Nurses spend more time with patients than most other types of providers and have unique insight into patient care and the the healthcare system.

We’re Not Going to Lie to You

By D’Arcy Norman, via Flickr

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

“Hgb 4.1,” the lab tech said, and we jumped as though someone had fired a starter pistol. While one nurse called the on-call trauma doctor, the rest of us mobilized in preparation for the interventions we anticipated.

The “critical results” call wasn’t a surprise. The teenager’s pelvis had been crushed when he was run over by a delivery truck. His blood pressure was holding fairly steady, but we didn’t put much faith in that. In cases of hemorrhagic shock, young patients tend to compensate until the very last second, and we knew that.

His heart rate was soaring and his color was terrible. In the 15 minutes since he’d been wheeled into the unit, flat and flaccid on a stretcher, he’d gone from barely arousable to completely nonresponsive. Aside from his shallow, even respirations, he looked strikingly dead.

A good nursing team functions like a choreographed troupe, and we were at our best that day, moving with staccato precision. Massive transfusions can do wonders; still, it was amazing how quickly he improved. He lost the gray-white pallor and his heart rate stabilized. Then his lashes fluttered and he opened his eyes.

He regarded us working over him for several minutes. The air of urgency remained, and the gravity of his condition was no secret.

“This is bad, isn’t it?” he asked.

And it wasn’t a time for platitudes.

“We’re […]

2016-11-21T13:12:12-05:00August 8th, 2011|nursing perspective, nursing stories, Patients|3 Comments
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Fecal Impaction and Dementia: Knowing What to Look For Could Save Lives

By Amy M. Collins, associate editor

Last October, I wrote a blog post about my grandmother, who is 85 and suffering from the first stages of Alzheimer’s disease, and about the failure of many providers to assess and treat the underlying cause of a sudden and extreme acceleration of her dementia symptoms (mania, agitation, and violence, along with nonstop, nonsensical talking).

The post generated a slew of comments on both the blog and Facebook, with over 20 nurses suggesting the probable cause for her symptoms to be fecal impaction or urinary tract infection. They were right. But several physicians and specialists had been shockingly wrong, diagnosing her with everything from closet alcoholism to VERY-late-onset bipolar disorder.

My grandmother did, in fact, have a severe fecal impaction, finally diagnosed—after several weeks of family turmoil—by a nurse in an ED. She was treated, and within a few weeks her symptoms slowly dissipated. I’m happy to say that she’s now back to her sweet and gentle self, with no memory of the episodes she herself would have deemed crazy.

Although her Alzheimer’s symptoms are still heartbreaking (she recently introduced me to a fellow assisted-living resident as her ‘special friend’ instead of her granddaughter), she isn’t agitated, hallucinating, accusing people of stealing, […]

2016-11-21T13:12:13-05:00August 4th, 2011|nursing perspective|6 Comments
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AJN’s Top 10 Blog Posts for the Last Quarter

At this blog we’re not always devoted practitioners of the art of the list. Used too often and too cynically (some of the more mysterious nursing blogs consist entirely of lists of articles and excerpts from other blogs), lists can be just another form of journalistic cannibalism.

But it sometimes occurs to me, as I publish a new post that takes its place at the top of the home page and pushes all those below down another notch (until, after a few such nudges, they gradually fall off the page, entering the purgatory of the blog archives), that this isn’t entirely fair.

While blogs allow for quick reaction to a news story, a public health emergency or controversy, a new bit of published research, they are also places for writing that isn’t so narrowly tied to a specific date and event. Many thoughtful posts by excellent writers have been published here in the past couple of years. With this in mind, here’s a list of the 10 most read blog posts for the past 90 days. It doesn’t mean that these are necessarily the very best posts we published in that time, or that they were even published in the last 90 days . . . but it’s one way of measuring relevance.—Jacob Molyneux, senior editor/blog editor 

1. Dispatches from the Alabama Tornado Zone
This one is actually a page with links to a series of powerful and thought-provoking posts by Susan Hassmiller, the Robert Wood Johnson Foundation Senior Adviser for Nursing, who volunteered with the Red Cross after the devastating Alabama tornadoes in late April of this year.

2. 

2016-11-21T13:12:17-05:00August 2nd, 2011|healthcare social media, nursing perspective, students|1 Comment
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What’s That on My Stethoscope?

by rosmary/via Flickr

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer for this blog.

The long shifts in the ICU are often chaotic. The days are packed with procedures, “road trips,” transfers, and admissions. The high acuity of our patients adds to the emotional intensity, and even the relatively smooth days are busy. Assessments, medication administration, and charting are all pressing and time sensitive, and there are a lot of strong personalities among us, resulting in occasional combustible strife.

Nursing is a high stakes occupation, no matter the unit, and the stress can be overwhelming. I’m grateful to work with a group of nurses who have excellent senses of humor. The levity provided by a quick laugh can be priceless, and sometimes a pointed stare or quick comment provides an essential release to a tense and pressurized situation.

Lately, along with our usual quips and sideways jokes, we’ve been inventing new nursing games with compelling names. They’re spur-of-the-moment games, usually inspired by whatever’s currently happening. My favorite, so far, is “What’s that on my stethoscope??” […]

2016-11-21T13:12:18-05:00August 1st, 2011|Nursing, nursing perspective|2 Comments
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Caught in the Crossfire: The Debt Crisis and a Child’s Shooting in the Bronx

By Shawn Kennedy, AJN editor-in-chief—The one good thing about commuting into Manhattan is that I have plenty of time to listen to the news on the radio. This morning, there were two stories that topped local news and gave me food for thought while I negotiated traffic.

One, of course, is the current debacle in Congress over passing a bill to raise the debt ceiling, a necessary move to prevent the country from defaulting on payments. It was expected that a bill put forth by Republicans would have been passed in the House of Representatives on Thursday evening, but Speaker John Boehner did not put the bill forward because he couldn’t garner enough votes from a handful of conservative Republican colleagues who feel the bill doesn’t go far enough in limiting spending and are therefore unwilling to compromise.

What’s ridiculous about all the posturing around this bill is that if it passes in the House, the Democrats in the Senate have already said they will vote it down. So the Republican holdouts aren’t about outcomes, but about appearances. And it’s wasting time we don’t have. As everyone knows by now, a solution needs to happen by August 2. The financial markets have been showing the stress for the last five days (and if you think it doesn’t pertain to you, think retirement accounts, college funds, etc).

And it’s not just the U.S. financial markets—markets around the world are down. […]

2016-11-21T13:12:20-05:00July 29th, 2011|nursing perspective|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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