November 15, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The normal cardiac index is 2.5 to 4.0 L/min/m2 at rest and is determined by contractility, preload, afterload, and HR. In normal hearts, the collective force of contraction of the cardiac chamber is the sum of forces generated by myocytes.

November 14, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Dysfunction of the heart or any component of the cardiopulmonary system initiates adaptive neurohormonal activation of the sympathetic nervous system, renin-angiotensin-aldosterone system, natriuretic peptides, endotheli, and vasopressin.

November 13, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
With the total artificial heart (TAH), the failing heart is removed and the TAH implanted. Because the native heart is removed, TAH patients have no cardiac electrical activity (asystole). Therefore defibrillation and pacing are not indicated.

November 12, 2018

I Just Can't & That's Okay


There will be moments in your nursing career when you can't do something and guess what? That is okay. Overworking yourself, both emotionally and physically will cause distress in your life and make you resentful of the nursing profession. Every time I've mentally told myself I couldn't do something and pushed and pushed on anyway, someone or something suffered. Whether it was my family or my professional standards, some part of my life took a hit. Let's all acknowledge that we can't be 30 places at once. Let's accept that we aren't perfect. You will have to prioritize what you can do and what you can't do given the time frames you have to work within. That doesn't make you a terrible nurse, that makes you human. If I'm not able to do something and I can't delegate to someone, it won't get done. And I hope the oncoming nurse can pick up the pieces. I can't be there 15 hours (without eating) trying to do everything. I won't. A 12-hour shift flies by when someone is crashing. Don't tell me to find the time. Don't tell me to make it work. Sometimes I can, given the right team and proper support system. But sometimes, I can't and pushing myself isn't healthy. Last month, I also peed my pants at work. I'm almost 40 damn years old, that's insane! I can't find time to pee?! And yet, every nurse has had one of those shifts where they just couldn't care for themselves. A rare occasion is okay, but if this is a pattern, that's a problem. If you NEVER take a lunch and you NEVER can go pee, that is a huge problem. There is no honor in an inability to take care of yourself. You don't get a badge for depriving yourself of things. This isn't a contest.

Listen, I work nights, and I love it. Sometimes I'm able to stay up all day (after a 12-hour shift), clean our home, prepare dinner, and pick our son up from school. I'm able to be that superstar. But some days, I lean heavily on my husband to pick up the pieces. Some days, all I can do is come home at 8:45 AM, get in the bath, eat leftovers, and head right to bed. I just can't push myself some days. I know my limits, I know what I can manage. It's one thing to motivate yourself and squeeze out the last bit of work. It's another thing to be so depleted physically and emotionally, that you can't function afterward. To the point where there is nothing left for you or your loved ones. Going through the motions of living is not living. I love nursing, I enjoy helping others. But trust me, I come home whole and intact. And yes, there are shifts when some tasks aren't completed. And yes management, along with the oncoming nurse, have both been made aware of my shortcomings. My job isn't to almost kill myself caring for others. My job is to care for the ill and help the healing within the time frame I am there.

When I get home, my feet might hurt but I'm mentally intact. I'm emotionally safe and present. If you are not, step back and reprioritize things. I'm all about hard work, but it shouldn't cost you family time or personal relationships. No career is worth that. If you feel this way, sit down, examine where you are in life and what you want out of life. I LOVE nursing, I have a passion for it. But, I've NOT loved it working at some places. A hospital, a floor, a schedule, a manager can make or break your wellbeing. Being strong isn't a contest of who can stretch themselves the most without snapping. You can't care for others if you are on empty. Do what works for you and your support system. But the priorities are balance and wellbeing. If you feel something truly isn't suitable or safe for you, it's okay to trust your inner voice. That voice that is honest and true. That doesn't make you a weak person, it makes you a person who knows what you need. Nurses care for others, but we tend to have a hard time caring for ourselves.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Dysrhythmias are frequent with LVAD patients. Because the pump can maintain forward flow despite dysrhythmias, the patient may remain awake and conscious despite persistent ventricular fibrillation.

November 11, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Like any other patient with indwelling catheters, the driveline can become a conduit for infection and patients with LVADs are prone to infections that may be localized around the LVAD device, as well as systemic including bacteremia.

November 10, 2018

Processing Emotions | Nursing Hacks # 9


So, you have an instructor, manager or preceptor you dislike, huh? Well, I've been there and I wanted to give some advice to those new nurses experiencing this currently or have in the past. Understand that nursing is based on relationship dynamics. Whether it's a patient's wife or your charge nurse, relationships are crucial in the nursing profession. The problem some new nurses face is their inability to see the forest for the trees. You want to mouth off, you want to act unprofessionally, that's fine. But trust me, nurses NEVER leave the profession. We grow, we progress and move upward. That manager you disrespected many times might have left your unit months ago. But now, he or she is the chief nursing officer at the hospital you're working at. And currently, you're at an interview, seeking a management position and guess who walks in? That manager from the past. They have been resurrected like a zombie, BAM! That's what I'm talking about. People come and people go, but they never go-go in nursing. Understanding how to remain professional even if you have strong emotions is essential. So when opportunities come up, your past transgressions or emotional episodes don't interfere. Nurses are humans, with histories and issues (like everyone else). And sadly, some nurses hold grudges. We might not have office politics like some professions, but we are humans with memories and what you have done in the past could impact what you want to do in the future. Some opportunities can be missed based on your past interactions.

Emotions run high when you being pulled in five different ways. I understand, I get where you're coming from but understand remaining professional doesn't require any additional actions. It just involves always understanding you are on. When I worked at Disney (everyone who lives in Orlando works at Disney for at least one summer, haha), they explained front-stage and back-stage attitude expectations. When you were in front-stage, meaning in the view of visitors, your attitude had to be per policy and on-point. When you were back-stage, the employee area, you didn't have these same rules. As you were on break and changing into costumes. The point of this example is to illustrate that each job has communication expectations. In nursing, you are always on, there is no backstage in relation to your emotions. You are expected to be professional to staff, patients and families. There is no discrimination or separation. You have to maintain your chill and emotional wellbeing up until you get into your car. Please don't explode on staff members and act unprofessionally in front to family members. Your job is stressful, yep we get it. You signed up for this, you wanted this. Here you go. Embrace and enjoy getting your dream job and stop giving reasons why you're allowed to act childish and unprofessionally. Nursing is a team effort. When you act unprofessionally and disrespect your teammates, you are less likely to get a team to work with you or support you. It's a lose-lose situation. Whether I like or dislike someone (on a personal level) isn't a factor at work. Helping each other and taking care of patients are the priorities. Stop with the high school shenanigans.

I have a rule. If I'm angry. I stop talking, wait an hour or call my husband (if I have time). My initial reaction is usually one of anger or hurt. I know this about myself, so I don't allow myself to reply immediately. Give yourself a time to process things BEFORE I act on them. I then sit down and write my feelings out on my laptop (or on a notepad), this act will dissipate some anger and allow me to get my thoughts together. By the final stage of actually discussing my feelings with the other party, I'm relatively calm. The two previous steps really slow things down and stop me from making big mistakes. Anger is like a hot stove, the processing turns the burner off. Being busy doesn't mean you get to be verbally abusive. Being stressed doesn't mean you get to be verbally abusive. Process and examine why you're really mad. Most of the time, there is more there. Take a deep breathe and don't allow your emotions to get the best of you or your career goals. You can apologize all day but you will never know why you didn't get that job. Was it based on past dynamics or emotional episodes? Who knows. It's hard controlling your emotions initially. But processing them in a healthy manner works. I've been doing this for years now. Just yesterday someone was screaming at me and I processed in the moment and remained calm. You will get to a point where you're the calm, professional one watching all these folks lose it over nonsense. You will see the power that being in control of your emotional well-being will give you. It brings the ability to see past the emotions and gets you to the real issue or problem. Now that's gold and works in professional and personal relationships.

When I process emotions, I ask myself...
1. Why am I feeling this way? Angry? Disappointed?
2. Am I mad about this current issue or past issues?
3. Is this hindering me from doing something?
4. Do I think this person deserves this? Why?
5. What will the anger accomplish? The value?
6. Is my ego hurt? Does this bother me? Why?
7. Do I think this is healthy? Professional?
8. Will I look back and regret my actions?
9. What points do I want to get across?
10. Is this really about this one thing?

... sounds long, huh? It isn't. I do this in about 2-3 minutes.

Listen, I'm not perfect. I have random freak-outs (serenity now, haha). It's a rarity but happens. I feel terrible when it occurs and I apologize a million times. Attempting to control your emotions and understanding your process is the first step. Working towards these goals is what matters. But you have to try, you have to want to work on yourself.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Patients with left ventricular assist devices require lifelong anticoagulation to prevent the graft from clotting. Most patients also have a pacemaker or automatic implanted cardiac defibrillator (AICD) placed.

November 9, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The left ventricular assist device supports the patient's cardiac output via a mechanical pump that draws blood from an inflow cannula in the left ventricle and pumps it into the ascending aorta via an outflow cannula.

November 8, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The most common left ventricular assist devices (LVADs) produce a non-pulsative flow, therefore patients are essentially pulseless making traditional hemodynamic vital sign interpretation impossible.

November 7, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
ICD discharge during manual chest compressions poses no risk to providers, although the rescuer may feel a weak shock. Although generally not indicated, the device can be deactivated with magnet application during resuscitation.

November 6, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In contrast to patients with a permanent pacemaker, ICD patients are usually aware of when the ICD delivers a discharge or shock. The most common complaint of ICD patients is the occurrence of frequent shocks.

November 5, 2018

Apple Watch | Nursing Reminders Tutorial (Brain Book)

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In most cases, the cardioversion and defibrillation thresholds are determined at time of implantable cardioverter-defibrillator insertion by inducing VT/VF and adjusting the shock strength above the minimum required to terminate the rhythm.

November 4, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
All implantable cardioverter-defibrillators are also ventricular pacemakers. The right ventricular lead is used for sensing and pacing, and shocks are typically delivered between a coil in the right ventricular lead and the pulse generator.

November 3, 2018

Preceptor Tools | Training New Nurses

The following are a few forms I use when I train new nurses. I noticed that conversations were not enough to properly assess an individual's growth. I needed proper documentation in order to properly evaluate the new nurse's development. The goals are to have specific learning plans each shift, set measurable expectations, and to provide comprehensive feedback. If we want new nurses to flourish and meet floor expectations, we must give them feedback and guidance.

1. Bedside Report Evaluations: After giving bedside report, I would give these slips out to oncoming nurses to evaluate the new nurse. They tended to be honest and help me in getting the new nurse to understand what areas they were missing and why certain information was important. I'd do this for the first 2 months only. By then, must new nurses knew what was expected.

Download WORD Version
Bedside Report Review Slips
Created By | Nurse Nacole


2. Shift Game Plans: Each shift, I would type up new expectations and goals. This was a document the new nurse could look at repeatedly and know what was needed that day. There was no confusion or misunderstanding because before we started our shift, we would verbally go over the form and he or she would sign the bottom. This was something I did up until the end of the training period. It was documentation of their progress and I wanted to always keep track of their achievements. I wanted documentation of their milestones and growth. If there was ever a concern regarding their ability to work on the floor, I had concrete evidence they were growing and developing. No gossip, straight documentation.

Download WORD Version
Shift Game Plan & Goals
Created By | Nurse Nacole

    
3. Patient | Environment | Documentation: This was just a cheat sheet of what I needed the new nurse to review each time they walked into the patient's room or as the shift went on. It was a little reminder of what needed constant assessing. I only used these for the first few weeks, as this process became routine after a certain point.

Download WORD Version
PED Assessment Tool
Created By | Nurse Nacole


I've been that student getting yelled at for something I was never told. I know it seems like a lot but these forms provide direction and focus. Are they a must when training a new nurse? Of course not. I like documentation and feel that people are more accountable when documents are signed and reviewed. These forms kept my trainees on track and everyone was aware of the educational game plan and goals for the shift. Oftentimes, things get lost in verbal conversations. I like things in print, what can I say.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The typical modern implantable cardioverter-defibrillator (ICD) consists of components similar to those in the standard permanent pacemaker, namely, a power source, electronic circuitry, and lead system.

November 2, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Electrical defibrillation at recommended shock strengths (200-360 J) can be safely performed in the patient with a pacemaker. All pacemakers should be interrogated after successful resuscitation, as well as placement.

November 1, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
If the pacemaker recognizes or senses an intrinsic atrial depolarization (P wave) or ventricular depolarization (QRS complex), it inhibits or resets its output to prevent competition with the underlying intrinsic rhythm.