t part with them.

9. I love to fold clean laundry but hate to put it away.

10. Math was always my favorite subject. I took Calculus I and II as my electives in nursing school and now I enjoy tackling math homework with my kids, although they are learning things very differently than I remember!

11. Nurse bullying, horizontal violence – whatever you want to call it – upsets me tremendously, especially when it involves students or new nurses. We really need to support one another! We all started as beginners!

Eleven Questions From Julianna
1. Who was your childhood hero? My older brother! I would do anything to get his attention! I remember even begging my mom to make him say “I love you” to me. 

2. What book (s) have you read more than once? Firefly Lane by Kristin Hannah.  It’s a wonderful tale of friendship, but a real tear-jerker! Also, The $64 Tomato by William Alexander.  I read it every year while prepping our garden for the upcoming season. Even my kids like to hear excerpts of the author’s trials and tribulations in the garden!

3. If you could do one thing in your life over, what would it be? I probably would have done my MSN in acute care. I enjoyed women’s health and am glad to have that knowledge and experience, but I think my real passion is critical care.

4. In one sentence or less, how would you describe yourself? This is tough! Ok, here goes… I am a mom, wife, daughter, sister, and aunt who thrives on being with and caring for others.

5. What is your favorite way to exercise? Walking with friends. It’s a great way for us to catch up on each other’s lives and put in some miles!

6. Name one person from any era, dead or alive, you would like to meet. Mother Teresa. 

7. What is your secret talent? I can tap dance; took lessons for 13 years!

8. Do you ever dance to music when no one is watching? Yes, but it’s definitely more fun when my whole family gets into it!

9. What is your all-time favorite TV show? Friends.

10. What TV show theme song do you know by heart? So many! Friends, Cheers, Brady Bunch…. Also, thanks to my kids – Phineas & Ferb and Good Luck Charlie. 

11. What is one ability you wish you had, possible or not? I wish I could control time – the possibilities are endless…

Eleven Nominations
These are my favorites – enjoy! (Full disclosure- two are LWW journal blogs)
Nursetopia
Nurse Story
Correctional Nurse.net
Infusion Nurse Blog
Nursing Staff Development: Behind the Firewall
ANS: Advances in Nursing Science Blog
AJN’s Off The Charts
RNspiration
3cs: coffee, children, and cancer
At Your Cervix
Crass Pollination: An ER Blog

Eleven Questions for My Nominees
1. What makes you laugh?
2. Have you ever written for publication?
3. What was your first nursing job?
4. What is your favorite blog post that you’ve written?
5. What’s your favorite TV or movie quote?
6. What is your biggest fear?
7. Do you sing in the shower? If yes, do you have a favorite genre or song?
8. What’s your favorite vacation spot?
9. Can you describe your best memory of nursing school?
10. When did you know you wanted to become a nurse?
11. What do you find most fulfilling about being a nurse blogger?

As I write this, I’m on my flight home from the Clinical Symposium on Advances in Skin & Wound Care 2012 which was held at Caesars Palace in Las Vegas, Nevada. Thank you to the conference chairpersons, Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN and Richard Salcido, MD. It was an informative, well-organized, and fun conference!

I was particularly drawn to the sessions which addressed skin care and pressure ulcer management at the end of life. Even in the keynote address, Legally Defensible Wound Care, presented by Caroline E. Fife, MD, CWS and Kevin W. Yankowsky, JD, this was a theme. An interactive case presentation was the format and we, the audience, got to share our opinions/votes by holding up a red or green card to questions such as “Was this pressure ulcer a result of negligence?”, “Would you take the case?”, and “Should the hospital be sued?”, among many others. During the presentation, an interesting observation was shared. When a cause of death is identified as ‘heart failure’ or ‘renal failure,’ a response of sympathy often results; however, a cause of death of ‘skin failure’ often leads to more negative responses, such as “that never should have happened” or even a search for somewhere or someone on which to place blame. 

The lesson that I learned, both from this keynote address and from a session titled Skin & Wound Care at Life’s End: Clinical Considerations, presented by Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN, is that the skin is an organ and at the end of life, it will fail just as the heart and kidneys and other organs do. Despite optimal care and evidence-based interventions for skin and wound care, skin failure and pressure ulcers often are unavoidable at the end of life. 

Here are some more highlights from the conference:

• Book signing! Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN and Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN were on hand to sign their book Wound Care Essentials, Third Edition. 

• Exhibit Hall! The exhibitors shared their products in dynamic ways, including wound care karaoke & dressing change races.

• Resources! Here’s a list of resources shared by the presenters – be sure to check them out!
  • Advances in Skin & Wound Care
  • The National Pressure Ulcer Advisory Panel 
  • SCALE Final Consensus Statement
  • Screening for the High Risk Diabetic Foot: A 60-Second Tool
  • Braden Scale for Predicting Pressure Sore Risk

• Quotes! Looking back on my notes, I just have to share these wise words that were shared.
  • “The keys to preventive legal care and effective communication are managing expectations beforehand and answering questions afterward.” Kevin W. Yankowsky, JD
  • “Edema is the real enemy.” Sandra Wainwright, MD (discussing chronic venous hypertension ulcers)
  • “Anytime cartilage is present, you have a stage IV pressure ulcer.” Diane K. Langemo, PhD, RN, FAAN
  • “If there is stable eschar on a heel, leave it alone!” Diane K. Langemo, PhD, RN, FAAN
  • “We all own pressure ulcers, not just nurses.” Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN
  • “The Braden scale accounts for most risk factors for pressure ulcers, but we also need to think about perfusion, age, comorbidities, and if the patient has a history of pressure ulcers.” Dr. Janet Cuddigan

You can see some pictures from the conference on our Facebook page. Next year, this conference will be held in Orlando, FL on October 24-27, 2013. It would be great to see you there!