hardcore nursing. putting my care where my mouth is.
Yesterday was yet another very bad shift.
Why bad?
Not enough available hospital beds led to an overflow of patients in our emergency department that were waiting to be admitted. This is referred to as access block and it quickly leads to a dangerous overcrowding of our department.
Why dangerous?
Overcrowding of emergency departments has been shown to result in an increased morbidity and mortality of patients. It also results in an increased likelihood of medical errors, a decreased capacity to manage emergencies, unacceptable waiting times, more incidents of violence, high levels of stress, poor morale, and a pernicious ...
Source: impactEDnurse - August 15, 2013 Category: Nurses Authors: impactEDnurse Tags: piss and vinegar Source Type: blogs
when our patients steal from us.
One afternoon I was walking across the ambulance bay to get a coffee from the hospital foyer when I happened across a man and his partner attempting to fit one of our non-collapsible hospital wheelchairs into the boot of a Taxi.
There was simply no way it was going to fit, despite him lubricating it with gobs of foul language.
As the Taxi lay between me and my caffeine hit, I had no choice but to confront the couple.
“I’m sorry mate, but you cannot take that wheelchair. It is hospital property.”
He looks up, lets the wheelchair drop and strides over to me.
So…. you know those clips from baseball matches where a...
Source: impactEDnurse - August 13, 2013 Category: Nurses Authors: impactEDnurse Tags: ectopics Source Type: blogs
CPR: a skill we must improve.
We should really stop referring to CPR as basic life support.
It is in fact essential life support.
Often hospital accreditation of healthcare providers in CPR is seen as a box easily ticked off so staff can move on to more important things.
Many staff are accredited annually with little opportunity to practice CPR and teamwork skills at any other time.
Such a lackadaisical approach risks a wide range of standards and poor consistency between individuals, and studies seem to point to this currently being the case.
As nurses we should not suck at CPR.
The American Heart Association has recently published a position paper th...
Source: impactEDnurse - August 10, 2013 Category: Nurses Authors: impactEDnurse Tags: clinical skills Source Type: blogs
The ThunderBox Papers: Normal Values INR.
The ThunderBox Papers are a set of short pithy one page information sheets.
The idea is that you stick one on your toilet door for one week and commit to learning the information during each visit.
A Thunderbox refers to an old Australian ‘out-house’ or outside toilet. These toilets were often nothing more than a small drafty wooden shed containing a seat over a deep hole in the ground.
Toilet paper consisted of old pages from newspapers or magazines threaded together with string and hung on a hook.
I will post a Thunderbox Paper here every week or so. Stick it in your toilet at work (or home) and use yo...
Source: impactEDnurse - August 6, 2013 Category: Nurses Authors: impactEDnurse Tags: the nurses desk: Source Type: blogs
skin traction.
Skin traction is indicated for fractures or dislocations that require only a moderate amount of traction force for a relatively short period of time.
The goals of effective skin traction are to:
Prevent muscle spasm
Immobilisation of the effected limb.
Reduction of fracture.
Skin traction must not be applied over an open wound.
Take care with correct preparation of any superficial lacerations, incisional wounds or infections that will be covered by the skin traction or the bandage. Again this may lead to a decision that the traction is contra-indicated.
If you are using adhesive traction tape check for potential allergie...
Source: impactEDnurse - August 4, 2013 Category: Nurses Authors: impactEDnurse Tags: clinical skills Source Type: blogs
how to dispose of your patient’s ID bracelet.
So. Its a busy shift and you are about to discharge one of your patients home.
You cut off their ID bracelet just before they leave. Now what?
Do you usually throw it in the general waste bin?
There is a potential here for a breach in patient confidentiality if you do.
So where should you dispose of it?
I asked some of my friends what they would do and here are some of the responses.
Heather: I’m naughty and throw it in the nearest Sharps bin
Nardine: I chop it up with scissors then chuck in general waste!!
Tom: As funny as it sounds, clinical waste.. I reckon people are less likely to rummage through it for a name band...
Source: impactEDnurse - August 3, 2013 Category: Nurses Authors: impactEDnurse Tags: tips and tricks Source Type: blogs
Comment Crack 2013.
Well, it is that time of the year again. Time to ask you for my fix of crack.
This website is up for renewal in a just few weeks.
As I make absolutely no money from this site (notice the lack of annoying advertising banners?), all expenses are out of pocket.
Make no mistake though, I have absolutely no problems with coming up with the dosh to keep the site going.
After all, it has become not only a labour of love for me……but it is my own personal portal to interact and cross pollinate with some of the most incredible nurses and doctors that exist in the known universe (apart from the ones I work with that is).
And that...
Source: impactEDnurse - July 31, 2013 Category: Nurses Authors: impactEDnurse Tags: ectopics Source Type: blogs
the ThunderBox papers: paediatric weight estimation formulas.
The ThunderBox Papers are a set of short pithy one page information sheets.
The idea is that you stick one on your toilet door for one week and commit to learning the information during each visit.
A Thunderbox refers to an old Australian ‘out-house’ or outside toilet. These toilets were often nothing more than a small drafty wooden shed containing a seat over a deep hole in the ground.
Toilet paper consisted of old pages from newspapers or magazines threaded together with string and hung on a hook.
I will post a Thunderbox Paper here every week or so. Stick it in your toilet at work (or home) and use yo...
Source: impactEDnurse - July 29, 2013 Category: Nurses Authors: impactEDnurse Tags: the nurses desk: Source Type: blogs
My Hospital. On approach.
Just a quick post for no other reason than I thought this was just a bit cool.
Yesterday I happened to ask Bryce, one of the pilots of our Snowy Hydro SouthCare Helicopter if he could snap a picture of our hospital (including our emergency department) from the air on his next approach.
He very kindly obliged.
So this is where I work.
Canberra Hospital in the Australian Capital Territory. If you look at the long grey building with the wavy roof at the back of the buildings you can just make out two ambulances (Only two ?!?) parked outside the emergency department.
In fact the picture only shows about half our campus which...
Source: impactEDnurse - July 28, 2013 Category: Nurses Authors: impactEDnurse Tags: ectopics Source Type: blogs
Nursing ring theory: Care goes in. Crap goes out.
Susan Silk is a clinical psychologist who is also a breast cancer survivor. In a recent story in the Los Angeles Times, her friend Barry Goldman recounts the day a friend wanted (needed) to visit her immediately following surgery:
Susan didn’t feel like having visitors, and she said so. Her colleague’s response? “This isn’t just about you.”
“It’s not?” Susan wondered. “My breast cancer is not about me? It’s about you?”
Following her experiences at this time, Susan developed a technique to help people stop communicating un-skilfully (or even harmfully) to the wrong people during times of crisis....
Source: impactEDnurse - July 27, 2013 Category: Nurses Authors: impactEDnurse Tags: reflective practice. Source Type: blogs
palpating your patient’s radial pulse.
To palpate a radial pulse, use the sensitive tips of your first three fingers over the expected radial pulse site.
To be specific: at the wrist…lateral to the flexor carpi radialis tendon.
You can use your other hand to support the patients wrist.
Once it has been located, some nurses like to just use two fingers over the pulse.
The pulse is felt as a pressure wave produced by ventricular ejection during systole. Interestingly this pressure wave travels down the artery much faster than the blood itself (5 metres/sec versus 40–50 centimetres/sec respectively).
With increased age, or due to changes in the wall of the art...
Source: impactEDnurse - July 26, 2013 Category: Nurses Authors: impactEDnurse Tags: clinical skills Source Type: blogs
Resource: ECG teacher.
ECG teacher is a website that contains a suite of excellent educational videos on ECG interpretation.
Although some of the site requires a paid subscription to access (quizzes, revision notes, tips etc) the videos themselves are free.
An excellent resource for nurses and other medical professionals wanting to get their heads around the normal and not so normal ECG.
The electrocardiogram is one of the most important diagnostic tools in acute medicine. In this course, we use straightforward language and graphics to explain in simple terms how the normal ECG readout is generated and presented. We then go on to explain how the...
Source: impactEDnurse - July 25, 2013 Category: Nurses Authors: impactEDnurse Tags: clinical skills Source Type: blogs
nursing perceptions.
This nursing meme has been doing the rounds on the Internet for some time now (and there are quite a few variations).
I’m just throwing these two up here because……well because they made me grin at the grains of truth they contain. (Source: impactEDnurse)
Source: impactEDnurse - July 25, 2013 Category: Nurses Authors: impactEDnurse Tags: the funnybone. Source Type: blogs
Hair Tourniquet Syndrome.
We recently had a young girl present after her parents could not settle her. During a thorough assessment by one of our nurses, the cause of the girls unhappiness was identified.
A single human hair had wrapped itself tightly around her toe.
The photo above shows the girls foot after a liberal application of hair removal cream which successfully dissolved the hair after 2 applications (over about 30 minutes).
Hair Tourniquet syndrome:
Hair Tourniquet syndrome is a relatively (although often unreported) common occurrence in the hospital setting.
It requires high vigilance as it can quickly lead to ischaemia a...
Source: impactEDnurse - July 22, 2013 Category: Nurses Authors: impactEDnurse Tags: clinical skills Source Type: blogs
from silence to voice. read it. STAT.
From Silence to Voice: What Nurses Know and Must Communicate to the Public.
This is a book that EVERY nurse should read. It is that important to us.
It is a clarion call for us to examine our profession and to find our own voices…. to break down stereotypical perceptions or misconceptions of our work, show what exactly it is we do, and define our absolute importance within the health system.
This we need to do in the public arena, the media and with each other.
Just do yourself a big favour and get your hands on it as soon as possible.
The 3rd edition has just been released: Available here from Amazon in paperba...
Source: impactEDnurse - July 21, 2013 Category: Nurses Authors: impactEDnurse Tags: the nurses desk: Source Type: blogs
