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Monthly Archives: May 2012

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Peanut Butter Energy Balls: A Tribute to Nurses Week

Thankfully, I am feeling much better at work lately. It is amazing what 2 months can do. It’s still isn’t perfect, but the fact that I am posting a recipe again means that I am cooking again, which must mean that things are at least a little bit better, and I am a little less stressed. Nurses Week just passed. I was hounded by a couple of the ANCCs to write a story for an “anthology” of stories that was going to be published for the event. Naturally I agreed to do it, but only so long as my story was anonymous, and was only published if plenty of other submissions were received as well. As my luck would have it, my story was the ONLY submission received, and it was published alone, on the back of the nursing newsletter, which was distributed at a very public ice cream social. I didn’t find out until after, and I can tell you, without exaggeration, that my cheeks were as bright as my pink scrubs. Oy! But since the whole world has read my story (it seems) I guess you can read it too. But before that, check out these balls.

I made this recipe because I have been SO hungry at work lately! My coworkers joke that I always seem to be eating something…but I just don’t understand how they aren’t eating something, too! I am training for a half marathon and it is inevitable that some of my runs occur before work, even though that means that they precede a 12-hour cardio endurance event in the ER, which makes me feel that I just created a new Olympic event: the Nursing Duathlon. These energy balls are perfect to pop in my mouth between patients…or on a hike in the Catskills, or a long travel day cross-country to Seattle, the possibilities are endless. And it doesn’t hurt that the “energy” balls kind of taste like cookie dough.

Peanut Butter Energy Balls

Adapted from: The Diva Dish

Ingredients:

1/2 C pecans

1/2 C almonds

1/2 C chopped, pitted dates (I bought pre-pitted)

1/4 C carob/chocolate chips

1/2 C unsweetened finely shredded coconut (plus more for rolling your balls)

1/2 C quick oats

1/4 C pure maple syrup

1 tsp vanilla extract

1/4-1/2 C Peanut/Almond Butter (depends on how extreme you want the PB/AB flavor to be)

First gather your ingredients. In a food processor, first pulse together the pecans and almonds until you see chunky crumbs. Then add the dates and chocolate/carob chips and process some more until your mixture looks pretty crumb-y again. Next, mix in the coconut and oats (one at a time) and pulse until they are integrated. Lastly add the wet ingredients: maple syrup, vanilla and peanut/almond butter and process until they are fully incorporated. Scoop the mixture into a bowl (so the blade isn’t in the way), remove your rings 🙂 it is sticky! Start to roll balls. You can leave them “naked” (which I did for Matt, who has an unfathomable aversion to all things coconut) or roll them in a pretty dusting of coconut flakes (for me, who knows what is better) and then store them in the fridge/freezer as a snack for now/later!

Naked Balls

And now for a little post-cooking story time…

I eye the clock with apprehension. 6:52: my shift starts in less than 10 minutes. I pack my pockets with all manner of nursing paraphernalia; arming myself for the onslaught of patients during the 12 hours that lie ahead. A Carpuject, pulse oximeter, handy notebook of nursing diagnoses and interventions and plenty of saline flushes line my pockets, and my stethoscope is looped around my neck. With a deep breath, heart racing, I set off to receive report, wondering what sort of night lay ahead. It’s impossible not to wonder, but also impossible to control: this is life in the ER.

I thought I knew what to expect. I spent eleven eye-opening weeks as a student in the St Luke’s ER. But “Student Nurse” has a much different ring to it than “Staff Nurse.” As a student, I could apologetically shrug my shoulders and say, “I don’t know” to a patient, and come back with an answer later. As a registered nurse there is a much different expectation. Certainly, I can, and do, ask many questions. But I also feel the weight of responsibility in a different way.

Now, 8-months as a nurse, still green in many ways, I can at least look back on my first few months of being a nurse and see how far I have come. In the beginning, it didn’t take much to throw me off my A-game: a missing piece of equipment that I had to go hunting for or back-to-back “notifications” in the trauma room. Anything could do it, and often did, because the role of the ER nurse is to expect the unexpected and be comfortable feeling perennially behind. Every task is urgent…except for the ones that are emergent. My baseline emotion when chaos erupted was low-grade panic, punctuated by spikes sheer terror.

My confidence was (and admittedly still is) easily shattered. I can start IVs, administer medications and blood products, insert catheters and assist with other invasive procedures. I can competently help stabilize a trauma patient or efficiently do a cardiac work-up. And while I may not yet have the grace of far more seasoned nurses, I can feel satisfaction knowing that as I run around looking harried and crazed, I will get the work done.

It is only recently that I feel a small but perceptible transformation. Gradually, I anticipate what the plan of care will be for my patients, and find that I am correct more often than not. I assist my fellow nurses, like they so often help me. I feel a growing sense of familiarity and comfort with the staff, and realize that in knowing each other well, we work together like cogs in a well-oiled machine. But most significantly, I have started truly hearing my patients for more than their medical histories, and remember the real reason behind why I became a nurse.

One night, as I was busily scurrying around the ER, I picked up patient who had tripped and hit his head. When I went to see the patient, I found a man in his mid-80s, quite confused to find himself in the ER in the middle of the night and with a bloody forehead, to boot. I helped get him settled and explained the purpose of doing a CT of his head. With trepidation, he agreed. He miraculously had nearly no past medical history, and was staggered by the tubes of blood I had to draw for labs and bothered by the incessant beeping that came from the monitor whenever he pulled off his leads. Then, we were called to the trauma room and for 30 minutes I didn’t think about anything else besides the new patient in front of us.

When I eventually made it back to my older gentleman patient, he was agitated and disoriented. While his words came out in a tumble, I gathered that he was afraid, tired, annoyed and that he had soiled the bed. He told me that he had called for someone to help him but wasn’t heard and eventually couldn’t wait any longer. He was embarrassed, and rightfully indignant. I felt terribly that I had been holed up in the trauma room for so long, and apologized profusely. I helped change the linens and his wet gown. Now calmer, clean and settled, we spoke the plan for him to be admitted to the hospital, and I also learned about his wife of 60 years at home with whom he was still head-over-heels in love. In the end, I realized that it wasn’t the subdural hematoma that made my patient feel so scared and upset, but the feeling of being neglected. Everyone deserves dignity in their care and I felt reassured that despite my rush, I am still able to find moments in the ER to provide reassurance, listen to touching anecdotes, and care for my patients during their most vulnerable times. In nursing school, you learn about the progression of competence that every nurse makes in their journey to becoming experienced. It is gratifying to move past a near-exclusive focus on the completion of discrete tasks to the ability to view and implement comprehensive patient care based on individual needs.


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Real ER Nurses Don’t Cry

I wrote this post in mid-March…one year from the date that I first started my stint in the ER as a nursing student. I never published it…I’m not sure why, but here it is now. I am feeling so much better and it is really nice to read this post, just two months later…

***

I am no longer a student nurse, no longer an orientee. It is unofficially my 1 year anniversary in this ultra-urban level 1 trauma center ER, yet it is actually only my 2nd month off orientation (which was a six-month endeavor), and now here I am, rolling along, sort of wobbly, like a kid on a bike without training wheels for the first time. It’s funny how impatient I am for confidence. I expected after 8 months of being a RN, I would feel better…not fearless per se, but better than this. I like the ER, but I don’t love it. I always take a very deep breath before going in and brace myself for the assault that I know (most nights) is inevitable. I know now that I wasn’t built for the ER long-term. I’m not a huge fan of blood and guts (though I’m pretty proud to say that I have nearly perfected my mask of nonchalance) and I consider it a great night in the ER if we don’t get any terrible traumas or cardiac arrests. Funny, because most ER nurses get their kicks from a “good” trauma. I just pretend to understand that.

I’ve noticed that my moods have been more mercurial these days. Part of this I attribute to the recent passing of my wonderful grandfather. But I also suspect that my newfound capriciousness and random bouts of teary-eyes may stem from sadness and intensities that I haven’t found time or energy to deal with from the ER. Again, why am I not blogging? That always helped me before! But then again, I am a morning person…living on the night shift. I’ve noticed that I have also been cooking less (I crave cereal ALL the time), knitting less, and even exercising less. I really need to fix this lifestyle…it’s gotta be possible to live a normal life on the Night Shift!

One thing I like about nights, though, is that sometimes…sometimes, I get the kind of quality time with my patients that I got in the nursing home. It never felt like there was enough time on the Day shift to ever spend that kind of quality time with a single patient. But on some nights, the really good ones, there are nearly empty hours. I only have 3-4 patient that are “mine” and I really get to take my time.


On one such night, I was working a patient up for chest pain. He knew the drill, he had been to the ER plenty of times for much of the same. An older gentleman, he was a little gruff and curt with his words in the beginning. He was polite, sure, but not exactly a fount of engaging conversation. However, as the night wore on, and more patients were discharged, I had the opportunity to check on him various times. He was asymptomatic and in the wee hours of the morning, our banter developed. Shortly after his second set of labs came back, it was discovered that his potassium was quite elevated. This is the moment most nurses dread for their bed-bound patients. I include myself in “most nurses.” This is the moment of the Kayexalate. And to be quite honest, most patients aren’t exactly jumping up and down for it, either.

The elixir of Kayexalate is an ominous-looking thing, and its looks reflect its purpose. It comes in a small plastic bottle, and pours into one of our styrofoam cups like a long viscous concoction, slightly lighter brown than Hershey’s Chocolate Syrup, but of the same consistency. Most patients get two bottles for a dose, which comes out to be more than a 2-swallow shot. Nurses hate it because it makes their patient have MANY bowel movements, and patients hate it because it tastes bad (or so I’ve heard) and, well, the same other reason — MANY poops.

So, when I introduced the elixir to my new friend, I didn’t exactly expect a warm reception. But there he was, grinning, saying, “Ah yes, I was wondering when I would get this.” Surprised, I asked whether he had tasted it before. “Oh, yes,” he assured me, “My potassium is ALWAYS high. And I just love this cocktail,” he said, grinning some more. Surprised, I proffered the styrofoam cup, and he took it, immediately raising it to his lips for a sip. Yes, a sip! Not a chug and grimace, or the other many expected responses, but instead a small sip with a smile as if it were a fine scotch. “Ah, cinnamon,” he said. And then another sip, “And a touch of vanilla,” another sip, “and dare I say apple pie?” By this point I’m not just smiling back at him, I am actually laughing. Clearly, he is playing with me. But it is such a welcome change from the usual replies. This man reminds me of my residents at the Assisted Living Home. He is graceful in his aging, he is not remotely angry to be awake and drinking Kayexalate at 3am with a nurse in the ER. In fact, he is making it a fun experience for everyone. And this is what my patient taught me. As much as I can, I want to treat this experience in the ER as a chance to make the night better, lighter, less serious, or just more comfortable for my patients and myself.

 

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