The Atheist

Diabetes Nurse Educator – Midwest, USA -1980

I exited the elevator on the cardiology unit and asked the head nurse if they had any patients with diabetes they would like me to see? She said Richard was admitted with congestive heart failure (CHF), but also was newly diagnosed with diabetes. I knocked on his door and entered his room.

He was a stout 70 year old white haired man sitting up in bed who appeared weak and weary. I sat down in the chair next to him and began to teach him about his diabetes and how he could control it with diet, exercise, and an oral medication which his doctor had prescribed for him. He paid good attention and asked some very specific scientific questions.

I asked, “Richard, what kind of work did you do before you retired?” He replied, “I was a physics professor at the University for 35 years.” I replied, “That was my Alma mater where I graduated from the School of Nursing! I never took any physics classes since I was so busy with my nursing courses. I really loved attending the Bible class on campus and meeting students from all over the world.” We continued our conversation which I concluded a few minutes later.

As I was leaving, I asked Richard if I could give him something to read with some Bible verses that told how he could have a personal relationship with Jesus Christ? He answered, “Well, Pam, I have to tell you that I’m an atheist. I don’t believe God even exists. But I will take it and read it.” He put the gospel tract on his bedside table.

As I left the room, I silently prayed, Dear Lord, You know all about the poor condition of Richard’s physical heart. I pray He would read those verses and receive You as his personal Savior so He can have a new spiritual heart.” I wondered if he would throw the tract in the garbage as soon as I left. I also thought about Psalm 14:3:

The fool hath said in his heart, “There is no God.”

Richard was discharged home the next morning, so I didn’t have an opportunity to visit him again.

A few months later, I was sitting in my office in the diabetes classroom when my phone rang. The man introduced himself and said, “Pam, do you remember me? I’m Richard, the retired physics professor who told you I’m an atheist.” “Oh, yes! I remember you Richard. How are you doing with your diabetes?”

“Pam, about a month after I came home, I was readmitted to the hospital because my heart failure flared up again. But while I was going for a heart test, I had a heart attack and my heart totally stopped. They did CPR (cardiopulmonary resuscitation) and brought me back from the dead! I was so terrified to die again. I couldn’t wait to get home and read that little paper you gave me with the Bible verses. As soon as I read it, I knew I was a sinner, and prayed and received Christ as my Savior. I am so happy now and full of peace and joy! I know the next time I die, I will go straight to heaven to be with him! I just wanted to thank you for giving me that paper.”

I listened in dumbfounded silence, hardly able to believe my ears! Then I told Richard how thrilled I was that he now knew Jesus Christ as his own Savior. I asked him a few more questions, and it appeared that he truly understood the gospel and had done business with God. He certainly sounded like a totally different man. I asked him if I could visit him at home to meet his wife and study the Bible further with him? He said he would absolutely love for me to visit him!

The next evening I entered his spacious lovely home and met his wife. We all sat down at the kitchen table and began to read Bible verses together. It was such a delightful time of fellowship as Richard asked me many questions as a newborn babe in Christ. I asked if one of the elders from church could come and teach him the Bible? He said that would be marvelous!

Richard grew wonderfully in the Lord in his spiritual walk, but his physical heart continued to decline. About a year later, his wife called me and told me through thankful tears that Richard had passed on and was now home with the Savior in heaven above. We rejoiced together that he was no longer suffering physically. She sent me a beautiful note which said, “I feel good I know he has gone to join the Savior above and is at rest.”

I wrote in my journal that night “Richard is the first person I know of that is in heaven as a result of my testimony. What a privilege to be used of the Lord. May I labor in love more zealously and sacrificially!”

“Salvation is of the Lord.” Jonah 2:9

Reflection – 2014

It still amazes me how God allows us sinners who are saved by His grace to share the good news with others. Like Paul said:

“I have planted, Apollos watered, but God gave the increase. So, then, neither is he that planteth anything, neither he that watereth, but God that giveth the increase.” I Corinthians 3:6-7

Some of my favorite gospel tracts to give to people.

Some of my favorite gospel tracts to give to people.

I always carry gospel tracts in my purse so I’m ready to hand them out at restaurants, the airport, to store clerks, etc. The following are some good websites where you can obtain gospel tracts.

Moments with the Book:

Print My Tract:

Good News Publishers:

Gospels of John in several languages can be found at the Pocket Testament League at

I would love to hear how you have had opportunities to share the gospel with your patients! Please email me at



September 30, 1978 – Midwest, USA

Last spring, after I had completed my initial mandatory year of experience on a medical-surgical floor, I began asking the Lord for a position during the day time with weekends off so I could participate more at church. I so missed evening worship and prayer meeting, as well as going door to door calling with the brethren to share the gospel. I thought about applying for a visiting nurse job, but didn’t really feel it would be safe in the big city here.

When I returned from Europe, my head nurse, Mrs. H. told me the administration had approved a new position for the hospital as diabetes nurse educator. The role would include teaching the daily group diabetic classes, making daily rounds on all the patients with diabetes in the hospital to give them individual education, and teaching the staff more about diabetes. The nurse would become an expert on diabetes. They required the nurse to have a BSN, so that eliminated many of the Tower 5 nurses. Mrs. H. only has a hospital diploma in nursing, but she would be the supervisor. The goal is to make our program one of the premier diabetes programs for adults in this part of our state! She asked me to apply, and so I did. The interview was fairly easy with her and Dr. L., the medical director who is an endocrinologist.

I’m not sure how many applied, but she notified me that they chose me for the position! How I thank God for giving me such a wonderful schedule of Monday-Friday with no weekends or holidays! Nothing is too hard for the Lord! I truly love to teach and am looking forward to stretching my mind again to become an expert in the area. So I began August 1. It was such a blessing to be able to drive to and from work in the daylight one week after my apartment mate and I were mugged. (See previous blog – Terror at Night). Surely, God’s timing is perfect! How I thank God for His wonderful encouragement after going through the difficult trial. He blessed me in reading Psalm 37:4.

Delight thyself also in the Lord, and He shall give thee the desires of thine heart.

So now that I have been in the position for two months, I am becoming more comfortable each day in my role. I go to the hospital library many days and read the endocrinology medical journals to discover the most recent research in diabetes. I love it when the other nurses ask me questions, and I can assist them. I also enjoy having the time to teach the patients individually in their room, especially how to give their own insulin injections. I help them overcome their fear of sticking themselves by letting them practice sticking an orange or a sponge again and again until it becomes second nature!

I enjoyed teaching the patients how to give themselves insulin.

I taught the patients how to give themselves insulin.

I contacted the Mayo Clinic in Minneapolis, and discovered that they have a special week long educational session for diabetes nurse educators. I asked Mrs. H. and Dr. L. if I could attend, and they obtained the funding for me to attend in November! I am so excited! I have never been to a national nursing seminar before. And to think I get to visit the world famous Mayo Clinic!!

Reflection – 2014

Sadly, I didn’t record any details in my journal about my week in Minneapolis at the Mayo Clinic. But I remember the lectures by the diabetes nurse educators were very helpful and gave me some new ideas for our fledgling program. I greatly appreciated their sheltered glass sidewalks downtown which protected us somewhat from the bitterly cold wind, and the great restaurants the nurses from out of state shared at dinner!

I have found the Mayo Clinic website to be an excellent source for patient education and often recommend it.  The clinic has expanded over the years and now have clinics in Florida and Arizona as well.

Statues of the founding Mayo brothers at the Mayo Clinic

Statues of the founding Mayo brothers at the Mayo Clinic

U.S. News & World Report ranked Mayo Clinic in Rochester, Minn. as the best hospital in the nation in their 2014-2015 rankings. Mayo Clinic has ranked at or near the top of “Honor Roll” hospitals through the history of U.S. News and World Report’s best-hospital rankings.

S-O-A-P Notes

March, 1978 – 11:30 p.m.

I had just finished walking rounds with the night shift nurse, clocked out, and sat down beside the chart rack to begin my charting before I could go home. I usually was able to complete some of my assigned five patient charts during my shift, but it had been nonstop all evening so I barely had time to gulp down my dinner. Each nurse was assigned five charts and must chart on two of the patient problems before going home. We were not paid overtime to complete our charting. We used the S-O-A-P format.

S is for subjective- what the patient says. soap bar

O is for objective – what you observe.

A is for assessment.

P is for plan.

I took the heavy 3 inch thick chart and turned to the tab marked “Nurses Notes”. I took out my blue inked pen and began. Day shift charted in black ink, evening shift used blue ink, and night shift used red ink. I remembered my college instructor’s words about charting.

“If it’s not charted, it’s not done. Try to paint a concise picture with words of exactly what you did. If you are ever sued, you likely won’t remember the patient several years from now. The lawyers and jury will scrutinize your every word.”

Mrs. K. in Room 515 had had a below the knee amputation two days previously. I scanned her problem list and chose Pain and Diabetes from her list. I began writing using approved abbreviations:

#1. Pain

S: c/o moderate RLE pain. (complains of moderate right lower extremity pain)

O: RLE incision intact. Moderate swelling, slight erythema. VS (vital signs): 99.2-76-18-136/84. (temperature-pulse-respiratory rate-blood pressure)

WBC (white blood cell count) 7.4. Given 2 Percocet.

A: Moderate post-op pain. Pain relieved with Percocet. No sign of infection.

P: Continue to monitor incision qs (every shift), medicate for pain prn (as needed). Instruct pt (patient) about phantom pain.

I completed my last chart at midnight, put on my coat, and drove wearily home through the black night.

Reflection – 2014

Charting has changed over the years, but the saying of my instructor still holds true in the litigious American society, “If it isn’t charted, it isn’t done.” After Xerox copies were invented, we switched to black ink for charting so the charts were more legible when copies were made.

In labor and delivery, we had to write our initials and time on the fetal monitor strip whenever we entered the mother’s room, and whenever we gave any medication or did a procedure. When I was a visiting nurse in the 1990’s, we used a check list system for the daily visits and left a carbon copy in the home for the next nurse. When I worked in the nursing home as a nurse practitioner, we had a dictation service with secretaries which worked very well. We returned once again to the S-O-A-P format.

In my current job, we have an electronic patient record and no more paper charts. I have machine dictation which is only about 70% accurate, so it takes quite awhile to correct all the mistakes. But at least you can read everyone’s notes and never have to go hunting for lost charts. However, when the computer system crashes, it shuts down the whole system because we have no access to the patient records. Thankfully, that doesn’t happen often.

I recently called a doctor’s office to request a copy of a patient’s records. His assistant said she would fax them over, but warned me we would not be able to read his handwriting! Over the years, I’m afraid my handwriting has deteriorated also as I have spent countless hours writing in patient charts. Charting isn’t the most satisfying part of nursing, but it is necessary for communication and a required part of my job, so I try to do it thoroughly and above all, honestly, to honor God.

“Not with eyeservice, as menpleasers, but as the servants of Christ, doing the will of God from the heart, with good will doing service as to the Lord, and not to men.” Ephesians 6:6-7

When I toured hospitals in China in 1986, I was amazed that they only had one sheet of paper with a few characters on a clipboard hanging on the end of each patient’s bed. The patients were not allowed to sue their provider, so the documentation was very minimal. A Chinese friend told me each person keeps their own medical record in a notebook and takes it with them each time they go to the clinic for the doctor to write in. It sure seems like a much simpler system!


Blizzard of 1978

January 26, 1978 – 10 a.m.

I turned on the TV and watched the weather prediction. They told us to brace ourselves for a terrible storm that was coming with high winds. We usually only get 10-15 inches of snow all winter, so this was very unusual. I have never seen a blizzard. It’s about 50 degrees Fahrenheit right now. The wind began to pick up, the snow began to fall, and the temperature plunged.

The phone rang and I answered it. My nursing supervisor, Marie said, “Pam, pack a bag to prepare to stay overnight at the hospital. The National Guard will be at your house in 30 minutes to bring you in for the evening shift tonight.” I quickly packed a couple extra uniforms, toiletries, and my Bible, and watched out my front window. When I saw a 4 wheel drive Jeep pull up, I put on my warmest hooded coat and ventured out. I had to lean into the wind,because it was so difficult to walk. I climbed in the back seat and said hello to the driver and three other nurses he had already picked up.

We drove slowly through the deepening snow on the deserted streets and arrived safely at the hospital five miles away. I took report from day shift and began my evening rounds. My head nurse, Mrs. H. and I were the only staff that made it in for evening shift. Thankfully, they had cancelled all routine surgeries, but all our 30 beds were occupied. There was a friendly air of comradeship with all the patients that night. Those who were there for their week of diabetes classes helped us pass dinner trays to the patients who were bedbound.

I went down to the cafeteria for dinner, and the hospital administrator was serving our food on the tray line. He smiled and thanked me for working through the blizzard! No charge for dinner tonight!

The Guard brought in the night shift nurse and aide, so I was able to sign off at 11:30. Marie told us there were some empty patient rooms on the 9th floor, and to pick whichever one I wanted. I grabbed my bag, found an empty room, and closed the door. I turned on the TV and watched the blizzard. There were unbelievable pictures coming in of 15 foot snowdrifts from the high winds of 69 miles per hour. The roads were impassable and the temperature had dropped to -30 degrees. I could hear the howling wind as I looked through the window and watched the snow blow sideways in the dim street light. It was nearly a whiteout!

I put on my pajamas and climbed into bed. I had never been a patient in a hospital, so this was a very strange experience. I was too keyed up to sleep. Then I heard a patient in the next room start to scream. I lay awake and prayed.

The alarm went off at 6 a.m. I guess I dozed off at some point. I got dressed, read my Bible, and committed the day to the Lord. I went out to the nurses’ station and asked my nurse friends about the patient next to me. They said he was an alcoholic going through withdrawal, and they had to put his arms and legs in leather restraints while they medicated him. He nearly destroyed the room.

I went down to the cafeteria and ate my free breakfast and then went back to the fifth floor. I was totally exhausted from little sleep and asked the Lord to give me strength for the day and to bring in the evening shift.

Mrs. H and I were the only staff again so we split the floor in half. After we passed the medications and trays, we began the bed baths. We were running out of linens so we only changed the patient’s gown and sheets if they looked soiled.

I was so happy when the evening shift arrived courtesy of the National Guard! I gave report, and then found a coworker who lived near me and volunteered to give me a ride home.

I could barely get in my front door from the drifts. My roommate, Jane, had shoveled out as much as she could. We looked at our cars that were buried in the parking lot and decided to wait until the next day to shovel them out since we were both off of work.

My car was buried after the Blizzard of 1978!

My car was buried after the Blizzard of 1978!

I fell into bed after a quick supper, thanked the Lord for carrying me safely through the blizzard, and fell into a deep sleep.

God is our refuge and strength, a very present help in trouble.

Psalm 46:1


Reflection – 2014

I have never needed the National Guard to bring me to work since then! Sadly, 51 people died in my state in the blizzard of 1978; 22 died when they left their trapped car and froze to death while trying to get to cover.  But I still remember the comradery of the staff and patients as we all helped each other through that terrible storm.

Now that I live in New England, I have been through several more blizzards. Later in the blog, I will share some of my harrowing tales of reaching my patients in the community as a visiting nurse.


State Nursing Boards- Zzzzz…..

July, 1977 – Midwest, USA

It’s hard to believe I graduated in March, over 3 months ago! I have learned so much working on evening shift with my diabetic patients. I’m feeling fairly comfortable now with my skills and organization.  The most difficult decision is if I should call the doctor at home, or if it can wait until morning. In March, I received a 6 month Graduate Nurse permit which I’m working under. Whenever I sign my name on the chart, I follow it with GN1117 which is my permit number. The doctors have started calling me “007”!

The state only offers Nursing Boards twice a year in July and February. If I don’t pass my boards the first attempt in July, I will lose my job and have to work as a nursing assistant which would be a huge pay cut and very embarrassing. Since my sister, Linda, has been a nurse for 3 years now, I asked her for suggestions in preparing for the boards. She said she reviewed her notes from all her classes and asked the Lord to help her choose the right answer. So I have been reviewing my class notes and textbooks an hour a day and more on my days off.

Tomorrow is the big day! The boards are being given at the State fairgrounds, of all places. I hope we’re not in the same barn as the cows….

State Boards – Day One – July 6, 1977

I’m afraid I was so nervous last night that I only slept a couple hours. It is 100 degrees Fahrenheit today, so the heat didn’t help either. (I do not have any air conditioning in my apartment.) I entered the large room that held about 100 single desks. The air conditioning felt wonderful! (No cows in sight!) The moderator instructed us to put our purse under our chair and look straight ahead or at our desk at all times. If anyone was caught trying to look at their neighbor’s answer sheet, they would immediately be expelled from the room and not allowed to take the test again. There were two sharpened pencils on each desk and a blank scantron answer sheet with bubbles to color in with pencil. Each person had a blank white sheet to cover up their answers so no one walking past could see.

There were 3 tests today and 3 tomorrow. Each test lasted 2 hours. Today we were tested on Medical and Obstetrics before lunch, and Psychiatry after lunch. Tomorrow we will be tested on Surgery and Pediatrics before lunch. After lunch we will take a test of sample questions for next year’s boards.

I completed Medical and Obstetrics and began to relax a little. Then I found some of my classmates and we went to lunch together at a nearby German restaurant. We all compared our answers and wondered if we had done well enough to pass? It was good to see them again since I had not been with them since March.

We returned after lunch and the moderator handed out the test and answer sheet for Psychiatry.  The air conditioning felt so good after being outside in the heat. I began reading through each question and coloring in the bubble for the best answer of the 4 multiple choice answers.

All of a sudden I heard the moderator say, “You have 10 minutes remaining to complete this exam.” My head snapped up. Ten minutes!!! I couldn’t believe that I fell asleep in the middle of the test! I quickly prayed and asked God to help me finish on time. I had about 20 more questions to complete. I quickly read the question, chose the best answer and moved on. As I colored in the last bubble, the moderator said, “Time is up. Put down your pencil and bring your exam to me.” There were only a few of us still there. Normally I am a fast test taker, but there was no time to go over my answers.

State Boards – Day Two – July 7, 1977

I am so thankful that I slept like a rock last night! It’s also a little cooler today. I completed all the tests today without falling asleep! The surgical exam seemed fairly easy because I have taken care of so many surgical patients on the diabetes unit. There were about 15 questions on diabetes on the Pediatric exam so I whizzed through those since I could apply the same knowledge from my adult diabetic patients that I had learned. My three months of experience was definitely helpful today. Now I wait about 6 weeks for the results to come in the mail. I pray they arrive before my temporary nursing permit expires! The Lord’s will be done. If He wants me to be a nurse, I will pass.

August 30, 1977

I scanned the mail. There it was! The State Board of Nursing return address was in the left corner of the white envelope. I sat down on my bed and prayed to the Lord to give me a quiet heart of acceptance no matter what the results. I opened the single sheet of paper and scanned the results.


It listed my scores for each exam and at the bottom in capital letters it read PASSED.

I looked at the individual test scores and was amazed that my score for Psychiatry (where I fell asleep) was higher than Obstetrics (my lowest score). I was also amazed that Pediatrics was my highest score. I guess it was because of all those questions on diabetes.

Thank You, dear Lord!!! You gave me the strength and wisdom to get through four years of college and now I am a fully REGISTERED NURSE!!! I commit my nursing career to You, and ask that You would use me for Your glory and honor. Amen.

I can do all things through Christ, who strengtheneth me! Philippians 4:13

I went to work the next evening and proudly wrote RN after my name!

An official Registered Nurse! HAPPY DAY!!

An official Registered Nurse! HAPPY DAY!!


Reflection – 2014

The graduate nurse now takes a NCLEX exam on the computer at a testing center within a few miles of their home at a time convenient to them. It is no longer separated into specialty areas. The GN has 6 hours to complete the test in one day. There are also numerous review programs one can pay a fee and attend to prepare for the exam. A person can pay $7.95 extra to receive the “unofficial” results in 48 hours.

I remember when I took my GRE test for graduate school on the computer at a testing center 3 miles from my house. I received my test results in 5 minutes which was nice! There are certain advantages to computers these days.



April, 1977 – Midwest, USA – Orientation

I had just completed my class on handling emergencies including cardiac arrest when I heard the overhead page, “Code Blue, Tower 502, Code Blue, Tower 502, Code Blue, Tower 502!” I was standing in the nurse’s station, so I grabbed the Code Cart and pushed it as fast as I could to Room 502.

Running with the Code Cart!

Running with the Code Cart!

Ann, another nurse on our unit had started to give respirations to Eleanor, a small gray skinned elderly lady I had just talked with the hour before. The doctor and nursing supervisor ran into the room behind me. Miss S., the supervisor, quickly told me to give the medications while she recorded everything the doctor ordered. We grabbed the board off the back of the cart, lifted the patient and put it under her back. Debbie, RN started compressions while Ann grabbed the Ambu bag, hooked it up to the wall oxygen, and placed it over the patient’s face.

Dr B barked at me, “Give 50 cc of Sodium Bicarbonate!” I grabbed the box with the large syringe, tore it open, screwed the plunger on to the syringe, pointed it toward the ceiling, and pushed hard on the plunger to clear the air bubble out of the syringe. Oh, No! I realized that I forgot to remove the needle cap as I saw it go sailing across the room! Dr. B glared at me. My hands started to shake as I grabbed the port of the patient’s intravenous line, pierced it with the needle of the syringe, and began to push the fluid with both thumbs on the plunger as hard as I could through her line. Her body quickly was becoming acidic, so the bicarbonate would counteract this. The Doctor continued to give orders and I pushed the medications through the IV while Ann and Debbie continued respirations and compressions. After 30 minutes, Dr. B. said, “Stop…we lost her.” He turned and left the room.

Everything became quiet. Miss S said, “I’ll call the family while you and the aide wash her body, put a clean gown on her, and clean up the room. Ann removed the code cart from the room and took it down the elevator to the supply department to exchange it for a new cart.

After the aide and I cleaned up Eleanor’s body, I stood alone beside her bed gazing at her. Her face looked relaxed. Her body was still warm. This was the first time I ever saw anyone die. I didn’t know her well, so I don’t know if she had a personal relationship with Christ or not. Silently I prayed, Dear Lord, Use me for your glory and honor. I don’t know how many days I have left here on earth, but You do. Help me to always be ready to meet You. Thank You for saving my soul by your precious blood. Amen

June, 1977 – Evening Charge Nurse

I have now completed orientation and feel like the biggest adjustment is over. It  came to the point where I was daily dreading when the time arrived for me to leave for work. The pressures and responsibilities almost overwhelmed me because all I could hear in my dreams at night was, “Code Blue, Tower 5, Code Blue, Tower 5…” I was so fearful of resuscitating anyone because of the havoc and chaos at my first Code Blue.

I poured out my heart to God and realized I must trust Him, because He is the one who controls life and death, not me! As it says in II Timothy 2:4-5, Who will have all men to be saved, and to come unto the knowledge of the the truth. For there is one God , and one mediator between God and men, the man, Christ Jesus. How God longs for each person to receive Him as their Savior, but He will not force Himself upon anyone.

Now I enjoy going to work every evening, and rest in the Lord to give me the wisdom and strength in every emergency, allowing Him handle it through me! I am just the glove on His hand. How delightful to rest in Him!

And now, the exciting part… the Lord has opened the door for me to teach a Bible class with one of my former patients! One day when I was teaching the class about diabetes, I was able to share the gospel with the patients. Mary listened attentively and asked me to come to her room after class. She shared with me that she also is a Christian and was longing to learn more about the Bible. She lives close to the hospital, so I offered to teach her, and she eagerly said, “Yes!” So every Tuesday morning I go to her home before I go to work and we have the most wonderful time together in the Word.

I was preparing for tomorrow and studying Genesis 22, where Abraham was willing to offer up his only son, Isaac, in obedience to God. He believed that God could resurrect Isaac and was willing to totally obey God in simple faith. I so desire to always obey God like that!

Reflection – 2014

Since those days, I have been involved in many Codes for cardiac arrest including infants in labor and delivery and adults when I worked in dialysis and the nursing home. Some nurses enjoy emergencies, but I never have. I am more comfortable having the difficult conversation with elderly terminal patients about their choice of whether or not they want to be resuscitated, and when to choose hospice care. It is a sobering thing to watch someone pass into eternity. But it is truly delightful when I know the person has received Christ as their Savior, and he is welcomed home into heaven above! What grace of our dear Savior to save sinners like us!

Precious in the sight of the Lord is the death of His saints.

Psalm 116:15



Graduate Nurse Orientation

April, 1977 – Midwest, USA

After one week of vacation visiting friends, I began orientation on the diabetes unit on day shift. The nurses have been very friendly and encouraging as they teach me about diabetes and how to care for the patients. This new hospital is a circular tower with 10 floors of 30 private patient rooms on each floor. It was designed with nurses in mind since the nurse’s station and elevators are in the center. This way, each patient room is equally close to the nurse’s station. Since no one has a roommate, it also eliminates roommate problems, and it is easy to put someone in isolation when they have an infection.

I stand in front of the new hospital tower where I worked as a new graduate nurse.

I stand in front of the new hospital tower where I worked as a new graduate nurse.

I quickly learned the day shift routine. After clocking in with our badge, we began by listening to the cassette taped report from the night shift nurse in the conference room. Then we made walking rounds with the night shift nurse and checked how much fluid was remaining in each IV (intravenous) glass bottle and marked the tape on the side of the bottle with the hour. Next we counted narcotics with the night shift nurse, both signed the book, and she handed me the keys. Then I mixed all my IV antibiotics for my shift in 50 cc bottles of normal saline. This could be quite time consuming if I had to mix 10 to 15 bottles. First I wrote out all the labels with the patient’s name, medication, time, date, and my initials. Then I gathered the glass bottles of dry medication from their tray in the medication cart and  enough 10 cc syringes from the supply cart. Next I withdrew 10 cc of saline, injected it into the bottle with powdered medication, rolled it between my hands until it dissolved, withdrew it from the small bottle, injected it into the 50 cc bottle of normal saline, and pasted on the label.

By that time it was breakfast. The aides checked each patient’s urine sample for sugar and handed us the list of results: negative, trace, 1+, 2+, 3+, or 4+.  Then I checked he patient’s insulin dose, drew up NPH or Lente, and added enough Regular Insulin (short acting insulin) to cover the amount of sugar the patient spilled in his urine. Then I went to the patient’s room and watched him inject himself while giving him further instruction.

After the patients finished breakfast, the aides started baths and bed changes while the nurses passed the 9 a.m. meds. After meds, we did treatments such as dressing changes. In between all this, we made rounds with the chart rack whenever the doctors appeared, and then processed the orders. After the MD wrote the orders on carbon paper, the unit clerk tore off the extra copies and sent them in the pneumatic tube to the correct department (lab, pharmacy, dietary, etc.) Then the nurse cosigned the order after checking their work for accuracy.

On day shift, there are 3 nurses, so each cares for 10 patients and there is one nursing assistant for each block of patients. On evenings, there are only 2 nurses so each cares for 15 patients with 1 nursing assistant on each block. On night shift, there is usually only 1 RN and 1 nursing assistant for the entire floor. This is really challenging trying to manage 15-20 IVs alone with antibiotics, hypoglycemia, etc.  It is quite a shock to me to take care of so many patients after only having 2 patients in nursing school! Probably my best preparation was the summer I worked as a nursing assistant on night shift in the nursing home and was in charge of 50 patients at night. But the nursing home patients only needed custodial care; they were not acutely ill such as these complex diabetic patients.

All patients who are diagnosed with diabetes come to our floor whether they have a medical or surgical problem. We can closely monitor their blood sugars and adjust their insulin or tablets appropriately. We also are taught to quickly recognize and treat low blood sugar with 50 cc intravenous injection of glucose if they are unconscious.

When a patient is newly diagnosed with diabetes, they are admitted to the hospital for an entire week of classes. We have a new diabetes classroom and have class every day after lunch. On Monday, we teach them about diabetes in general by showing a short 8 track film and using posters. On Tuesdays, the dietician teaches them about the diabetic diet and counting exchanges of the different food groups. Wednesdays, we teach them about the 3 different oral medications (Diabenese, Orinase, Tolinase) and the 4 types on insulin (Regular, NPH, Lente, Ultralente) and they learn how to inject insulin into a sponge for practice. Thursdays we review exercise and how to travel with diabetes. Fridays we teach them about foot care and skin care since they are prone to ulcers on their feet, and what to do when they become sick. We also encourage them to walk around the unit to get their exercise. I really enjoy teaching the classes!

I have completed 4 weeks of orientation on day shift. Next week I go to evening shift for 2 more weeks of orientation, and then I’m in charge of the whole unit. I have to admit, it sounds rather scary… Every day before I go to work, I ask the Lord to give me wisdom in making the right decision and to help me learn all this new information. I am definitely on information overload!

If any of you lack wisdom, let him ask of God, who giveth to all men liberally, and upbraideth not, and it shall be given him. James 1:5

Reflection – 2014

As I think back over the workload on that very busy diabetes unit, I can recall so vividly my feelings of inadequacy and struggles with time management and making the right decisions, especially in emergencies as a new graduate. I quickly became much more comfortable with patients with diabetes which had been a weak area for me in nursing school. There are now so many medications available to treat diabetes, that it is hard to keep up with them!

I am so thankful we now have plastic IV bags and that the antibiotics are mixed in pharmacy before they are delivered to the floor. I recall dropping a glass bottle on occasion which shattered and made a big mess!

The advent of the blood glucometer so each patient can check their own blood sugar numerous times daily has made patient management much easier. As a result, the urine dipsticks for sugar have become obsolete. Our unit piloted one of the first glucometers which cost $500, needed to be plugged into an electrical outlet, and was about 4 inches by 6 inches in size. But it was much better than calling the lab for a stat blood sugar before giving the patient orange juice loaded with 3 packets of sugar while we waited for the results.