See no Ebola, Hear no Ebola, Speak no Ebola

016“The Nurse Killer Disease” is Ebola’s nickname in Liberia. And its coming to a hospital near you. Will your hospital be ready?

According to National Nurses United conference call today, and reports all over the country, and abroad, hospitals are NOT prepared for Ebola – not at all.

Why is there no political support? Talking heads just keep talking.

Why do hospitals have no mandated training, no consistent guidelines or policies, no protocols, no adequate PPE or  hands-on training with practice?

Why are potentially adequate hospital isolation rooms not being reserved for Ebola cases – in favor of totally inappropriate rooms?

Why is a nurse being fired, for calling CDC to get advice on how to handle a potential Ebola case, in the name of a HIPPA violation?

How can hospitals get housekeeping to clean Ebola rooms adequately and dispose of used PPE and other waste from those rooms?

How many nurses will die and transfer EVD to others because of hospitals denying adequate training and appropriate PPE?

Per one of the expert speakers – whether or not EVD is classified as being transmitted by aerosol, the EV is now known to demonstrate an affinity to macrophages in the respiratory system where it replicates itself. Tiny particles become airborne as copious sprays of emesis and stool are broadcast. So whether or not the affected person develops respiratory symptoms, inhalation still could have been the mode of transmission.

Donning and removing PPE is, of course, the most vulnerable time. PPE needs to be impermeable. Rooms need to be negative pressure.

Caregivers need to wear respirators – not surgical masks. Preparadigm N-95 respirator is recommended underneath impermeable PPE that covers all. Massive supplies will be sorely needed.

Don’t let your hospital get away with saying that traditional contact isolation gear will protect you. Band together and insist.

If a member of the management team had to enter the room of an Ebola patient, you can bet your bottom-dollar that they would put on the best quality hazmat suit known to man.

Well-known, retired pediatric brain surgeon, Dr. Ben Carson, said: “I have no desire to induce panic, but we must realize that some viruses are known to undergo mutations, which make them even more virulent. If the Ebola virus becomes even more pathologic, the ensuing panic and destruction of human life could go far beyond what is currently being acknowledged…”

Fear, fear, fear, fear, fear. It can paralyze us, or it can push us to action.

Where will help come from? It may need to come from you. Here is your time to shine. Be passionate. Be heard. This is life or death – seriously.

More is being learned daily about Ebola. Know and practice at least the currently accepted CDC protocols found at .

The National Nurses United website has created a marvelous “toolkit” that is a must-see for all nurses: . It is a great place to start as you arm yourself with critical information.

If you see a breach of safety, call NNU at: 1-888-381-4585. They promise to keep your call as confidential as possible.

When given a chance to use more – or less – PPE, choose MORE. Cover it ALL up, baby!

L’Chaim! (To LIFE!)

What Surprising Factor Drives Patient Satisfaction Scores?

Patient satisfaction scores RULE. Nurses are constantly being told to change aspects of their practice, in order to raise “those sacred scores.”

But what is the number one underlying factor influencing the scores that patients give?

Just to validate surveys for a second – most of us appreciate honest feedback. Even in personal friendships, we like to know if what we offer to the relationship is beneficial. Feedback gives us a chance to alter our future behaviors – or not.

Not surprisingly, because of their effectiveness, satisfaction surveys are widespread – not just for hospitals. Most businesses ask customers to participate in their surveys.

Why? Because the results are valuable to competition and business growth. Survey Monkey says its all about patients/customers receiving what they expect.Scan0004

Of course you know patients want to feel that you know them very well. They like for you to speak to them in plain language, and to make sure they really understand the content and how to apply it. They also want to feel your positive attitude and see great teamwork.

Am I saying that its all about YOU? YES! I am saying it is all about YOU.

You are the one they have to trust with their lives and well-being for 12 hours. You are the one they hope will get their medicine right, keep them safe, advocate for them, and promote their healing with knowledge, compassion and honesty.

They are trusting their lives to you. What an honor!

But what makes YOU feel positive and work well with your team? Had you thought about how much your own feelings about your work directly influence your patients’ perception of their own safety?

In other words, do you and your nurse managers realize how closely YOUR satisfaction is linked to your patients’ satisfaction scores?

Not surprisingly, according to Science Direct, a strong correlation was found between poor patient satisfaction surveys and burned out nurses.

Patients who had nurses who were exhausted and ready to quit gave negative scores. Conversely, patients cared for by nurses who found their work meaningful, gave higher scores on their surveys.

The bottom line seems to be that, “IF MAMMA AIN’T HAPPY, THEN AIN’T NOBODY HAPPY!”

In other words, if nurses are not happy, and no longer view their job as meaningful, the patients will sense it and feel less confident that they are getting the best care possible. Studies across the globe have found this true, as you will see in the article in thebmj .

So, for floor nurses and nurse managers alike, “THE SURVEY SAYS”: Patient satisfaction = nurse job satisfaction. Food for thought, eh?


Sources for this article:

Survey Monkey

The Profitable Practice

Science Direct

The bmj

For more information, see:

Love Your Patients! Improving Patient Satisfaction with Essential Behaviors That Enrich the Lives of Patients and Professionals
TIME to CARE: How to love your patients and your job
How to Survive and Maybe Even Love Your Life as a Nurse

Retiring Boomers – Want a Brain-Dead-Simple Plan?

Finances after fifty – yes, you have more buying power than any other generation alive. But here is what credit card companies and other lenders don’t want you to take seriously. In reality, this might be catch up time for many.

But who feels like dealing with it? When you’re short on time and energy, what brain-dead-simple retirement solution can you put into place FAST?

And where should you begin?

  1. First, decide to get serious about it. Start with what you know. Use the Nursing Process.
  2. Assess. Inventory your assets and debts. Include how much time and money you might have to pay to help your elderly parents. Remember Dave Ramsey’s asset calculator which is free for your use.
  3. Diagnose. How bad/good is it?
  4. Plan. Set a financial goal and a time frame in which to reach it. Remember that you might live longer than you expect.
  5. Implement.
    • Tweak things in your life to: make more money, spend less, and save/invest more.IMG_0078
    • Do you still need that big home and new car? Can you save more if you downsize and get rid of your monthly interest-charging bills?
    • Tell your family you will be cutting way back on holiday gift spending.
    • Prepay your funeral expenses. You certainly don’t want your grief-stricken, vulnerable loved ones to pay extra to a hungry salesmen at the funeral home – especially if you haven’t made your wishes known. (I wrote another article, called “What Motivates a Nurse to Prepay Final Expenses”, in May of last year, that you can check out if you want more detail on that.)
    • Decide if you should work extra shifts or take a second job for a year or two? Is there a hobby you love that has earning potential? Many Boomers are moving into business.
  6. Evaluate. Calculate your progress so far. (Like Dr. Phil says – “How’s that working out for you?”)
  7. Start over with another assessment.

Here is a great basic starting point: The Charles Schwab Guide to Finances After Fifty: Answers to Your Most Important Money Questions .

Many nurses have scoped out the other, less strenuous, jobs at their hospital and learned how to fill those positions when the time is right. Why Retire?: Career Strategies for Third-Age Nurses .

There are so many productive ways to keep busy and find meaning after retirement. Portfolio Life: The New Path to Work, Purpose, and Passion After 50 .

Many Boomer nurses dream of creating their own business after they retire from the hospital. Boomers into Business: How Anyone Over 50 Can Turn What They Know into Dough Before and After Retirement .

So, any person can do this – even if they feel brain-dead sometimes. Here is a way to make it more interactive: Quicken Financial Planner, QuickPlan Edition .

So you see? Boomer nurses’ retirement planning is so simple! Just do what you’ve been doing it all of your nursing career – using the Nursing Process.

What do you love? Go for it! Let your excitement for a bright new future come alive!


10 Prep Ideas for Retirement – The Working Years

Can’t wait to retire? Will you be ready? How much money will you need to live your dream-retirement? How long will it take to save enough money?


What are some tricks you can use to move you toward your goals during your working years?

Let’s get started.

  1. Learn how to start making your money work for you. Rich Dad Poor Dad: What The Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!
  2. In the meantime, work extra shifts – as long as it doesn’t interfere with your family or your health. Besides the money, it looks good on your performance review.
  3. Keep an eye on your 403-B or 401-K’s performance and the overall health of the country’s economy. Intervene only if really necessary.
  4. Daily, spend time day-dreaming about your desired retirement. The more you do, the more your subconscious prompts you to move you toward your goals. Think and Grow Rich: The Landmark Bestseller – Now Revised and Updated for the 21st Century
  5. Buy quality, and take excellent care of your belongings to make them last longer. 925 Ideas to Help You Save Money, Get Out of Debt and Retire A Millionaire: So You Can Leave Your Mark on the World
  6. Advance your own physical, mental, and financial health. Don’t allow dysfunctional people to drain your hard-earned assets. Boundaries: When to Say Yes, How to Say No to Take Control of Your Life
  7. Give to charities according to the way God leads you. Do not be coerced.
  8. Whenever possible, get needed surgeries and treatments completed before you retire. That way you get paid during recovery – with FMLA and/or PTO.
  9. Never allow credit card debt. If you have it, get rid of it fast. Rich Dad’s Advisors®: The ABC’s of Getting Out of Debt: Turn Bad Debt into Good Debt and Bad Credit into Good Credit .
  10. See the post just previous to this one. Do your best. Learn about money. Diversify your investments. Never stop dreaming.

A lot of nurses worry that job-hopping (common among nurses) might hurt their retirement goals.  Not as much as you might think! Just remember to always keep rolling your 403-B or 401-K over to your next job.

And if you do job-hop, you might consider travel nursing. You can even stay in your same city, the agencies offer more than all the usual benefits, and travel nursing generally pays a lot more than working for any hospital.

*****Do you want to use Dave Ramsey’s investment calculator for free? This Dave Ramsey article lets us do just that. Just go to his article and clicking the link there.

Dave Ramsey has also brilliantly written some good news about: Retirement for All Ages: A Planning Guide for Your Retirement At Any Age . He shows the steps to get you from where you are to where you want to be.

The recommendations here are from various named sources and from my experience. Verify before taking action on any of it. Hope this helps! What are some of your savings tricks?


11 First Steps: Retirement Planning Tips

Here are some of the things I did to sabotage my own retirement plans during the initial phase of my nursing career.001

Upon landing my first GN job in 1987, I was thrilled to earn $11.00 per hour! We had been struggling financially during nursing school – and it was finally time to celebrate! We started immediately on our “well-deserved” upgrades.

Meantime, student loans, from nursing school, would soon require monthly payments. With me as the only support for three people, I soon realized that our money left after bills was going to be less than before I landed that great job.

So, when a US Army recruiter told me we would get free housing, free medical, and my student loans would be deferred for as long as I was working as an Army nurse on active duty, I grabbed the chance.

I should have begun my early phase of retirement planning right then. But the starting salary of a Lieutenant – nurse or otherwise – was not much. Even after my two year raise, we were still struggling and getting further into debt.

We could have budgeted better, but we were stationed in Honolulu. We “needed” all of the Hawaiian things that other nurses’ families had.

Some friends worked another nursing job on their days off. But I had two kids, and we wanted quality time together. So instead of making money, we made (semi-expensive) memories.

What could I have done differently, and what strategies do I recommend?

  1. Don’t take student loans if you can avoid it. Work a job to pay for as much of nursing school as possible.
  2. Burn off your excess energy and frustrations by working a physically active job instead of paying money to go to a gym.
  3. Live with family or get an honest, reliable roommate – especially when you are a single parent. Even if they don’t contribute any money, you will still usually get free help with child care.
  4. Shop thrift stores. But watch prices and ask for better deals. Some will negotiate if you ask.
  5. If you have a neighborhood co-op near you, find out what tools, yard equipment, etc. you can borrow. You might be able to – say – borrow equipment, for free, to paint somebody’s bedroom for $100.00 in your pocket!
  6. Grow some of your own food – organically. You will save money – and nurses know the importance of eating healthy.
  7. Save 10% of each paycheck toward your one-year savings account to sustain you in case you are ever out of work for up to a year. And do not ever dip into it except for a true emergency.
  8. Start, the day each child is born, to save for their college.
  9. Deliberately live below whatever lifestyle your nursing income allows.
  10. If you want/need something big, save for it and buy it with cash.
  11. Never take on a car payment again, and make your current car payment your last.

I learned this from experience as a new nurse – and there are even more great tips in this terrific little book: 925 Ideas to Help You Save Money, Get Out of Debt and Retire A Millionaire: So You Can Leave Your Mark on the World This book will save you tons of money!

P.S. Its not that we nurse just for the money. But in order to pay our own way through life, we need to manage what we earn as well as possible. So, plan early – and live long!


Snakebit – Patients who Hiss at You

128px-The_Grass_Snake_-_Natrix_natrixWhat does it mean when a patient hisses at you?

Could it have been ICU Syndrome, mental illness – was he a terrorist – or maybe he was raised by snakes???

Ridiculous? Maybe – but here is my story.

I remember caring for one particular non-English speaking patient when I worked in the ICU at the county hospital in 1987. I was a fresh new grad – had not even taken state boards. Yet, I was being groomed in the SICU. So fun!

They let me care for extremely critical cases with all kinds of monitors, drains, and devices! It was a teaching hospital, and every day was new and exciting.

We got the rare and hopeless cases that other hospitals could not afford to take – because of their need to keep their scores high. We were not in competition. We accepted everybody. Nothing was too hard for us!

But this one angry patient was probably my biggest challenge in those days. He was in his early 20’s, slim, dark skin, black straight hair, and buck-naked. He violently refused to wear gown or covers. So there he was, day after day, wearing only his foley strap.

He was handcuffed to the bed (not unusual for our hospital), but nobody could communicate with him. His police guard didn’t understand his language any more than we did. Staff of various ethnic backgrounds also tried to understand his speech – but to no avail.

Communication was nearly impossible for staff – except for facial expressions and hand gestures. But he would make deliberate, angry, piercing eye contact, wriggle like a snake in the bed, say words I didn’t understand, and hiss.

Oh, yeah – and he would spit at us too.

My most memorable day with this patient was when his serum potassium level rose high enough to treat with Kayexalate – but he was NPO. Uh Oh. Not good news for him, for me, or for all my helpers.

I’ll bet you can imagine how many milliseconds he retained that enema. And – no – my flying leap was not fast or far enough!

After that, I had a couple of days off. When I returned this patient was no longer on our unit. Nobody knew what happened to him, and I never saw him again.

Not much later, I was recruited into the US Army to serve in Honolulu. New nursing job. New life. But, for a long time, I could still sometimes see those angry eyes and hear that sound in my memory. And I always wondered why he wriggled like a snake and hissed at us.

What was your most unusual patient encounter?

Here is something that might tickle your funny bone: Snakebit: Confessions of a Herpetologist


Haldol – a Nurse’s Best Friend

Vitamin HH letter

What are some of the main indications for Haldol use?

  • Uses the callbell too often
  • Talks too long
  • Repeatedly comes out of room to find nurse

No – really – just kidding!

Official indications for Haldol administration is to gain therapeutic control of the patient whose behavior may be a danger to themselves.

In hospital – Haldol (haloperidol lactate) – fast acting antipsychotic – pharmacological class: Butyrophenone – Old Faithful


Indications Schizophrenia (Moderate), Psychosis Schizophrenia (Severe), Psychosis ICU Delirium Ticks and outbursts as in Tourette’s Dementia related psychosis
PO 0.5-2mg Q8-12H prn 3-5mg Q8-12H prn – up to 30mg/day 0.5-2mg Q8-12H initially. May need to increase to 3-5mg Q8-12H. Some have had up to 100mg/day. Not approved due to increased risk of death
IM 2-5mg Q4-8H prn (may require Q1H prn initially) See note below table Not approved
IV (off-label) 2-10mg initially. May repeat Q15-30min (doubling initial dose sequentially. Then 25% of last bolus Q6H & taper off as able) Monitor EKG for prolonged QT intervals. Not approved
Geriatric dosages 0.25-0.5mg Q8-12H initially Less and less often than adults under age 65 0.25-0.5 Q4H & watch EKG for prolonged QT intervals Not approved
Negative (potential) side effects EPS, Tardive dyskinesia, Prolonged QT interval, Torsades de Pointes, Neuroleptic Malignant Syndrome (NMS), can affect blood, blood pressure, GI, liver, skin, endocrine, electrolyte balance, ability to drive -> -> -> ->Highest risk group for Tardive dyskinesia, Death
Contraindications CNS depression, coma, Parkinson’s -> -> -> ->
Use caution in patients with Allergy to Haldol, severe CV disorders, neutropenia, seizure disorder on meds -> -> -> ->
Potential interactions Neurotoxicity if on Lithium, potentiated by many other meds
Storage In syringe, in your pocket (just kidding!)

If Haldol is being given to a person with bipolar in the manic phase, they could quickly move to depressive phase after receiving med.

IM or PO haloperidol decanoate (depot)  is for home use – not for hospital use. Dosages are different and it is longer acting.

Thanks to: , ,  and .

So there is your handy-dandy snapshot of Haldol – a nurse’s best friend! (when used with caution) Here’s a great resource to find out more: Mosby’s 2015 Nursing Drug Reference, 28e (SKIDMORE NURSING DRUG REFERENCE)

Thanks for checking in! Let me know if you want more med summaries like this.



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