Thursday, June 28, 2007

My Learning Edge

Adam Kayce of "Monk at Work" has challenged me to push the envelope of my intellectual horizons...which I believe I do on a daily basis in my commitment to lifelong learning.

I just finished reading "It's Okay to be the Boss," by Bruce Tulgan of Rainmaker Thinking. I was a hands-off leader, which is great if you're leading Marines, but it wasn't the appropriate leadership or management style for the nursing unit I was assigned. It only took me 15 months to realize I needed to be more hands-on, more involved, and more directional.

When one of my staff members died at his own hand last year, I realized I didn't know as much about him as I wanted and now it was too late. I was very blessed to have had the conversations that I did with him, but I didn't ask the difficult or probing questions that might have given me more insight, might have made me more empathetic, might have given me more forgiveness. I vowed never to let that happen again. So I gave index cards to my staff members and asked them to write the names and addresses of someone who would care to hear news about them. I asked for their birth dates, their anniversaries, and the names of any children, their ages. I wish I could say I developed this myself, but Michael Abrashoff of "It's Your Ship: Management Techniques from the Best Damn Ship in the Navy," gave me the idea.

So far, I have written 15 cards to parents and friends discussing one or two qualities I admire in their loved ones, how happy I am to have them working on my unit and what they are doing or learning, and how much promise they show. My staff members are, for the most part, under the age of 24, away from home for the first time and half a world away. It costs at least $1800 to fly home and it cannot be accomplished over a long weekend. They are also in a profession where they can be called as an individual augmentee to any humanitarian or wartime mission.

It has taken being a mother and losing a shipmate to improve this particular leadership element in myself, pretty steep tuition at the School of Heartbreak and Brutal Experience.

Individual staff members have spoken to me over the past few weeks saying how much their family appreciated hearing about them. One staff member did not know that his family had received my card until he saw it posted on the refrigerator while home on leave. They didn't throw it away. That means a lot to me.

Saturday, June 23, 2007

Anything in the Nut Family

The ICU transferred a patient to us. Admitting diagnosis was "1. Salicylate Overdose, resolved. 2. Suicide Attempt 3. Depression."

In response to questions regarding allergies on her nursing assessment database, she wrote, "Anything in the nut family."

Sunday, June 10, 2007

Pathological Rib Fracture

A 77 year old male with no relevant past medical history checked in with back pain. Films showed an abdominal aortic aneurysm and a pathological rib fracture. On incidental findings, the patient also had a pathological hip fracture.

He had a mass in the left lower quadrant that I was quite able to palpate, although I was unable to appreciate the AAA (which, according to assessments, was a "pulsatile midline abdominal mass").

He is a full code---he and his family couldn't wrap their brains around the fact that if he were to code, we wouldn't be able to save him. We would break all his ribs and probably rupture his abdominal aorta, causing certain death.

I think the thing that made me saddest was what Dr J said when I called to get an order for Zofran. "Thanks for taking such good care of this patient."

And I wasn't doing anything different I wouldn't do for any other patient.