MGS RADAR

My nursing training is coming to an end, it’s almost unrealistic to me because I can remember the first day in nursing school, the first patient I washed, my first room I got for myself, the first patient that died in my care (though, very late in my whole career), my first CPR, my first emergency suction, my first intubation assisting, my first intravenous line, my first intramuscular injection.

In the first year I knew nothing, I thought I knew something but I didn’ knew shit

In the second year, I thought I knew everything but everything was “limited” to a small ammount of patients

In the third year, I have so much knowledge and doesn’t really know how to put it into action, frankly I feel like in my first year where I didn’t knew shit!
People are telling me, after you get your R.N. title the whole training starts from the beginning, limited to a one month frame.

People outside the hospital see me as a kind of medical expert, in the Fire Department they think of me as some kind of medical hero who knows everything. How many times I have been asked “Do you know what that could be?”and the only thing I could say was a list of probable diagnoses.

I’m applying for intensive care nursing jobs, and it’s quite unusual because the general public of nurses think you have spent some time on the regular floor to earn yourself some credibility then you can transfer to intensive care.

I want to take a shortcut, some people advice me not to do it , some of my mentors say do it, what do you have to lose?

If I think of myself a few months from now on and I see myself on the regular floor with 30-40 patients, I’m a little bit afraid. I’m not sure if I can handle this “good” which means according to my standards. I have high standards to myself, but I don’t tell anybody about them because I think development and skill starts in your own mindset, deep inside yourself you should be your worst and strictest critic, but you don’t have to tell anybody about it!

If I think of myself a few months from now on and I see myself on the Intensive Care Unit or in the Anaestesiology Nursing Department which is in some aspects more demanding, I KNOW that I can handle it.

It’s a little bit crazy, around monitors, suction tubes, intubated and sedated patients on a thin line between life and dead with thoausands of infusion pumps and solutions…I feel comfortable !

A CPR-Emergency is the worst nightmare for any nurse working on the floor, if a code blue is coming in they sweat blood and they have a natural tendency to “hate” it. Even though it sounds a little bit strange and weird, during a CPR or code blue I’m in my business. I’m still a little bit shaking during CPR’s BUT in fact everytime I take an act, I feel comfortable and “like” doing it. Sometimes it’s just crap, sometimes the humanity is fucked up but I like it.

I can watch a patient’s monitor for hours. I get hypnotized by watching the curves, the ECG , the blood pressure which raises everytime I touch the patient. I can watch the pressure - meters on the breathing - apparatus for hours, adjust the monitors, listen to the patients breathing. I like calculating the fluids, I like working with medications, drawing up syringes - Nursing the numbers and having a challenge.
I’m far away from knowing everything for working on the floor, but I won’t be good at it. On the floor I’m only average because the surroundings only allow me to do “average” work. And I don’t like average work, I want to give my best and I think from all the wards and all the patients I worked with that THIS is my place at least for the next 2 years!

I really don’t care about the money, beginners salary is so fucking bad, I could get more money at McDonalds (I think , don’t know) and my plan of reducing my hours is not worth the money. At an university clinic I’d get 1966,00 € which is around 1400 - 1300€ taxated salary. Around 15000 € per year left for me. There is a plus for nightshifts , weekends and public-holiday working, but in my paying level it’s ridiculous. Nursing is nothing that will get me rich…

I don’t know how I can bring this to a boss-friendly level and sell it to them, but this is my idea!

A 12 year old male patient presents in the Emergency Department with acute abdominal pain in the whole abdominal region. The pain started around 8:00 at the same day of presentation in school, has no specific details and can’t be relieved by positional change.

Pt. states, that he ate a sandwich at school, then cornflakes at home and rice in the evening and ate 2 cheeseburgers despite abdominal pain plus slight discomfort or nausea.

At the time of presentation (around 23:00)  he denies any kind of nausea.

Abdominal exam shows no pain to pressure , visible and papable meteorism (air in the stomach and intestines) no masses. Auscultation indictates elevated peristaltic movement.

The father of the patient insists on clincial admission due to “things” he read in the magazines
The pt. is asked why he decided to ate these “heavy” things due to abdominal pain, pt. states he just was hungry and “forgot about the pain….
Diagnostics:
Physical Exam and Assessment of patient

Nursing:
Pain relieving positional change

Therapy:
Pt. recieves one tablet of Simeticon

Sometimes I just think, that mytime is wasted despite the fact that I can’t change it!

Today I finished my last day on an internal medicine ward. Five Weeks of hard work behind me and I must say I was bored, really bored.

Everyday I sense the scent of pampers diapers, shit,wet wipes and Baby cream before I even enter the ward, I see the patient bells ringing and the moaning of sick patients who spent the night on the floor because they are completely desoriented. I enter the kitchen, where the night shift handover is going on, I see the tired and meaningless faces of my co-workers, facing a massive army of highly dependend and very sick patients, some of them nearer to death than life. They are all tired, many of them went into sickness because they are so burned out and came back just to end up in a frustrating circle of a endless flow of patients. No moment to step back, if a bed is empty it’s filled within a shift and if you sent a sick one home, you are partly afraid of the unknown patient coming in.

With coincidence, a very fit patient will see a nurse on the morning round, on breakfast, on lunch and maybe two times in between to measure some things or do some necessary things.

A few ammount of patients is going home “healed” or “better” from there. Most of them are just stable, some of them are unstable, they come back in 24 hours because some nursing home is under-staffed and give their patients some laxatives to sent them to hospital because of diarrhea. They know for sure, that they are gone for at least 3-5 days, maybe 50. One less patient to deal with.
One patient was (and currently is) on this ward for 150 days. He was admitted because of unkown decrease of general condition, then he had a heart attack, then he had a pneumonia, then he refused to eat. He is a little bit desoriented, but he does his job very well. He is still in hospital because…yeah nobody really knows the reason!

The work is not quite enjoying, but one thing I learnt is that your co-workers can improve something, if you are part of the team. But I wasn’t even if I thought I was.

I refused to be a part of a team which left me alone and didn’t help me. I refused to be part of the team which isn’t really a team because they are backbiting each other.

I know really good teamwork, I had it in our project and I loved it it was such a great experience. I know the difference. But in this case, I said fuck about the team let’s focus on my patients and they improved very well , but they were to sick to tell me that they took some enjoyment out of it and felt “cared”.

But it’s the last time I worked on a ward like this, it’s the last time I was “forced” the next time I choose what I do.

Here are fifteen basic rules that I established during my student nurse fellowship and I think these rules apply to everything you do as a nurse.

1. Learn and stay to the basics (Anatomy,Physiology,Basic nursing care)
2. Try not the get addicted to prestige from the wrong persons (attending physicians, physicians, charge nurses), set your mind in the “on” position and try to think in efficiency and not in how much prestige you are gonna get.
3. Try to train yourself and put yourself in a position where you can say no matter where I work , I can do it unrelated to the subject. If you specialize too early you blend out certain disciplines that you probably might enjoy later.
4. Don’t think you are the tributary of your employer,charge nurse or training nurse. You are in a training position but you don’t have to give up the other part of your life!
5. Learn to draw the line from frustration, anger and depression and hang it on the hook at the end of the shift - You can’t  change all the things that bother you and especially not at home in your mind.
6. Look for a mentor or advisor , preferably someone from the older staff with years of experience who will show you how shit works!
7. Be an advocate for your patients, stand up for them and try to protect them from bad decisions doctors do SOMETIMES - This means you can stand up to the doctors which means you have to beat them at their level which means: know everything
8. (I hate this rule, but it’s simple) You can’t be a very good nurse without experience, no matter how good you are in school and no matter how good you think you are in practice, you need years of frequent doing.
9. Don’t kill your patients (Which means, be safe about medications, injections…anything)
10. Try to assess the patients or critical situations by half your knowlege and half your gut’s feelings - That’s your job
11. Never under-estimate the importance of a good breakfast or meal!
12. Try to maximize the bedside - time and minimize the writing - time without forgetting either subject
13. Document often, Document early!
14. Prioritize your work, sometimes things that seem important are not important and can wait!
15. Seek help often and early in case you are not capable of doing it alone! + Seek for reflection of your work!
16. (Introduce yourself to everyone from the cleaning lady up to the chief resident physician, especially to people whom you work close with, and if you go by a ward which is unknown to you, introduce yourself to everyone around. Beeing known is the key for getting help at night shifts where you are alone and need help)

I’m in charge for a ward of four rooms with five people on a trauma surgical ward and considering we’re still student nurses it’s a challenge for all of us.

We split the four rooms in half so for each shift half of the staff is responsible for EVERYTHING what the nurses normally do which means I have three to six patients.

Positive:

- My team is great, just great they are putting so much effort in this thing and they work like maniacs to get the best out of our patients.

- Everybody is an expert in a certain aspect of nursing, Mine is pain medicine and medications, other is mobilization of patients and besides that everybody is an expert of the basics

- The team itself is great because WE TALK. We talk about everything and everybody knows about everything. The key of pushing teammates is to give them personal responsibility for their work and the consequences of their actions.

- Our teaching nurse is very helpful, she wants to see the absolute maximum !
-  The doctors are new on this ward and besides that they care about true teamwork which means interchanging work. We think about things they have to think and they think about our things. We have a very experienced surgeon and a very new and dedicated intern surgeon. Makes fun.

Negative:

- The material we are working with is shit. I have to work with broken toilet seats, I have three bedsheets and three bedcovers (on a GOOD day) to take care about post-operative (Which means dirty and bleeding) patients. I have no towels or washcloths. The blood-pressure - cuff is either lost or also not working and I need thirty minutes of searching through the whole hospital to get a decent cuff so we have at least the BASIC equipment to take care about patients. This is not funny at all!

- The division managing nurse bothers me as a charge nurse with permanent shitload of things. She has no fucking clue about my patients and tells me to take a patient out of the bed or give him something to eat which I didn’t because the patient didn’t WANT TO EAT OR GET OUT OF BED. During the talking with her, she signalizes me exactly what she thinks of us: I have no clue, I have no experience, I’m just a fucking student nurse to fuck up with shitwork she won’t do.. I respect 20 years of nursing experience but I think respect should be on both sides.

All in all, we handle our patients very well and they are improving…great job!

Well today we didn’t have many patients on our ICU, and the ones who were present…well not something you might expect on an ICU.

I took the chance to do some things…I visited my head teacher about some things and then she asked me the following question.

“Well do you feel capable about working on sick kids and babies?”

And I answered :”Iam expected to take care about any patient around any age!”

“Well, then go to the Neonatal Intensive Care Unit right now, there is a 4 year old intubated child on a respirator where your expertise is needed!”

TRUE CHALLENGE!

I really liked pediatric nursing and working with the children on the ward, and I miss it during the days I spent washing 90 year olds. But…I’m formally not capable of doing it

Well long story short, there it was the intubated, sedated child with a minor surgery. I’m not in the position of mockering about other nurses, and I’m not a pediadric nurse but the nurse on THIS particular ward was a real bitch!!!

But, with some knowledge I pulled out of my back part in my memory I was able to take care of him and another newborn child, very pleasing for me at last!

…what a freaking PiCCO Line is and how to set it up!

…what a Swan-Ganz-Cathether does!

….how to prep an arterial line!
…all emergency medications used in case of Resus!

…how to interpret an ECG quickly!

…what the fuck BiPAP and CPAP does!

…the different forms of enteral nutrition!

…the differential diagnoses for chest pain!

Three weeks to go!!!

If you think Diarrhea is nothing to bother and nothing but a symptom or sign, you are WAY wrong…it can…no wrong it WILL fuck you up if it will last LONG and it is dangerous…but no tears and fears - It can be handled without beeing a physician.

Why do I write this article?
First of all, I’m an official victim of Diarrhea…I catch it up at least once a year since I work with infectious patients OR I was getting fucked by a homojock Kebap - Maker - Idiot with lack of hygiene in his meatshed.

I also hear a lot of childish - half knowledge - cowfarm alike - rumors about dealing with Diarrhea…even in the internet on professional webpages which give actual medical ADVICES to people without any medical backround.

I spare you the routine disclaimer, I mean why should I point out that you should catch up professional medical advice and that this isn’t something you should transfer 100% to your case of bad luck?  Thats common sense and even medical disclaimers won’t let this show up in front of the idiots that got and will get killed becaused they tried to cure SEVERE illnesses just by wikipedia (nothing AGAINST wikipedia, I absolutely HATE Wikipedia-Credibility-Bashing - It’s just about the stupid shitbags putting medical advice into practice without load up their brains from a hybernating status.)

If some of my former or future employers will read this, see it as a part of small nursing science research shit. I mean I’m not the new Nancy Roper, but hands down I know something about Diarrhea. It’s still an advance if some of my employers is smart enough to understand the language I tend to write in, but no offense!

No make anything clear, I’m speaking about a short !(1 day to 4, maybe 5 days depending on your system)  diarrhea which is probably from eating something bad or having an infection in your intenstines. Now comes the bad part which is part of my job: Take a look at the diarrhea if it’s anything than fluid shit or something inside (slime, blood, something you might not really identify as old food) this mess must be reviewed by a physician!!!

Also I’m just speaking about diarrhea alone. They are common symptoms like nausea, general sick-feeling (like you have a flu) vomiting, light general stomach-pain and sometimes high temperature. If they are symptoms present which can’t be related to the diarrhea itself or the effects of this –> Physician

THE PRACTICAL PART FOR HELPING YOURSELF STARTS HERE
What causes diarrhea ?

For the average diarrhea it really doesn’t matter which bacteria or which virus exclusevely infected your intestines.  It doesn’t matter!

Does antibiotics help in case of diarrhea ?

I see some physicians prescribing masses of antibiotics against diarrhea, but the guidelines do not see the clinical outcome in this step. This might be a point of discussion for medical experts, but I see it rarely and in case I see it - never helped. Period.

What is the best medication against diarrhea?

Loperamide
I would personally not recommend loperamid in case of in infectious diarrhea…only in cases where you need to buy some time to get yourself in a calm position to heal, but loperamide and any other stuff like this will lower your peristaltic - bowel - movement of and you might give the possible virus or bacteria the best place to establish himself in your system. 37°Celsius - No bowel movement - Wet and dark condition PERFECT for developing of bacterias and viruses. This means the medication loperamide will actually make your diarrhea last LONGER.

Saccharomyces cerevisiae (Yeast) is something very nature and it hasn’t got many side effects, no relevant to me I think. It will re-establish the intenstinal flora in your colon and it will fight the bacteria. It helped me very often and also you can take this as a PRECAUTION a week before a flight to turkey or egypt OR you know that you’ve eaten something from the east that tasted not very good. Take it, it won’t bother you that much except some well…sounds and flavor.

This is basicly the BASIC medical treatment of diarrhea, if you are not interested in the whole understanding part you start here.

This is my flowchart like “MGS RADAR Diarrhea Treatment Scheme”
CAUTION: Brain must be used by application!

• If you have the first Diarrhea like stool and no other symptoms that may lead to a serious shit (take the word!) LIKE stomach mumbling or a “different” feeling in the guts, you start preparing but you should not call the cavalry ! One time can happen!
• If you got some strange feeling that this might last longer OR you have the second occur of diarrhea take exactly ONE pill of loperamide + 2 - 3 pills of  Saccharomyces cerevisiae (Perenterol etc.)
• In the first two days take 2 pills of Saccharomyces cerevisiae three times a day after the third day and if the symptoms are weakened take one tablet three times a day until you got exactly one week after the first occur of diarrhea
• Go to the local supermarket and buy:
  - Three bottles of Powerade or similar like Isostar (without bubbles, with sugar and with electrolytes, they need to be isotonic!!! NO ENERGY DRINKS!) The Powerade is the base of your re-hydration it works very fast and very well to my experience
  - Lots of salty stuff like Potato Chips, something that you really like
  - Buy lots of water without carbonide and with some taste in it, so that you can consume masses of water.
• You go home and consume the bottles of powerade in a row, after that you need to drink at least 2 liters of water, if you are able to do more drink like a moron!
• Eat the salty stuff whenever you feel like it
• The keypoint behind this is, if you are hydrated very well the side symptoms like weakness should be lowered to a point on which you can keep alive daily tasks, but KEEP A LOW PROFILE . You gotta imagine your body has a large wound and it may lose MUCH fluid.
• You should keep hydrated like this at least for a week
• Now comes the part which many people don’t aggree with, THERE IS NO REASON TO STOP EATING NORMAL FOOD. You can eat a light version of your normal stuff, but if you feel very good there is NO REASON to stop eating.
• Avoid food like: Whitebread, ANY FASTFOOD, eating outside, very sweet things, FAT FOOD, Salad, EGG
• food to like: Fruits in general, Carrottes, Apples, BANANAS, Potatoes
• Don’t drink alcohol, it’s a rollercoaster for your digestive system
• Use common sense!!

Be safe!