Nursing Influence

Many people, especially those who are healthy, do not think of what would happen if they should suddenly fall ill or become injured in a serious accident. But this topic is far more important than most people in my age group think.

We recently had an experience in the hospital where a 25 year old man went down at home, he was revived by paramedics, and brought to the hospital. After a few days on life support, he was declared brain dead. His fiancee, whom he had been with for several years, wanted to withdraw care and let him go, as she knew that this was the decision he would have wanted to make. However, he did not have an advanced directive to appoint a power of attorney or living will, so the decision legally went to his mother whom he was not close with. His mother couldn’t bear the thought of her son passing away, so she refused to let the hospital withdraw the life support. He laid in the bed for several days before physicians stepped in and told her that it was not ethical to keep his body going with the ventilator and other supportive equipment.

We, as nurses, had several conversations with his fiancee and she confided with us her frustration. Her and her fiance had actually had the conversation about “being a vegetable” after seeing a story on the news. They both vowed that they never wanted to lay in a hospital bed in that exact condition. But, because they never filled out an advanced directive (and weren’t legally married), she had no say on this decision. With just a few signatures, this situation could have become slightly less stressful on the fiancee.

Below you will find links to the PDFs provided by the State of Arizona to easily fill out your living will and healthcare power of attorney forms (at absolutely no cost to you). The living will is a document that discusses only “deathbed” decisions, while the healthcare power of attorney appoints one person to make all medical decisions for you, limited by decisions you made in your living will.

So, take a few minutes to print out the attached forms, take some time talking with your loved ones, and fill out the forms. Each form requires a notary to verify the signature, and most banks offer a free notary service when you use their company for banking. Many libraries also offer notary service, so make a quick phone call to find out.  After you have filled out your forms, you can choose to file them with the State of Arizona’s Advanced Directive Registry (the pdf with instructions is below). This registry keeps your forms online, easily assessable to anyone you choose to give your password to. You can also choose to give copies of your advanced directives to your loved ones in case your find yourself in an unthinkable situation.

Living Will Form
Healthcare Power of Attorney Form
AZ Advanced Directives Registry Instructions

The last two weeks at the hospital have been insane. We’re a 28 bed ICU; in the winter months, we generally have about 18-24 patients at a time and in the summer months we generally have 8-12 patients (due to the snow birds we have visiting during the desert winters). Well, it’s currently the beginning of August and we have had 20 patients on several days in the last few weeks. We don’t have as many staff members in the summertime because staff are allowed (and encouraged) to take their vacation days during our slower months and the hospitals hire travelers in the wintertime to accomodate the increase. So, having a winter-like census during the summer months is a struggle as far as staffing goes.

I was the team leader (aka relief charge) for the ICU a couple days during our craziness and I can’t even begin to explain what a difference it makes to have such a wonderful coworkers at the hospital. I’m lucky to work alongside a group of people who are truly a team. If one person is getting their butt handed to them by their patient load, you’ll always see another staff member in the room. You’ll rarely see someone sitting down to chart if someone else needs a hand.

Just throwing that out there…. thanks to all my coworkers for being so great. I can only hope that most hospitals can retain this kind of staff. :)

Our country is battling obesity and the profession of nursing is not immune. You can walk into any hospital and notice this fact. Nurses are teachers and role models in our communities and while at work, we often take advantage of “teachable moments” with our patients. A clinically obese nurse on medication for diabetes and hypertension is going to have a difficult time getting through to their post-MI patient with education on diet and exercise.

One of my favorite examples of inspiration in the medical field was from several years ago, Dr Nicholas Yphantides was extremely overweight at 467 pounds and teaching his patients “do as I say and not as I do” and feeling badly about it. So, he kicked his life into gear and lost over 250 pounds without the help of surgery or medications….and has kept it off. He can now teach his patients to “do as I say AND as I do”.

Or, back in March, when Methodist Healthcare System in Texas encouraged it’s employees to be more health with a “100 Day Live Healthy Challenge” where employees form teams and compete on the amount of aerobic activity per week or weight lost. If every hospital developed a program like this, especially with incentives, I think our workplaces would be quite a bit healthier. Maybe we’d stop seeing boxes of Krispy Kreme or oversized bagels and cream cheese sitting in the nurses’ lounge?

At the last nursing conference I attended in Las Vegas, the brochure said that the price of the conference included a “continental breakfast and lunch” each day. So, we show up at 7am and see this picture… trays of danishes. No fruit, no granola bars, nothing else. Oh, and they had coffee… but no juice, no cold water. Outta luck for this girl who doesn’t like coffee and is trying to eat healthy. From doing some research, one of these small pastries has about 150 calories and 8 grams of fat… and many nurses had 2 or 3 of them on their plate as it was the only thing to sustain us until lunch was served at 12:30pm. I would hope that nursing conferences would be a place to start for a healthy change in our profession.

A few of my coworkers and I drove up to Caesar’s Palace in Las Vegas last week to attend the Critical Care Nursing Symposium, which is put on by Education Enterprises (a company who is run by Dr Laura Gasparis-Vonfrolio, who you may have heard about through the nursing speaking circuit). The conference was three tracks; one was a CCRN/PCCN review, and the other two tracks were focused on various topics in critical care.

Already having my CCRN, I didn’t attend any of the review sessions, but the critical care sessions I did attend on the first day were uneventful. Day 1 recap: session on New Cardiovascular Drugs consisted of all medications I was very familiar with; Complications of Critically Ill Patients was basic talking about sepsis, abdominal compartment syndrome, etc; ARDS looked great from the look of the powerpoint slides, but the basic review of the mechanism of breathing took up three-fourths of the allotted time and barely any time on the meat of the presentation. The first day was rough – at the end, I was regretting my decision to drive five hours and spend the money to attend the conference.

Day two started out just as rough, with the keynote leaving me with a bitter taste in my mouth. Laura Gasparis-Vonfrolio gave a speech entitled “Condition Critical” where she spoke of her perceptions of why nurses leave nursing, nurse-patient ratios, and mandatory overtime. While I’m sure these are big issues at some hospitals, they’re not big in my professional life and I felt the talk to be extremely negative and disheartening at 7am. What would have made this talk better were more solutions to the problems. For example, she mentioned that we should all create nursing corporations and market them back to our hospitals, but that was all that was said – no one at our table had any idea what that even means. I can understand frustration in the field of nursing, but I would have liked to see more of a call to action, rather than just discussing the negatives. I’ve listened to Laura Gasparis-Vonfrolio’s CCRN review DVDs in the past and she had been hilarious, knowledgable, and easy to listen to.

During that second day, I went to all four sessions presented by Carol Jacobson; on Pacemakers, ACS, Differentiating Wide QRS Tachycardias, and Cardiovascular Drugs. I loved each one of them. While the sessions on ACS and cardiovascular drugs were more basic (probably geared towards the nurse on a step-down unit), it was still full of great information for the less-experienced nurse. Her sessions on pacemakers and wide QRS tachycardias were the highlights of the conference for me.

I’m really glad that I went to the nursing conference. It was actually my first out of state conference, which was a great experience to talk to other nurses in other parts of the country and learn what they were doing on their units and what issues they were facing. It was also a great break/vacation as Las Vegas is a great place to go for any reason. While we were in bed by 10pm the night before each of the conference days to be awake and attentive, but the night after the conference we had the chance to go out and experience the city. (Photo: That’s me in the middle, Erica on the left and Melissa on the right)