Posts Tagged ‘nursing’

nursing, lately

I don’t write too much about work these days since I work at a very obvious hospital and a very obvious population.  Talking about an experience with a patient who has abdominal pain is a bit less obvious than talking about someone with an oil burn to their left foot, so there’s that.  However, some exciting things have been happening in my nursing world, so let’s talk about it!


After talking about it for about two years, I finally buckled down and studied for the Critical Care Registered Nurse exam.  It’s a test that isn’t necessary for practice, but it demonstrates that you have superior knowledge in critical care and know what’s going on under different circumstances.  You need about a year worth of hours in critical care nursing in order to take the exam, but I do think it made it easier to take the test having more experience.  That being said, the exam covers all areas of critical care and all the body systems, so for once in my life I’ll admit that it was helpful that my unit is the main ICU overflow for the neuro ICU, as I actually saw a patient go into diabetes insipidus with crazy high urine output and super high sodium levels.

That’s the only time I’ll ever admit I like neuro patients…because I don’t.  (Mainly I hate waking patients at all hours of the night for hourly neuro checks.  Whispering, “Can you tell me your name?” into someone’s ear at 3am isn’t creepy at all.)

I was so worried about taking the exam, mainly because I worry about all exams.  I used to study for a week straight for my organic chemistry exams in college, which paid off since I got A’s in both semesters.  For the CCRN exam, I used the same tactic:

photo 1 (4) Flashcards.

I still have my orgo flash cards somewhere even though I have no idea what they mean anymore.  I read through the PASS CCRN book and made flash cards out of the things I didn’t know and seemed the most important.  (Such as what types of MIs show up in which EKG leads.)  I also did a million PASS CCRN questions and read through the Laura Gasparis book from the class I took about a year and a half ago. It ended up paying off since I passed with 111 of out 125.  (Passing is 71%.)  Oddly enough, my best section was cardiac (96%…CTICU, here I come!) and worst was GI (70%).  And I definitely guessed on all the “ethicial and nursing practice” questions because the right answers aren’t what you actually do in real life.  (There, I said it.)  If any of you out there are thinking about taking it…just pick a test date and go for it.  I studied for about three weeks, so it’s not a terribly huge commitment.  (Anyone want my flashcards??)


My next nursing adventure is into SAFE nursing, for which SAFE stands for “sexual assault nurse examiner.”  Perhaps I have some liking for traumatic events (because working in a burn unit isn’t full of traumatic events…), but SAFE nurses are the ones who are called in to work with victims of sexual assault when they come into the ER.  It’s a unique position compared to my usual floor nursing, as the SAFE nurse is not considered part of the medical team or the police department.  Instead, we’re solely responsible for the evidence collection including photographs of any trauma and collection of samples either through skin swabs or a vaginal/rectal exam.  The class taught us how to do these exams (speculums are fancy instruments…), as well as included talks from sex trafficking experts and a district attorney specializing in special victims.

photo (87) At work watching SAFE videos after I fishtailed my hair.  Note:  It is awkward when a patient’s family member walks in on you watching those videos…

Not that I would ever wish sexual assault on anyone, but unfortunately it happens and we need people to help these people at an incredibly tough time.  (Interestingly enough, in court you’re not allowed to mention what the victim was wearing unless it’s relevant such as “and then my shirt was ripped” since what you’re wearing or how much you’ve been drinking doesn’t mean you’re given permission to anyone.)  It will be a different angle from working on the floor, as you’re one on one with the patient with no interruptions or obligations to anyone else.  It’s a huge responsibility and allows for independent work, so I’m looking forward to it while hoping I’m never actually needed.

April is Sexual Assault Awareness Month…current statistics state that 1 in 6 women and 1 in 33 men are the victims of rape – with both numbers mostly likely higher due to underreporting.  It’s a huge problem, more so than I can simply state here.

American Burn Association

About a month ago, I headed up to Boston for the American Burn Association meeting, which is an annual conference related to all things burns.  Doctors, nurses, physical therapists, researchers, and more come from all over to present research and talk about improving care.  I volunteered for a few sessions which involved collected tickets (pretty easy for free admission to the conference…) and sat in on some presentations and talks, including research discussions from people I work with.  It was interesting to hear how other burn units work with children (ketamine and Versed for EVERY dressing change??  We give small amounts of oxycodone…yikes) and what research is being done.  Interesting but not surprising, much of the burn research comes out of military medical centers.  Nursing talks included how to standardize a precepting program so that you know a new nurse is ready to be on their own versus just relying on people saying, “Oh yeah, they’ll be fine.”

The social aspect of the ABA is also quite large, and it was fun to see my friend Amy (of Boston Marathon spectating fame) for an evening.  Another evening led us to a fancy dinner at the Boston College Club with an beautiful view of Boston.  Unfortunately, that view included the smoke from a nine alarm fire that happened that day.  A bit sobering as the Boston Fire Department lost two of their men that day, one of who had attended one of the ABA events the evening before.  It’s hard to lose a member of the burn family, but also serves as a reminder as to the power of fire and how important our work is.

On a related/slightly happier note, I was able to get out for a run in Boston.  Although I’ve been to Boston many times, I haven’t spent much time running downtown except for the finish of the marathon.  Luckily, I squeeze in eight miles along the Charles on a beautiful spring day in Boston.  It’s fitting that my run ended as a crossed this mark:

photo 2 (4)

I won’t be crossing that finish line after 26.2 miles this year, but I’m excited for those who will be doing that in a few short weeks.  It will be a meaningful day for everyone in the running community, and I can’t wait to cheer from afar.  (At work, actually!  Full circle.)

And that’s enough nursing babble for now…I know have a fair amount of fellow nursing runner readers.  Any CCRN or SAFE nurses out there?  Anyone attend conferences in their specialty?



04 2014

Why I Chose to be a Burn Unit Nurse


One of the greatest pros to the nursing profession is how many options are available for us.  You can work in intensive care, labor and delivery, home care, dialysis, physicians’ offices, clinics…the list goes on and on.  Whatever interest you had that initially brought you to nursing, there’s probably a place for you and then more than a few places to explore when you’re ready to try something new.  Although you may not always get to work on your favorite unit (I worked on medical/surgical/oncology/hospice floor for my first job), it’s important to spend some time getting to know which areas of nursing you like and which you’d rather let someone else do.

My interest in the medical world began at a young age, and I always thought I would become a doctor.  During my junior year of college, I changed my mind and decided to become a nurse instead.  However, long before any of these thoughts crossed my mind, I read the book Burn Unit by Barbara Ragave.  My trips to the library often involved browsing the medical section, and that one caught my eye.  I found the book to be very interesting as it explained what a burn unit is like from both the nurses’ and patients’ perspectives.  My critical care class in nursing school briefly touched on burns for one hour long lecture, and I’m pretty sure most people brushed over it just as information they needed to learn for school, but would probably never use in their careers.

I, however, was fascinated.  After spending some time on a med/surg unit, I was ready for something new.  Although I applied to a wide variety of jobs, one of the first interviews I had was for a burn unit, and I was excited to finally see one.  My nerves were on edge as I interviewed and eventually received an offer to work on a burn unit.

The burn unit is certainly a special place and many people don’t ever think about working here.  Although I certainly have ups and downs, overall I still find burn injuries to be very fascinating.  For any nurses, future nurses, or anything simply interested, this is why I chose to work on the burn unit.

1. Burns can happen to anyone

Although burns have a population that they generally affect (the old, the young, the poor, the homeless), they can happen to anyone.   Plenty of people fall asleep smoking (what they’re smoking I’ll let you decide…), you never know when coffee may accidentally spill and who it might spill on.  The population varies, especially in a big city.  I suppose anything can happen to anyone, but the diversity makes burns varied and interesting.  This variety can lead to something new with each shift.  One shift I may have a single intensive care patient who is so sick that I can hardly leave the room, while the next week I may have three patients with small burns who require basic wound care and monitoring.  It keeps you on your toes and never turns into a routine.

2. Burns are very physical

I certainly believe in things such as cancer pain, but for the most part, you can’t physically see how cancer is causing pain.  With burns, I can see how and where it hurts.  It makes much more sense to me.  (That being said, high fives to the oncology nurses…I don’t know how you do it!) 

3. Burns affect every system in your body

I think that this is the most fascinating part about burns, and it demonstrates just how related all the systems of the body are.  The burn injury is only to your skin (and possibly your lungs if smoke inhalation is involved), but harming the largest organ in your body makes your body go crazy.  When you break the integrity of the skin, you lose the barrier that protects you from infection, helps maintain heat within your body, and helps keep your electrolytes in check.  These are issues all on their own, but it doesn’t end there.  Burn injuries cause a hypermetabolic, hyperinflammatory response throughout the body.  This basically means that processes in your body become exaggerated, which may lead to fever (fevers are normal in the first few days), increased blood sugars, and definitely leads to increased need for calories and protein as your body fights to heal.

Fluid shifts occur in burn patients due to that hyperinflammatory state, due to the capillaries (your tiniest arteries and veins) becoming more permeable so fluid leaks from your vascular system (the vessels) into the interstitial spaces (such as when you sprain an ankle and it swells).  These fluid shifts affect your electrolyte (sodium, potassium, magnesium, etc) balance and your general fluid status, which is why we encourage fluid intake or place patients on intravenous fluids.  Inadequate fluids can harm your burn, your blood pressure, and possibly most importantly, your kidneys.  (Trust me, you want to keep your kidneys.)

Of course, fluid may affect your lungs (your lungs don’t like excess fluid), or smoke inhalation may have caused damage.  Otherwise, pain medication slows down your GI system, which can lead to constipation…and that’s not fun for anyone involved!  Your protein needs go through the roof (protein = building block of healing).  And your skin, one of your best defenses, is broken.

All the body systems?  We nearly hit them all.  From an injury to your skin.  Interesting, right?

4. But that’s not all…let’s talk psychosocial

Burns are traumatic not only because it’s a devastating injury to your body, but also devastating to your mind.  The event that caused the burn may have been traumatic, such as a house fire.  Additionally, the results are not necessarily the prettiest.  Many people think that we have plastic surgeons who operate on these patients, but we don’t.  Burn surgeons, physicians who specialize in the care of burn patients, perform skin grafts.  While they do a great job of closing the skin and assisting in healing, the truth is that skin grafts aren’t the prettiest, nor the most comfortable.  They can be itchy.  You shouldn’t expose them to the sun.  They might not be your normal skin color.  You have donor sites with the same issue, and they can be difficult to live with.

The physical changes associated with burns can be traumatic at any age.  For the young, the grafted skin doesn’t grow like normal skin and may require a lifetime of revisions.  For most people, but especially for teenagers and young adults, appearance is very important.  The burn wounds can be just as psychologically scarring as they can be physically damaging, and I find this to make a burn such an all-encompassing injury that really makes you use all aspects of your ability to care for someone.

5. It’s a long term relationship

As I alluded to above, a burn injury is possibly a lifelong event, starting with hospitalization.  When patients are admitted to the unit, I generally tell them that the minimum amount of time they will be spending here is at least a week.  That’s about the minimum time it takes us to determine how the burn is going to heal and if the patient may need surgery or not.  If you think about the last time you got a sunburn or even a scratch, you would probably remember that the skin is fairly slow to heal.  Patients with larger burns usually stay for months, and some patients have stayed for over a year.

Because of this length of stay, you really get to know patients.  You know what works for them regarding pain medication, what the names of their children are, how they like to have their burn care done…everything.  I find it to be much more interesting and rewarding than working on a unit where people are constantly being admitted, transferred, or discharged.

Additionally, nurses are providers with the most direct patient care.  We change your dressings, know how well your pain regimen works for you, and can notice subtle changes because of the understanding you get from working with someone repeatedly.  It’s amazing to have such an knowledge of a person and to be able to make a difference because of it.

6. Teamwork

Gearing up for a four nurse burn care session.

Most nurses will tell you that it is their coworkers that help them get through a shift, whether it’s answering a call bell for you or simply talking with each other.  Teamwork is especially key on the burn unit, and it’s amazing to see a team of nurses work together.  When a patient with a large burn comes in, it’s all hands on deck to get the patient set up and get treatment underway.  A large burn care may have three-four nurses working to hold, clean, and dress a patient.  It’s a great feeling to know that you can count on your fellow nurses, and I think the teamwork on the burn unit is second to none.

7. And most importantly…

burn unit

Above all, the best part about working on the burn unit is that people usually get better.  It’s a long, painful road, but burns heal.  It’s very rewarding to see a patient walk off the unit and know that you played an integral role in helping them get there.

For the nursing students, nurses, or anyone…what kind of unit do you work on?  What drew you to that?  If you could try a new field in nursing, what would it be?


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12 2013