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Before yesterdayNurse Jess

My One Month Postpartum Food Photo Journal: Day 3

23 September 2022 at 21:45
By: Jessica

Breakfast was oatmeal, goji berry tea, and a tea that helps with getting rid of lochia. We waited until 4 days postpartum to start the red blood cell production and decreasing anemia first. This tea is taken for 7 days daily.

For lunch, I had leftover soup from last night and added pork in.

For dinner, I had pork, eggs, bok choy, noodles and goji berries soup.

I started to feel more weak today compared for the first couple of days. I am resting quite a bit and I have to thank my mom mostly for making all this delicious food. This one month postpartum period is an important time for healing.

We are entering day 5 of life for my son. Colostrum has transitioned to milk. He gained 3 ounces in from day 3 to 4 reaching a low weight of 7 pounds. He does eat and poop a lot and his latch has been great so I really cannot complain. Since our first son had high bilirubin levels (thus his jaundice was above 20), he needed to go to the hospital for phototherapy. So far with the second son, his bilirubin levels are lower so it is unlikely that we will need phototherapy this time around!

The post My One Month Postpartum Food Photo Journal: Day 3 appeared first on Nurse Jess.

My One Month Postpartum Recovery Photo Journal: Day 2

23 September 2022 at 21:28
By: Jessica

For breakfast, I had oatmeal again. There are berries, nuts, apples and banana. Great for milk production. There’s also a goji berry tea.

For lunch, I had a soup. It’s made with lotus root…

山藥 (shen yao) translated as yam but it’s not the same as a sweet potato.

Sparerib soup with red dates and seaweed.

For dinner, we used the same soup base and added lamb, tofu, and udon noodles.

The post My One Month Postpartum Recovery Photo Journal: Day 2 appeared first on Nurse Jess.

My One Month Postpartum Recovery Photo Journal: Day 1

21 September 2022 at 23:40
By: Jessica

Dear journal,

I haven’t updated this website in a long time. Earlier this year, I got pregnant with my second child and I just had him a couple days ago. The labor and delivery took 12 hours from when my water broke and I had such a wonderful team of midwives and nurses to help me through the process.

From my first birth, I wanted to write about my first month’s postpartum recovery period where my mom prepared intentionally selected foods to help with recovery. A lot of things I never knew and thought it would be interesting to share. I plan to show pictures and the rationale for the foods I eat throughout this important recovery period.

Today was my first full day home with my newborn. For breakfast, I had oatmeal, eggs and zucchini. Oatmeal is a good source of iron and help with red blood cell production. It is also good for increasing milk production. My mom added in some nuts (almonds, cashews), dried fruits, banana, and blueberries.

For lunch, I had sea bass soup. My mom went to the Asian grocery store and bought a pound of live sea bass. Sea bass is good for healing wounds. For me, I had a first degree tear and received 3 stitches. This will help heal my wound faster.

Also, there’s tofu for protein and goji berries. Goji berries have several benefits including it is high in antioxidants, improved vision, more energy, lowering of bad cholesterol, increased energy, better sleep, weight loss, improved hair thickness and luster, and less dryness. Goji berries also may help fight depression. It is also great to put goji berries into some hot water to let it open up and drink it like a tea. It is slightly sweet.

My mom also added white cabbage for vegetables and less “flavorful” so it does not taint the taste of the breast milk. It is also advised to not add too much spices (including pepper).

For dinner, we continued to use the same fish soup base and added lamb. Lamb has heme iron, which is easier to absorb and help with the anemia associated with childbirth. Lamb also has zinc, which is vital to maintain an optical immune system, wound healing, DNA and protein synthesis.

If you noticed, everything is soup based. Hydration is incredibly important to maintaining breast milk, which is the primary food for the newborn.

Today I felt great. I’m not sure if it’s because I got stitches this time for a first degree tear so I’m not nearly as painful in my perineum area. Or maybe it’s because I’ve had experience and systems in place at home already. Or if it’s because I’m so glad that my newborn is able to latch well today (and not cause a bleeding nipple). Anyways, see you tomorrow.

The post My One Month Postpartum Recovery Photo Journal: Day 1 appeared first on Nurse Jess.

Happy CRNA Week 2022

25 January 2022 at 15:47
By: Jessica
Happy CRNA Week 2022

It’s 2022 and we are entering our third year of the pandemic. Omicron is ravaging the country. In Michigan, it’s currently plateaued at 1600 new cases a day. At my hospital, we haven’t completely stopped surgical cases. We are canceling cases due to the nursing shortage. There aren’t enough nurses to watch the patients after surgery overnight. There aren’t enough nurses to monitor patients in the ER, med-surg, ICU and PACU. There are overtime mandatory hours. Nurses are asked to work 20 out of 24 hours. How can that possibly be safe? Is it simply getting out of hand.

What we need to have is an appropriate nurse to patient ratio. The frontline nurses who have too many patients are bound to miss something in the patients’ care and that could be your mom, brother, child. In California, it is mandated at every hospital to have a certain nurse to patient ratio depending on the type of care rendered. The result of this is having more nurses hired who can provide the care necessary for the patients. Why can’t that be in every state?

Some may argue that would close down more hospitals because there aren’t enough nurses. However, that is furthest from the truth. There are more registered nurses now in the USA than ever before and yet we still have this nursing shortage.

Proposed Federal RN to patient safe staffing ratios https://www.nationalnursesunited.org/ratios

This nursing shortage exists because nurses are burnt out and the hospital doesn’t want to pay for more nurses. The hospital administration knows that nurses cannot take care of too many patients and yet they ask them to. They keep hoping new nurses come to replace the retiring nurses. There are more people applying for nursing school now than ever before. When you are chronically overtaxed with patients, you know you aren’t providing the best care that you can. You start to perform sub-optimally, and that eats away at your soul. It gets to you emotionally and physically. It happens to the nurses who want to provide great care but they aren’t able to because there is just too much to be done in a safe manner. If you’re constantly being asked to provide care that isn’t up to standard, you will become demoralized and burned out.

The 5 stages of burnout from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604257/

If there is less burnout amongst nurses, more nurses would stay in their career and continue to care for patients. It is satisfying work to care for patients but when it starts to negatively affect nurses, they will make a jump to retire early or go into another career.

Just remember, when you enter a hospital, you are depending on the care of the watchful nurse to ensure your treatments and monitoring for changes. Without appropriate ratios, the nurses can no longer do their duties to the best of their abilities and things will get missed. And that can be the difference between life and death. Is that really fair if it was your loved one?

I think this is the year to ask our state legislators to make a change to get safe staffing ratios. This will make a life and death difference. Thanks for reading.

The post Happy CRNA Week 2022 appeared first on Nurse Jess.

https://nursejess.com/9280-2/

31 August 2021 at 19:13
By: Jessica

This last 8 months of 2021 has been difficult, polarizing, and changing. At the beginning of this year, I got the Pfizer COVID-19 vaccine and thought everyone would eventually get on board with getting the vaccine and ready to cull the pandemic to its end.

People were going across state lines where less people were getting the vaccine. The rush to vaccinate began in the USA.

Then I heard chatter amongst my colleagues. People were scared to get the vaccine. A lot of misinformation was and is still out there. They hear about the cases where people got bad side effects. They weren’t going to chance getting the vaccine. They would rather get the virus and brave the disease process and treatment. While many survive, many also maintain “long covid” symptoms such as the loss or reduced smell or taste.

Finally, the rush to vaccinate had subsided and those hesitant to get vaccinated began to say “how could you want an experimental drug, I’m not a guinea pig.” The institutions were not to be trusted— only their “sources” would reveal the “actual truth”.

At the end of June, my hospital decided to implement a vaccine mandate by September 10th, based on the belief that the vaccine would pass FDA approval (and no longer under emergency use authorization). Of course there are medical and religious exemptions.

Since then, protests occurred in the name of freedom. People quitting, going into a different field away from healthcare. Others quit to become a “traveler” where in healthcare you could make 2-3x your regular wages. Nurses becoming jealous of those with big sign on bonuses and thinking of wanting some of that too.

Many religious exemptions were made. Personally, I’m not sure if it is to keep the staff or if there are truly that many religions that are against vaccines. What religion promotes transfer of diseases? When you know a way to protect yourself, adding a layer of armor against something, wouldn’t you want it to help yourself fight?

About a week ago, the FDA approved the Pfizer vaccine. The excuse to not get the vaccine changed again. Did it really encourage those people who were hesitant to get the vaccine to get the vaccine? I hear many say the government pushed them too fast to get it approved. Basically, why trust the government.

Right now in Michigan we are lucky to not have a big surge, unlike in Florida. We are lucky to be “business as usual” without delaying surgical care to patients. We don’t have a huge influx of covid patients and for that I am thankful. We are starting to get a few more covid positive cases compared to the last few months. I sincerely hope with the start of the new school year that everything stays the same. But I highly doubt that. More people will get sick. Sure there’s treatment for it but isn’t it better to take measures to prevent getting a disease?

Starting in September, we will see what will happen. Until then…

As for my little one, I feel fortunate to have pumped /breastfeed for one year. But I am also happy that he readily accepts whole milk and doesn’t mind (too much anyways) that it’s only bottles now.

I can’t believe he’s already 15 months old. He’s running around, bounces up and down to music, climbs furniture more readily, goes up and down the stairs, understands quite a bit of what I say to him (even in Chinese!), points where he wants to go or do or eat, and says a few words. He loves the water and can’t wait to jump back in the water again. It is such an amazing journey.

The storms are getting bad, with my parents losing power for 5 days. I am seriously considering getting solar with a battery backup.

That’s it for now.

The post appeared first on Nurse Jess.

Happy CRNA Week- How to have a happy breastfeeding and pumping CRNA

30 January 2021 at 09:00
By: Jessica

Disclosure: I share some affiliate links below of products that I personally use. If you purchase I may earn a commission. I only share products that I really enjoy using and hope that it’ll help you too.


First of all, happy CRNA Week. Today I’d like to talk about how to have a happy pumping CRNA.

Before I became a first time mom, I really had no idea what breastfeeding and pumping entailed. It’s not really talked about anywhere online especially regarding those working in healthcare and how they managed to work and pump. Now that’s been more than 8 months, I’d like to share my experience to encourage new moms to continue their breastfeeding journey once they return to work.

It’s good to share than the American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Personally, I set my breastfeeding goals to the first month, then 3 months, and then every 3 months to one year.

What I’ve discovered that the breast pump represents freedom from the baby and the ability to still provide the best and complete nutrition for your baby. You don’t need to have your baby attached to your hip to be a good breastfeeding mom. The breast pump gives you freedom to express milk whenever you want and it is not dependent on when the baby is ready to eat or if the baby has trouble latching. Also in the beginning, nipples take a beating (boo… I highly recommend Motherlove Nipple Cream and Lansinoh Hot/cold pack and Ameda gel pads especially for the first week or two) from breastfeeding so pumping gives your nipples a break.

Ever since I got back to work, I’ve had the support of my colleagues and family and the opportunity to continue feeding my baby breast milk. I have to be thankful for the positive nursing culture and a built-in system in the surgical department. That really is key!

It is super helpful to have supportive CRNA leadership, especially from someone who’s done it before. It’s also helpful to have an understanding from all the other CRNAs who can give me a little extra time to pump (getting a 20 minutes break instead of the usual 15 minute breaks).

For me, I take 10 minutes to pump. 5 minutes to clean my pump parts and use the bathroom. 5 minutes for walking to and from the pump room and getting my cooler bag. However, some moms may take more time to pump, usually up to 20 minutes.

My cooler bag from RTIC includes:

In addition, I just wear my nursing/pumping bra to reduce the time that I have to put on and take off a specific pumping bra. I love the one from Kindred Bravely.

When I get to work every morning, I write down my pumping times on the assignment board so that someone can get my pump break at those times. Breastfeeding is a matter of supply and demand and requires you to pump at least every 4 hours to maintain your supply throughout the day. It is extremely helpful to try to maintain this. It is ok to seldomly miss it but not on a regular basis. Otherwise your supply will take a hit.

Anyways, I try to pump at 5am, 9am, 1pm, 5pm, 9pm. However I do adjust my schedule and move it one hour earlier to accommodate the OR schedule. For example, at 5am (at home), 8am, 12pm, 4pm, 8pm. Many moms will try to pump around the same time she would feed her baby.

Having a dedicated private pump room that is close by to the OR is extremely helpful. When the pump room is far away, it takes so much more time to walk there and back, which cuts into the pump time (and every minute counts!). Also, when there are more than 2 pumping moms in the same unit, it is extremely helpful to have additional pump rooms available nearby. The reason is that frequently, pumping moms will have a similar pump schedule. Our unit has multiple pumping moms. We started with one room when I returned to work 5 months ago. Now we have 4 private pumping rooms near the OR. This will ensure timely pump times.

Here are “must haves” to a private pump room:

  • A lock to lock the room or curtains to separate the space in a large pump area
  • Private room with no windows or a screen if the room has indoor windows so no one can peek in
  • A table large enough to put all the pump bag and supplies (for example, a bedside table typically found in hospitals)
  • Chair where your feet touches the ground
  • Trash (housekeeping should empty this daily)
  • A whiteboard and a dry erase marker for the outside of the door when there’s more than one pumping mom to indicate the estimated “out” of the door time so the next pumping mom knows when the room will be available. It’ll help her decide to either wait for the room or try to find another room.

Here are “nice to haves” (but you can have workarounds):

  • Sink to wash parts
  • Paper towel to dry parts, clean off sink and pump area
    • Workaround: Use the wipes from above
  • Mini-fridge to keep the milk/breast pump parts cold
    • Workaround: get a cooler bag and place an ice pack in there. Or put the whole pump bag or just the milk bottles into your work refrigerator (but it may take more space)
  • Nice ambiance conducive to a relaxing environment. Stress decreases milk production so thinking or looking at pictures of videos of the baby helps
  • Extra pumping supplies. If the hospital already has a mother/baby unit that has a hospital grade breast pump, having this extra set is extremely helpful when something breaks (your own breast pump, parts) or is missing (you forgot to pack it!).
    • I always keep a manual breast pump (the hospital gave it to me after giving birth before I left for home) in my locker for those “just in case” times. I’ve used it several times and I could actually empty one breast in 5 minutes but it definitely requires using one hand to pump and the other to manually pressing the breast towards the nipple to empty the milk ducts.
  • Snacks such as lactation cookies- breastfeeding requires an additional 500 calories a day. Moms are feeding for two!

Whenever possible when I’m home, I’ll directly nurse the baby. Once you get the hang of breastfeeding, I find it to be easier than exclusively pumping. However, there are definitely pros and cons to both.

In conclusion, having a happy pumping mom at work is so vital to prevent burnout and help moms do great work and feed her little one. Having a private pump room close to the OR and a respected pump break time helps immensely.

If you’re a potential or current pumping mom, what would or has made your pumping journey easier?

If you’re in management, what can do you to implement a better pumping culture to reduce burnout for new pumping moms?

The post Happy CRNA Week- How to have a happy breastfeeding and pumping CRNA appeared first on Nurse Jess.

One week after the 2nd COVID-19 Vaccination

16 January 2021 at 10:26
By: Jessica

It’s been one week since I received the second Pfizer COVID-19 vaccine. I didn’t feel as fatigued compared to the first shot. However, the injection site became red, swollen, hard, warm, itchy, and painful starting on the second day.

On Day 4 after the 2nd Pfizer Vaccination Shot

It peaked on the 4th day where you could see red streaks and it got to be about 2 inches in diameter. After work, I went to my primary care physician to have her take a look at it. She said it was unlikely to be cellulitis since they clean off the site with an alcohol pad and used a clean needle. She said it looked more like a strong local immune response to the vaccine.

That same day, I started taking Tylenol, iced it, and rubbed some hydrocortisone 1% on it. I just went to my local CVS to purchase some. I also rubbed some Nature Republic aloe on it.

By the fifth day, the injection site started to decrease in size and became less tender.

Day 8 after the 2nd Pfizer Vaccination Shot

Today is now day 8 and while it is still slightly tender, it is in much better shape now.

Even though I had some side effects, it beats the unknown effects of COVID-19. While I’m unlikely to die due to my age and comorbidities, there is still a possibility of getting sick and worse– passing the virus to my loved ones.

I hope when the vaccine becomes available to you, you make the plan to get it. If you’re concerned about it, chat with your doctor about it or feel free to reach out to me. Do your part and get vaccinated!!

The post One week after the 2nd COVID-19 Vaccination appeared first on Nurse Jess.

Happy New Year 2021

1 January 2021 at 13:34
By: Jessica

I’m so glad that it is the new year and that 2020 is over. We have two approved, highly effective COVID-19 vaccines and vaccinations are on their way.

Next week I’m getting the second of two vaccine shots. I felt fine the first day besides a little arm soreness. The second day I felt fatigue, a slight headache and my arm was still sore. By the third day I felt much better. Since then (2 weeks now), I’ve felt fine.

It was a tough decision especially since I’m still breastfeeding and there were no clinical studies on that population yet. While there is unknown data for nursing women for this vaccine, there is plenty of data for providing immunity for our babies through our breast milk and it’s partially due to vaccines. Currently my baby is still doing just fine and progressively developing.

After weighing the risk vs benefits, I believe that the benefits of getting the vaccine outweigh the risks of getting COVID-19.

After speaking with some skeptics, I’ve countered some of their arguments below.

While we may not know the long term consequences of the vaccine, I do know possible long term consequences of COVID-19– neurological changes, difficulty breathing, and death for already over 330,000 Americans. I’m ready to have a 95% effective vaccine protect me from getting COVID-19.

While we may not know how long the immunity will last, I’m ready to take another booster shot if it means protecting my loved ones and anyone I come in contact with.

While we may experience worse side effects from this vaccine compared to other vaccines, I’d rather get known side effects than the potential unknown of how COVID-19 would affect me or others around me.

While this new vaccine development seemed rush, I also know scientists have been studying mRNA vaccines for YEARS, this vaccine has gone through rigorous testing, and the mRNA does not enter the nucleus of a cell and change the DNA. The mRNA provides the blueprint to make the spike protein found on the virus so our body can start making antibodies against this virus.

While there is currently no data due to a lack of studies to suggest a reduction in transmission of COVID-19, most vaccines do reduce the viral load buildup since you are much less likely to get sick. With a decreased viral load it would ideally be more difficult to pass the coronavirus. To suggest that getting the vaccine still would not protect those who haven’t or can’t get the vaccine is just unfounded.

I feel so relieved to be at the beginning of the end. I can’t wait for the pandemic to be over. I can’t wait to experience freedom from masks again. To go back to seeing friends and family, to traveling, and to eating at an indoor restaurant again.

While I know getting the vaccine seems scary, for me, NOT getting the vaccine is even scarier. If you’re ready to go back to any resemblance of normal again:

Be part of the solution, not the problem.

Protect those who cannot get vaccinated by getting vaccinated when the vaccine is available to you.

So here I am. I decided to borrow a book called “Dare to Lead” by Brene Brown. In there, the author discusses how on the flip side of courage is fear. And I definitely feel that. Fear that other people will judge me or think negatively towards me due to me speaking out. Sometimes it just feels easier to stay quiet and not make any waves.

But while we can’t be right 100% of the time, we can try. And we can keep trying to do the right thing. Just like in Frozen 2, when you’re feeling sad, you just have to do the next right thing.

The next right thing is to make a plan to get vaccinated when the vaccine becomes available to you. Let’s end this pandemic.

The post Happy New Year 2021 appeared first on Nurse Jess.

My First Labor and Delivery

14 August 2020 at 19:02
By: Jessica

I can’t believe it’s been twelve weeks since I had my baby. My entire life has completely changed in so many ways. I’ve become a first-time Asian American mother during a pandemic as a CRNA. Because it has completely changed my mind and body, I’d like to share my labor and delivery story, and later on, I’d like to share some products that made my life easier as a first-time mom.

As a first-time mom throughout the entire third trimester, the body is getting ready for labor by widening the hips. About 1.5 weeks before I went into labor, I lost my mucous plug. For me, it was a yellowish sticky blob.

First Stage

Early Labor

I was exactly 38 weeks along and wished my baby would come that weekend due to my work situation. On an early Saturday morning, my water broke while I was sleeping 3:20 am. A sudden wet gush woke me up! The water breaks before labor in about 15% of women. I called the midwife to let her know. We agreed that since my water was clear and GBS was negative, I could stay at home during my early labor. FYI, a GBS test checks if you have this common bacteria. If you are positive for GBS, you will get an antibiotic through an IV at the hospital during labor.

My goal was to rest and relax as much as possible. I went for a walk, ate breakfast, lunch, and dinner, watched a movie, and took a nap. Around 6:10 pm, my contractions became more regular, and by 8:15 pm, my contractions were 2-4 minutes apart, 45 sec to 1:15 min long, for at least an hour. They wanted me to go to the hospital when it’s about 4-1-1 (4 minutes apart, 1 min long, for an hour) so that they know you’re in active labor. 

Active Labor 

Triage

I got to the hospital around 9:15 pm and went to the OB triage with my husband (I could only have one support person, so I trained my husband to be there for me!). My primary midwife happened to be on that night, which was awesome!! They checked fetal heart tones (FHT) and external contraction pressure. Normally, I think they would do a cervical exam in the triage area, but I asked to have it done once I was admitted to a room, and my midwife made that happen. 

Hospital Admission

They used a soft belly band to hold the two monitors in place and drew a CBC and type and screen (they draw blood just in case you need a blood transfusion). They asked if I wanted an IV, and I agreed to it since I know it sometimes may be more difficult to place one later. 

My midwife did a cervical exam and found that I was already 5 cm dilated, 100% effaced, and -1 station. 

Later on, my nurse Emily was able to find wireless monitors, so I didn’t have to be attached to the wall. Since I already had regular contractions, and my baby had accelerations during the contractions throughout the admission time, my midwife was comfortable with just periodic checks every 30 minutes. I was monitor free for a few hours and free to move around the room.

For the next 4-5 hours, I used a birthing ball and bounced on it. I breathed through my contractions, mindfully thinking about the pressure I felt.  I tried out different positions: “slow danced” with my husband, had my husband pull up on my belly from behind (or I called it a penguin pull). I even got into the water tub. The water distracted and dulled the immense contraction pressure. But at 3 am, I couldn’t take it anymore and asked for an epidural. As a first-time mother, I wanted to labor as long as possible without an epidural, because once an epidural is in, the laboring process slows down.

A Combined Spinal and Epidural (CSE)

I got out of the tub, and my midwife did another cervical exam and found I had dilated to 8cm. There was only another 2 cm left, but I knew that the transition phase was coming, and through my readings, I learned that the transition phase is the most painful part, and I just couldn’t take it anymore. Also, I had attended the AANA Annual Congress last year. I learned that the latest literature indicated that a combined spinal and epidural was a great anesthetic choice for a laboring mother. I couldn’t wait to get relief.

At 3:30 am, the anesthesia resident got the CSE quickly, and I immediately felt relief through the spinal. In case you don’t know, a spinal numbs you quickly, and an epidural keeps you numb. They used a 0.1% bupivacaine with 3 mcg fentanyl concentration solution, and I loved that it was a bolus every 30 minutes rather than a continuous infusion. I felt little light pins from my chest down and slight itchiness from the fentanyl. But it was much easier to tolerate a little itchiness all over than the pain, especially as it neared the transition phase. Once the epidural was in, I did have to be on continuous monitoring, but I had to be in bed anyway. The nurse placed a foley catheter, which drains the urine. Shortly after pain relief, I fell asleep for a few hours until the morning.

Second Stage

In the morning, the nursing staff helped me move into different positions in the bed. Moving into different positions encourages the baby to move down into the canal on his own. At 11 am, the midwife broke the forebag, which prevented the baby from moving into the canal. My body continued contractions, but with the epidural, I didn’t feel any of them. The nursing staff continued to monitor the baby’s heart rate. The baby had accelerations with every contraction that came every 2-3 minutes. The accelerations indicate that the baby was tolerating the contractions perfectly. Finally, after I felt rectal pressure, the midwife came to assist with the delivery. I pushed for about 1 hour lying on my side, and he was born at 3:46 pm!

Third Stage

My baby immediately went on my chest for an hour of skin to skin time. He looked healthy (a APGAR score of 9 at 1 minute and 9 at 5 minutes. The APGAR score was created in 1952 by Dr. Virginia Apgar MD, an obstetrical anesthesiologist, to determine how well the newborn tolerated birth in the first minute and five minutes of his life). so they were happy to wait to do the height, weight, and give 3 medications. He was calm and quiet, having gone through such a traumatic experience! The midwife delayed the cord clamping until it stopped pulsating so that majority of the blood went back to the baby. My husband then clamped the cord. Shortly after, I delivered the placenta as well.

Placenta and Umbilical Cord Blood Donation

The midwife and nurse then gathered the placenta and umbilical cord tissue to prepare it for donation. I decided to donate the cord blood and placental tissue to research and some went to storage to help others cure diseases. I picked Cellsure because it was free to donate the tissue that would’ve otherwise went in the trash. I also checked my hospital to see if they routinely donated tissue but they did not. Around 28 weeks, I spoke to my midwife about donating my tissue. I found Cellsure online that accepted donations. About a month before my due date, I filled out an online questionnaire to qualify. Once I was done, Cellsure sent me a box for me to bring to the hospital when I was in active labor (4-1-1). I let my midwife and nurse know about the donation and they took care of everything. After delivering the baby, the nurse did draw one more set of blood for the Cellsure. They called Cellsure and someone came around 4 hours after the baby’s birth.

During the first hour, my baby tried to nurse but was just figuring out how to latch on. Latching is probably the most important part about breastfeeding!

The next day, I was super sore all over. I had the first-degree tear, so the midwife didn’t think I needed stitches. For pain relief, I used lidocaine spray and cooled witch hazel pads provided at the hospital. When I ran out, I used benzocaine spray.  I took ibuprofen and acetaminophen whenever offered (every 6 hours in the hospital, and I slowly cut back over the following two weeks). I also took Miralax once a day for the first four days after birth to help with bowel movements. My first few poops were all nice and soft so, I was happy about that. 🙂

The post My First Labor and Delivery appeared first on Nurse Jess.

How Nurses Can Successfully Work in the UK

14 August 2020 at 10:41
By: Jessica

Working in the UK as a nurse could be an excellent career choice with the added bonus of an opportunity to travel. Hospitals within both the National Health Service (NHS) and private sector often conduct recruitment in other countries in order to attract qualified nurses. 

Employment opportunities in the UK 

UK recruiters have acknowledged that there is still a significant demand for full-time nurses. Besides hospitals and clinics, nursing and care homes are also looking for nurses to fill their vacancies.   

So where do you start?

If you are from overseas and want to work in the UK, then naturally you will need to make an application. The process will take some time and a little bit of paperwork. 

The requirements will also differ depending on whether you trained:

  • Within the European Economic Area (EEA)
  • Outside the EEA

The difference is due to the EU’s employment regulations. If you want to speed up the recruitment process, here is some sound advice.

Register with the Nursing and Midwifery Council

Registering is a requirement for all those who wish to work as a nurse in the UK as the NMC is the official organization that regulates the nursing profession.

If you are from overseas, you will also need to secure a UK work permit and find an employer who will sponsor you. Once you have registered with the NMC, you will receive a PIN number which will allow you to practice as a nurse in the UK. You can visit the NMC website to find out more information about registering as a nurse. To secure a placement, you should contact the hospitals directly. 

Once you have submitted your application, you will either be accepted, rejected, or asked to fulfill further requirements, perhaps by undergoing a supervised practice period.

If you have been trained as a nurse outside the EEA, you may have to take a nursing course so you can adapt your existing knowledge and skills to a UK setting. You can then register with the NMC once you have completed this course. Non-EEA trained nurses will also need to pass a competence test (CBT) and a practical skills examination (OSCE). 

The particular type of work permit or visa required will depend on your country of origin. If you are from the EEA region, you can visit the Home Office website for information on how to secure a UK work permit. If you are from outside the EEA and Switzerland, you need to apply for the General Visa – Tier 2.

UK nursing vacancies during the COVID-19 pandemic

The COVID-19 crisis has meant that some of the usual hiring practices have been modified, especially for nursing home jobs. For instance, candidates can expect to be interviewed by their prospective employers via a video call. In addition, candidates may only be able to visit the employer’s facility when it is necessary or after they have been hired. 

Even before the pandemic, there was a high demand for nurses in the care home sector. UK recruiters anticipate that this demand will only increase once the current crisis has abated. 

Apply for a nursing position in advance

As mentioned earlier, the UK nursing application process may take some time. It can also be rather complicated. As a result, it is vital that you make your application as early as possible, well before you arrive in the UK.

To expedite the hiring process, make sure you bring all your essential documents, such as:

  • Diplomas
  • Training logs
  • References
  • Birth certificate

Conclusion

Nurses who are interested in working in the UK can expect a warm welcome from recruiters and employers alike. The demand for qualified and skilled nurses is still very high. Although it may require some effort and time to apply, it will be well worth it in the end. If you want to evaluate your career options, go to the NMC and UK Home Office websites to find out more information.  

Guest Post by:

The post How Nurses Can Successfully Work in the UK appeared first on Nurse Jess.

The COVID-19 Crisis: CRNAs to the Rescue

8 August 2020 at 10:56
By: Jessica

One of the most memorable photos from the COVID-19 pandemic is an image of two healthcare workers in full PPE embracing, face shield to face shield. It’s an even prouder moment for the nursing community as the two are a certified registered nurse anesthetist (CRNA) couple from Tampa General Hospital. 

These two CRNAs, Mindy Brock and Ben Cayer, are on the hospital’s airway team. When a COVID patient is in respiratory distress and requires intubation, they are there to sedate and intubate the patient. This is a high-stress situation where time is of the essence, as a COVID-19 patient’s oxygen saturation is known to drop rapidly.

Mindy and Ben are just one example of the roles that CRNAs have played in helping fight COVID-19 across the country. Keep reading to find out more about how CRNAs are contributing to this health crisis.

How CRNA Qualifications Help 

CRNAs are advanced practice nurses who are trained in skills such as intubation, arterial line insertion, central line insertion, and pain management techniques, such as regional blocks. Prior to earning their degree and certification, CRNAs are required to have intensive care unit (ICU) experience so they are well-versed in managing critically ill patients. 

This education and training takes a CRNA to the head of the bed in an operating room, surgery center, or doctor’s office, but the COVID-19 pandemic has CRNAs finding new opportunities to pitch in. 

Continuing the Fight in Medically Underserved Areas

CRNAs have full practice authority in 29 states. This means they can practice without a physician’s supervision. As a result, CRNAs often provide care and airway expertise in traditionally underserved areas. An example would be in a community access hospital where hiring a CRNA can be a cost-effective practice. 

According to the American Association of Nurse Anesthetists, on March 30, 2020, the Centers for Medicare & Medicaid Services issued a temporary suspension of supervision requirements for CRNAs. This suspension meant hospitals and health systems could utilize CRNAs to the fullest extent of their practice. In a press release about the suspension, Kate Jansky, the AANA President, said this decision allows CRNAs to manage and staff intensive care units as well as staff operating rooms without a physician’s supervision.   

Traveling to the Front Lines

Lots of facilities canceled their elective surgeries to slow the spread and preserve their PPE, and many furloughed CRNAs took the opportunity to travel to some of the hardest-hit areas to provide their services. One example of this was when 30 CRNAs from the North American Partners in Anesthesia (NAPA) group traveled to New Jersey to join in the fight against COVID-19. 

CRNAs traveling to states that were hit hard would work on intubation teams as well as resuscitation teams. When a COVID-19 patient coded in the hospital, the CRNAs would provide assistance in airway management, medication administration, and other potentially life-saving tasks. 

Many CRNAs left behind families and risked their personal health to serve those most in need. Some have even come out of retirement to volunteer. 

Recommended reading: Love Thy Neighbor: Wear a Mask

Even with the right PPE, the work is dangerous. CRNAs are working with the airway, which means they are especially at risk for getting contaminated droplets on their clothing or breathing them in. An estimated 20 percent of the anesthesiology department at Mount Sinai Health System in New York City had contracted the virus as of April 2020, according to the Associated Press. Even with the increased risk many have voluntarily given their time and knowledge.

Returning to the Bedside

Because CRNAs have worked in different ICU settings before going to graduate school, some have opted to return to the bedside during the pandemic. For example, many have stepped into roles helping manage ventilators and airways in ICUs as well as taking patient assignments. 

With elective surgeries on hold in many parts of the country, working in the ICUs or in emergency triage settings allows CRNAs to utilize their hard-earned skills. 

The Takeaway

While 2020 has looked very different for the healthcare community than anyone had anticipated, there are countless stories of nurses, including CRNAs, who have answered the personal call to help. The pandemic has also shined a light on CRNAs’ services and engaged politicians and communities to lobby for expanded practice rights. 

Where there is a health need, nurses — including CRNAs — will answer the call. 

Guest Post by:

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Love Thy Neighbor: Wear a Mask

13 July 2020 at 17:15
By: Jessica

Michiganders are now required by Executive Order from Governor Whitmer to wear a mask indoors and in crowded outdoor settings except in certain situations. All workers in indoor businesses should also wear masks and businesses must turn away customers who don’t wear masks.

The Emergency Alert showed up on my phone today at 4:44pm

Our state leader is setting the right example by wearing a mask and is attempting to change the “American culture” of individual freedoms fast. She has to set this executive order to tell everyone the seriousness of this pandemic and what we all must do to combat COVID-19.

Unfortunately our national leader, the president of the United States, does not want to set a good example and has made masks a political movement. It should not be a political movement! Instead, this is truly a public health crisis.

Wearing a mask is a symbol of caring for thy neighbor, anyone you come in contact with. The mask protects the other person from you, just in case you are amongst the 40% of asymptomatic coronavirus carriers.

Being an asymptomatic carrier means that you have no symptoms whatsoever and you still have the virus and can easily spread the virus to others. Currently, the WHO and scientists worldwide tell us the primary way of getting this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the name of this coronavirus, is by being close to others in less than 6 feet and breathing in their air.

This coronavirus is not going away until a viable vaccine is ready, which is unlikely to happen until next year. We must remain vigilant and always think what we must do to protect our loved ones and those on the front line. Just when Florida and Texas think they are in the clear and open up the country prematurely, now they are paying for it with American lives and wrecking havoc on thousands of families. If Florida was a country, they would be number 4 in the highest number of cases right now.

Love Thy Neighbor: Wear a Mask

This is especially important as a nurse. You must always protect yourself in order to protect and serve others. Encourage those around you to follow good practices.

I have to admit it’s been difficult. I wished for my sister to drive from New York and visit me and my newborn. Unfortunately I had to decline and tell her to visit me next year when we have a vaccine. My newborn is completely vulnerable and I would feel horrible if something happened to him. She had also visited several groups of people in the week leading up to the planned visit and planned to stay in a hotel for a night. It doesn’t help that videos come up that show hotel rooms still not being adequately cleaned even during the pandemic.

What have you done to encourage others to wear a mask? How have you struggled during this pandemic? Let me know in the comments below.

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Happy International Nurses’ Day

12 May 2020 at 23:28
By: Jessica

2020 is also the year of the nurse and midwife as designated by the World Health Organization (WHO) in honor of Florence Nightingale’s 200 year anniversary of her birth.

Florence Nightingale is the pioneer of modern nursing.

It is almost very fitting that this is the year of the nurse and midwife. They are on the frontlines of taking care of patients with COVID-19 and must advocate for not only the patient but also themselves. The protection and safety for themselves is vital for taking care of others.

Unfortunately there are already too many stories of nurses who were not equipped with the appropriate amount of personal protective equipment (PPE) and died because of it. Every hospital system should do everything to support the nurses and anyone on the frontline to get the right PPE. No system should deny the nurses safety and their own judgement on what is required to keep them safe.

As for the midwives, I am proud to say that I choose a midwife to be my primary care provider. Thankfully midwives and the hospital system have a good working relationship and thus many best evidenced based practices are utilized. I’ll go over it in more detail tomorrow. Goodnight for now.

The post Happy International Nurses’ Day appeared first on Nurse Jess.

Numbers – week 36 day 3

5 May 2020 at 22:15
By: Jessica

Today’s goal will be to write some numbers and print them out. Examples:

  • Each day number of pee/poo
  • Breastfeeding amount
  • Category of positions for breastfeeding, burping, type of sleeper, eater, temperament
  • Ways to calm baby
  • Cycle of easy
  • Breastfeeding- out hours room temp, frig, freezer

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Day 1 of Stay Home Stay Safe Order in Michigan

24 March 2020 at 18:21
By: Jessica

Wow.

So much has happened since I last posted but almost more importantly, this pandemic is just starting to get crazy.

That’s right, just starting.

It’s been 2 weeks since Michigan declared a state of emergency when there were two positive cases of COVID 19. Now there are 1791 confirmed positive cases with 24 people dead.

“Flattening the Curve” by Staying Home

Right now our hospital systems can handle the number of cases. It will still be able to as long as people stay home. This week. YES. This week is the critical week that will help determine if our hospitals will be completely overrun with patients and us having to make decisions on who gets a ventilator and who doesn’t. I hope that we don’t get to that point. But the only way to stop it is by staying home.

I’m happy to see that Michigan has a stay home order. That is a necessary step to get people to take this seriously.
If we continue “Shelter in Place”, meaning staying home and only going out for groceries or essentials once a week, then we will be doing our part to “flatten the curve.”

“Flattening the curve” means that we will not exceed the number of available hospital beds.

If we all do our part, then this graph predicts that we will likely peak in the number of hospitalizations (4877 people) around May 18. As you can see in this graph, 4877 is much lower than our maximum capacity.

Staying home will make it possible to save more lives.
If we as Michiganders stay home, then it is possible to never overload the hospital system and decrease the number of deaths.

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Nurse Jess in Top 20 Nursing Blogs

4 October 2018 at 11:22
By: Jessica
Top 20 Nursing Blogs 2018

I received an email about a week ago from Theresa Frost stating that I was on the Top 20 Nursing Blogs list on the Online Nursing Degrees website. I feel honored. But more importantly, I’d like to introduce two other blogs that are great for learning more about CRNAs (certified registered nurse anesthetist).

  • Life as a CRNA – There are some detailed information about what to expect on a day to day basis as a CRNA. There is also some advice for getting into anesthesia school.
  • CRNA Career Guide – It provides a comprehensive guide along with advice from several presidents of state associations of nurse anesthetists.

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The Speed of Trust

3 October 2018 at 11:10
By: Jessica

I recently subscribed to the Blinkist, an app that summarizes nonfiction books and gets to the core of the book. I highly recommend it if you enjoy learning (and being a human, you naturally have curiosities in your life, right?).

One of the books is called the Speed of Trust by Stephen Covey. It tells us that trust affects everything, especially how fast communication and events go. For example, if you trust that the restaurant prepared your food safely, you’ll have no problem eating the food. However, if you had concerns over the food safety, you will hesitate and question the chef before maybe consuming the food (or even throwing it away).

Trust is one of the most powerful forms of motivations and inspiration. People want to be trusted. They respond to trust. They thrive on trust.

You must have self-trust so others can trust you. Because if you don’t trust yourself, then who will?

The way to gain trust in yourself is by following the Four Cores.

Integrity

Integrity is gained by making commitments to yourself and following through on them. Integrity is being honest with yourself. For example, if you tell a patient that you will return to them with information, then do that. If you tell yourself you will go to 50 crunches, 20 squats, 10 burpees, and jog a mile, then commit and do it! If someone blames another person for your mistakes, own up to it and take the blame. If you commit to waking up to the alarm clock and getting to work or school on time, then do it.

Intent

Having positive motives and behaviors will point you towards good intentions. Are you listening or do you just want to “win”? In many circumstances you can increase trust if you have good intentions.

Capabilities

Developing capabilities will improve your confidence. And life is always changing which requires you to keep learning. In the health field, learning what is the latest evidenced based practice and working towards incorporating it in your practice will keep you on the top of your game.

Results

When you build a track record of your results, you build self trust. In the world of anesthesia, you are constantly evaluating your actions– how well did the induction, maintenance, emergence go? How well did the patient do? What could I do differently to improve my results?

 

After developing trust in yourself, you develop trust in others

You develop trust through your actions and your truth. This includes understanding yourself — your strengths and weaknesses, your moods and behaviors, your actions and inactions. By knowing yourself, you can better understand others’ critiques of you and owning it.

You will also demonstrate trust by caring about others. Giving others credit when due. Being thankful for others’ actions. Showing that you are aligned in the same goals.

This will increase your credibility. This is important especially in the healthcare field and in the OR. You trust that the scrub tech stays sterile. You trust that the circulator nurse has the room and everyone responsible ready. You trust that the surgeon is able to safely complete surgery. You trust that the pre-op nurses get an IV and come talk to you if they have any questions. The more you trust yourself and gain trust in others, the faster things move and better the outcome.

With the lack of trust, everything and everyone is questioned. Only more delays occur. And that is why it is so important to gain trust in yourself and in others.

As a side note and reference to what’s going on in the real world…

Christine Blasey Ford showed tremendous courage in speaking out about her experience with Judge Brett Cavanaugh. She was incredibly credible — she had nothing to gain and everything to lose by speaking out, and the fear that her world would shatter and none of it would matter.

On the other hand, Judge Cavanaugh may have been a credible judge with many people who backed him up. He may have had a very credible record and people trusted his judgment. However, I feel that after his hearing, the American people, or at least me, do not feel that he would be impartial. He doesn’t seem like he would have the temperament of a judge. While one hearing doesn’t seem like it should change the fate of this candidate, he is also up for a LIFETIME job as a Supreme Court Justice. In my humble opinion, I believe that there are other candidates who would be better suited for this position. If he is confirmed, I believe that the American people will continue to lose faith in its institutions. Instead of trying to work together, we will continue to divide the nation.

I feel that problem with Judge Cavanaugh is not that he necessarily was a horrible drunk as a teenager and college student, but that he denied it and lied to the Senate. I believe that our principles and values are more important than ‘which party’ sits on the highest courts of our land.

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Awake Fiberoptic Nasal Intubation

3 September 2018 at 11:21
By: Jessica

So all the times that you practiced your craft (handling a fiberoptic scope such as during the difficult airway class weaving down the bucket with little holes; placing double lumen tubes),

all the times you’ve asked experienced providers what they did (for an awake fiberoptic intubation),

all the times you watched one (once for an awake fiberoptic oral intubation),

all the times that you performed one (under optimal conditions with a Glidescope and an asleep patient),

and all the times that you did something similar (nasal intubations),

it prepares you for this moment — for this call:

“There’s an emergency intubation for you and it must be done as an awake fiberoptic intubation nasally.”

You call your partner who’s already bedside and workout a plan

He’s optimizing the patient – Afrin drops, nasal trumpets, racemic epi nebulizer, and 4% lidocaine nebulizer

You’re ready – 7.0 oral ETT in warm saline, lubricated tube and fiberoptic scope, ketamine, precedex drip, an ENT surgeon and team for possible trach

The patient arrives, looking more perky, sats 96%, sitting up, switch monitors, fluids, ETT on the tip of the fiberoptic, suction on, sedation is in

Standing in front of the patient on the right side with the camera on the left

ETT inserted 1/3 in, cameras in, orientation, following the bubbles, past the epiglottis, vocal cords, tracheal rings

Holding still, inserting the rest of the ETT, cuff up, fiberoptic scope out, circuit on, positive end tidal CO2, sats 99%

Smooth, success 

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Optimizing Patients for Urgent Surgeries – Non-Elective Surgery Triage

30 August 2018 at 23:10
By: Jessica

Urgent surgeries — such as appendectomies, cholecystectomies, are common. Sometimes the patients are healthy and other times they are a train wreck. When they are of the latter sorts, the goal should be the optimize the patient for surgery so they are prepared to undergo the stress of surgery.

Understanding the classifications of semi-urgent, urgent, and emergency surgeries informs us of the time that we have to optimize a patient. For example…

It is the weekend call shift with limited resources. The surgeon schedules a laparoscopic cholecystectomy on a patient. Great, you go and look up the patient and find out that:

  • She’s scheduled for a CABG (coronary artery bypass graft) aka open heart surgery next week
  • There’s no echo, angiogram report, no cardiology note on the patient
  • BP 160/110, HR 115
  • Diabetic
  • On the kidney transplant list

So what do you do? The surgeon insists that it is urgent and must be done that day (later you find out that he has scheduled long cases for the next day).

Well, first the goal is to optimize the BP and HR so the BP is below 140/90 and HR below 100. We titrated in metoprolol to effect. We waited for vitals to stabilize before we went. Unfortunately, the surgeon later insisted that it was an emergency case so we had to go on the weekend.

However, was it really an emergency case? Could the case go the next day when there are more resources?

Without additional information, the goal for the patient was to do a slow induction, maintain perfusion, and gentle emergence.

Based on Non-Elective Surgery Triage (NEST), the acute cholecystitis could’ve been scheduled the next day on a Monday where there are more resources.

Non-Elective Surgery Triage (NEST) Level
Non-Elective Surgery Triage (NEST) Classification

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