Blood Glucose Meters in the ICU: Quick, Useful, But Regulatory Issues Still Unresolved

By Betsy Todd, clinical editor, MPH, RN, CIC

Photo © Life in View/Science Source. Photo © Life in View/Science Source.

Many time-saving clinical technologies are available today that were unheard of at the start of my nursing career. Have we always given careful thought to how this technology is applied? A controversy about the safe use of point-of-care (POC) blood glucose meters (BGMs) in the ICU is a case in point.

Quick, minimally invasive bedside blood glucose monitoring has become the standard of care in hospitals and nursing homes. Interestingly, though, the original FDA approval of POC BGMs was for at-home use only. But the agency waived any restrictions on inpatient use, as long as staff performing the tests were properly trained and the patients were not critically ill. The use of BGMs in critically ill patients is considered “off label.”

Early in 2014, the FDA proposed new regulatory requirements for BGM use in hospitals. Apparently in response to the FDA’s proposal, the Centers for Medicare and Medicaid Services then issued a memorandum of intent to cite and even fine hospitals for the off-label use of BGMs in critical care. A huge outcry from clinicians ensued. […]

April 6th, 2016|Nursing, nursing perspective|2 Comments

Nursing Reads: A Powerful New Novel Evokes Diverse Perspectives on an Organ Transplant

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By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

The Heart, a new novel by Maylis de Kerangal, caught my attention with a cover art image suggestive of the vascular and as beautiful as an angiogram. Taking place over a 24-hour period, the novel describes a 19-year-old accident victim who suffers brain death and the people who are connected to the heart transplant that follows: his parents, the doctors and nurses, the recipient of the heart. As a nurse who’s seen the organ transplant process from a number of angles, I wasn’t sure how De Kerangal could possibly navigate such material.

But the novel, which has been ably translated from French, is both subtle and powerful, casting light on the complexity of every character, from the pre-accident vitality of Simon, the donor, to the conflicted gratitude of the heart recipient; from the inexperienced ICU nurse to the surgeons.

Two important characters are nurses, though they are only a part of the larger picture:

Cordelia Owl, Simon’s ICU nurse, is an inexperienced practitioner. She carries out her nursing tasks in a distracted, perfunctory manner, speaking aloud to the unresponsive Simon as she cares for him. In doing so, she inadvertently intensifies the anguish of his parents, who are standing nearby and struggling with the concept of brain death.

Though her behavior shocks the attending physician, she’s not dealt with harshly. The physician tells her: […]

Thanksgiving in the ICU: Woven into the Tapestry of Traditions

By Marcy Phipps, BSN, RN, CCRN. Editor’s note: This post, originally published in 2011, remains as timely as ever. The author is now chief flight nurse at Global Jetcare.) 

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I’ll be working this Thanksgiving. I’ve worked so many Thanksgivings that the ICU feels woven into the tapestry of my own traditions. I don’t really mind; the cafeteria serves a fitting feast that’s embellished by the homemade treats we bring in, and although we won’t actually be watching it, the Macy’s parade will be on. Somehow, the smells and sounds I associate with the holiday will mix and mingle with the usual bustle of critical care, and it’ll feel like Thanksgiving. It’s actually a nice day to be at the hospital—for the nurses, that is.

For our patients and their families, I know hospital holidays fall far short. We have one patient, in particular, who’s been with us for a while. Her husband’s been a fixture at her side throughout her stay, and I expect to find him stationed there this Thanksgiving. Hospital turkey and television won’t give him the comfort or peace that he seeks, and I don’t know that he’ll be giving thanks. For many weeks I’ve watched him skirt a fine line between gratitude and despair; things could always be worse, but they could certainly be better.

When I stop to count my blessings, I’m overwhelmed. I belong to a profession that I’m passionate about—one that brings me great […]

Final Connection: An ICU Nurse Revises Her Feelings About Cell Phones

Illustration by Denny Bond. All rights reserved. Illustration by Denny Bond. All rights reserved.

Many of us have a love-hate relationship to smartphones, and each person (and generation) draws the line in the sand between invasiveness and usefulness in a different place. Cynthia Stock, the critical care nurse who wrote the Reflections essay in the November issue of AJN, “Final Connection,” starts her brief and moving story with honesty about such matters:

On Monday, if you had asked me how I feel about cell phones, I would have come up with this: I hate to listen to the drone of conversation coming from the person next to me on the treadmill at the gym. I don’t care about trouble with the HOA. I don’t care about a son who can’t decide on a career as a director or an actor. I work out to smooth the kinks in my soul from a job that requires me to navigate a relationship with life and death.

Today, ask me how I feel about cell phones. . . .

A good essay or story often centers around a reversal of some sort. What the protagonist believed may not be so true after all, or may be more complicated than first thought. As you can probably guess, in the course of the essay the author finds that she must revise her opinion of cell phones. Time and the […]

Patient Satisfaction and Nursing: Listening Matters, Whatever the Situation

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN. Her last post on nursing and patient satisfaction surveys is here.

by runran/Flickr Creative Commons by runran/Flickr Creative Commons

During this hospital stay, how often did nurses listen carefully to you?
1. Never
2. Sometimes
3. Usually
4. Always

Listening Carefully About Patients
“Her crit is dropping with each bowel movement, and she just won’t stop bleeding,” said my night shift colleague during the early moments of my shift.

As soon as she finished telling me the rest of my new patient’s care, I got on the phone for the ordered blood. Waiting for the first of many products to be delivered, I went to see her. As I poked around the hanging drips and fluids, checking dosages and orders, setting alarm limits, I heard my patient’s voice:

“Hello, hello? I’m so anxious. I just fell asleep for a moment and now I’ve woken up and I’m terrified. I think I need to be changed again, and I just don’t know what to do, and who are you?”

My colleague, busy with the details of resuscitation, hadn’t said much about my new patient’s anxiety. Anxiety, too often coded as neediness, is clinically important, especially in a patient with questionable stability, and doubly in a patient whose nurse must focus on speedy resuscitation more than handholding. I braced myself for what felt, just […]