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Thursday, July 17, 2008
11:23:19 AM EDT
Feeling Relaxed
It's official!
I have a second job! I got the job at the other hospital and it turns out, another nurse from my unit also got hired there and starts orientation with me on Monday. I didn't even know she was applying nor did she know I was. Small world! Hopefully it will be a positive experience.
My patient that coded a couple of weeks ago passed away last week. He had been in hospice care and ended up passing away after his wife left to make a phone call. Some say that he was waiting until she left the room. I'm not so sure he was even aware enough to know whether she was there or not. I think it was the transfer from ICU back to PCU that did him in. It seems like when we have patients that are very close to passing - that when you move them around - such as giving a bed bath or transferring to another bed - that's enough to push them over the edge.
I had a patient this week that had been made hospice and was supposed to be transferred the next day to the hospice care center if he "survives" the night. Not exactly the words I like to see written about my patients. I informed my patient care tech that we would not be bathing or moving this patient at all - because I know the moment we start doing that stuff - bad things can happen. He was developing a fever...he had been for awhile, but now that the antibiotics had been stopped...it seems the infection was causing his temperature to rise. We had an order for Tylenol, but it didn't make sense to me to even have that order....because Tylenol wasn't going to stop the infection which was the reason his temperature was rising. I tried to cool him down with cold washcloths - it helped a little bit, but we all knew it was just a matter of time.
One word of advice to those that may become hospitalized in the future....when the doctor is visiting you, that is the perfect time to ask questions and make requests. Don't wait until 10 pm or even 2 am to start making requests...because chances are the doctor is not very receptive at that time or he's not even the doctor on call.
I had 5 patients the other night all making requests thru the night that required doctor's orders. That's fine...I'm used to it, I'll make the call & try to meet your needs. I don't mind waking up sleeping doctors if the reason warrants that. But every one of the patients had told me "Oh, I didn't want to bother him while he was here." What? Bother him? He's there to see how you are doing and what you need. If he is talking to you - that is the time to ask questions and make requests...so he can write orders.
For example: I had a patient in with chest pain. They put nitropaste on him and the major side effect of that is a bad headache. So Tylenol was given at 9 am and the nitropaste was removed. The Tylenol didn't help, but the admitting (primary) doctor was in at 2 pm - even gave the patient his business card. Now it's 8 pm and the patient is very upset that he still has this headache. Ok...did you tell the doctor you had a headache? No, I didn't want to bother him with that. How is that going to bother the doctor? Plus the cardiologist was also in to visit and he didn't want to tell that doctor either. So I call the primary and of course his partner is on call who knows absolutely nothing about this patient. I tell the partner that this patient is complaining of a headache. The partner is concerned now that it might be more than a headache and should we order a CT or MRI of the brain. Ummm, I don't think so, but of course I don't want to be the one to decide that. He's running through all sorts of theories of what it might be....as opposed to a nitroglycerin induced headache. He finally decides we'll try Lortab and see if that takes care of it...which it did. But then I had to wait another 45 minutes for pharmacy to process the order and before you know it...it's about 10 pm before I can give this patient anything to help. I'm just saying it would have been easier if he had told the doctor standing in front of him at 2 pm that he has a headache unrelieved with Tylenol so we could resolve it then instead of 8 hours later.
Oh and another thing...if you want/insist on a private room...do that while you arestill in the emergency room. The time not to do it is when they are wheeling you into a semi-private room. My new admit started crying while still on the ER stretcher...declaring "I can't do this! I need a private room." I've never seen anyone react quite like that. The thing is...once the room is assigned, it's rather difficult to change the assignment unless we have plenty of extra room available - which is rare. So either insist on a private room and wait in the ER until one is available or suck it up and deal with being in a semi-private room. Don't get me wrong, I am a strong advocate that ALL rooms should be private - however, I don't get to make the decisions. I, for one, would be the one insisting on a private room if I ever have to be hospitalized. So don't feel bad if that's what you want also. :) Just make it known sooner than later.
Written by jennerizer
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Sunday, July 6, 2008
8:25:08 AM EDT
Feeling Thoughtful
My Second Code Blue
I went into work Thursday night - a night I did not orginally schedule for myself, but our scheduler rearranged my schedule that week. So I was there. I was just starting shift change report when the wife of a patient reported to me and the day nurse that she felt her husband was restless and anxious - could we get him a Xanax. Rather than insisting the day nurse get it - since it was technically still her shift as I hadn't even gotten report yet, I volunteered to get the medication so the patient did not have to wait at least 30 minutes because of shift change.
I brought the Xanax 0.25 mg PO (pill form) into the room. His wife who is also a nurse, sat him up in bed. The patient wasn't saying very much to me. The wife claimed physical therapy worked with him a lot today and he was tired. Yet anxious because he was not going to be discharged until tomorrow. So I give him the pill, he takes a few sips of water - swallows the pill - takes a few more sips of water. I ask him if he got the pill down. He agrees that he did. Within 60 seconds of that, he went unresponsive. His eyes were still open and that threw me a little, but his wife immediately starting mouth to mouth on him really threw me. It wasn't anything like what we learn in ACLS....check for breathing, check for pulse...nope, she just yelled "Something's wrong" & started mouth to mouth. I got the day nurse to come in to assess him and by that time the wife was now doing compressions. I guess she just went into panic mode. I went ahead and called a code blue because obviously there was a change in this patients condition - not that I was sure that he had stopped breathing or that his heart stopped.
The only good thing about a code at shift change is that you get twice as many people showing up - day staff and night staff. The patient's heart had never stopped beating and although he was having difficulty breathing, he never stopped breathing. They ended up intubating him and transferring him to ICU. Kinda weird considering the day nurse had spent all day getting his doctors to clear him for discharge the next day. Guess it is just not meant to be.
I don't believe he choked or aspirated the pill or water we gave him. I think the restlessness and anxiousness were more of a sign that he wasn't feeling right to begin with and that this would have happened regardless of whether I medicated him or not. There's always a doubt though. I felt a little helpless, but am grateful we have a good staff when it comes to codes.
I got a call from that other hospital. I have to call them back tomorrow. I'm pretty much positive they'll offer me the position - which I will accept. I want to see what it's like outside of my comfort zone.
I saw a couple of movies last week....Wanted and Hancock. I enjoyed Wanted = great action flick. Hancock....ehhhh, it's ok, very different.
I have to work the next 4 nights in a row. Hopefully it will be a good week.
Take care everyone!
Written by jennerizer
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Saturday, June 28, 2008
5:07:05 AM EDT
Feeling Jubilant
Best News I Heard All Week
I heard the other day that starting in July/August, my hospital is beginning a training program for the DOCTORS to enter their own orders. For the life of me, I cannot see them doing this. I mean half of them barely have legible handwriting - how are they going to be using a computer and ordering their own things? One of them I know can't even figure out how to sign onto the computer, much less look up any results or enter his own orders.
I wonder how much the redlining process will decrease - since their orders won't be written anymore unless given over the phone. I have a feeling, a lot of these doctors will be traveling with "assistants" to enter their orders. I cannot wait to see this take place. I'm not sure when it's going to be implemented, but it seems like it's just around the corner.
I interviewed at another hospital yesterday. I'm not sure if I'll get the job or not. Hopefully I'll hear something by next week. It's a per diem (as needed) position. She seemed like she was ready to offer me a full-time position, but I don't want that. I'm not planning on leaving my hospital - I just want to see how it is working somewhere outside of my comfort zone. I figure it will be a good experience and increase my confidence also. We shall see!
I worked 4 nights in a row this week. I'm debating about going back tonight. I should...for the overtime money, but once I get home - the last thing I want to do is go back to work. I'll see how I feel later.
I started off the week on the Med/Surg floor with 5 PCU patients. We have patients on Med/Surg when PCU fills up and for some odd reason - our hospital is super busy this month. So I was down there as the lone PCU nurse - which is sometimes good because you are basically on your own. It has shown me that I can do just fine on my own. I didn't even know who the charge nurse was - she never once talked to me the entire shift. Nice, huh? I had a patient with an active MI (heart attack). While I was getting orders for her, the Med/Surg staff was busy celebrating someone leaving and were having a party basically. They seem to eat a lot on that floor now that I think about it. Anyways, they were trying to get me to join in - which was nice - but ummmm, I have a patient with an active MI....work comes first. Their reply "You can never be too busy to eat!" Yeah, ok!
Luckily my patient was stable and unaware she was even having a heart attack. As the night wore on though, she was becoming a bit more confused - yet she could remember my name perfectly. How do confused people do that? They can forget who they are, where they are, what year it is....but they always seem to remember the nurse's name to yell out continuously. I don't get it.
I put a call into the PCU charge nurse & said "Please don't send me back down here tomorrow night." So the next night I was back on my usual floor. I'm not sure it was much better patient wise - but at least I had the usual staff around. I had one patient that was in with Altered Mental Status - but I am convinced what I was seeing was how she always is. She sure did love her call light. Every 15 min, she was calling - sometimes sooner, but never later. At one point, she asked how she can cover the call light so she stops pushing it. Ummm...how about if you just stop pushing it?
We had another patient that was convinced she had bird mites all over her body. Obviously she didn't, but there was no making her believe that. She had bottles & bottles of "at home remedies" set up all around her bed. It was pretty bizarre.
I had another patient in which the doctors totally forgot to see him. Try explaining that to the family members that were sitting at bedside since 9 am. I managed to iron it out, but it wasn't pretty.
Have a great weekend!
Written by jennerizer
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Saturday, June 21, 2008
3:59:13 AM EDT
Feeling Mellow
A Disgusting Memory
Ok, 2 McFlurries later and an evening of watching non-stop episode after episode of "Hulk Knows Best"....is it any wonder why I'm awake at 3:36 in the morning? I swear I'm meant to be a vampire....I dread the days & come to life at night. I can't even blame it on being a nightshift nurse, because I was like this before I went into nursing. Guess that is one reason I did go into nursing - the night schedule works for me.
I've been doing ok. Actually, one good thing that happened this week is that there has been a big change in the way we chart. No longer do we have to spend hours & hours charting after our initial assessment. There is a choice called "No change" and everyone already knows that if you mark the answer "No change" - that one would assume there has been no change in the patient's condition, right? For some reason, even with marking no change, they still wanted us to chart full assessments. Finallyyyyyyyyyy they have come to their senses & we can be nurses again. If there is "no change", all we have to do is mark that and move on. Yay!!!
I'm not going to go into all of my patients and their conditions, but I will tell of one that is quite disgusting...because I feel the need to share and it's something I want to look back one day & be reminded of something so disturbing. I had a male patient in his 40's that was in with chest pain. On the night I took over his care, he was supposed to be discharged after getting the results of his echo (sonogram of his heart). Well, it turns out he had a blood clot in the left ventricle of his heart...therefore no discharge and he was started on Heparin immediately. That isn't the disgusting part.
I was told that this gentleman's heart rate would occasionally increase to the 150's to 170's. Why? Do you really want to know? Sorry for the answer...but this man felt the need to...hmmm, how do I word this as to not offend people...this man would take matters into his own hands to make himself feel good. Everyone get it?
This isn't the first time that a nurse has walked into a male patient's room to find him taking care of himself and it probably won't be the last. I truly don't understand why they cannot wait until they are in the privacy of their own home, but I guess some men just don't think about it to that degree. Heck, maybe they like the idea of having a nurse walk in on them. Anyways....this male had been doing it quite often and was told multiple times to stop. Not because of his heart rate or because it was inappropriate - especially when he wasn't even in a private room...he had a neighbor not more than 3 feet from his own bed - but because he had aids. We all know how aids can be spread....thru body fluids & this guy was proud to be decorating his bed, his hands and anything within reach with his own body fluids. Ewwwww! One of the nurses tried to educate him regarding this matter, but he didn't care.
I tried a different approach - tried to explain to him that he had a blood clot in his heart and to try to avoid all vigorous activity. In fact....try not to move much at all...especially with the Heparin running. That seemed to work...for a night anyways. It was also a good reminder for myself that universal precautions should always be in effect....especially with male patients, because you just never know what they might be up to....sigh.
I had a good week at work...mostly because of my co-workers and also because I only worked 2 nights...haha. I like to mix up my schedule. I'm on for 4 nights starting Sunday. I'll probably be called off as we have way too many nurses now (never thought those words would come out of my mouth). At the same time though, our hospital has been busy, so who knows. It looks like the chest painers are back instead of being diverted to other hospitals. Yay! I love the chest painers.
I'm also going to apply at another local hospital - just to get more experience in a place different from my comfort zone. I don't know if I'll even get hired, but I'm going to fill out an application online and give it a try. I don't plan on leaving my current hospital....just trying to get a per diem position at this other place. The good thing about it is that it's the same hospital chain I'm at now...so if I work my regular schedule at my hospital and pick up shifts at the other...it's considered overtime. Even better! The travel nursing is still in the back of my mind and I will continue to get more information on it.
Hope everyone is having a wonderful weekend!!!
Written by jennerizer
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Tuesday, June 3, 2008
7:35:58 PM EDT
Feeling Cheerful
So much going on!
It's been quite awhile since I wrote last - so much has been going on - I'll try not to make it tooooo long.
First off - I got to see Tim McGraw in concert! Woo hoo! It was great, but went by way too fast & I probably drank a little too much...but it was fun. On top of seeing Tim McGraw...I got to meet Linda - someone that has been reading my blog here for a long time. She has always been so friendly & supportive...it was a real pleasure to get to meet her in person. We still have to go out for some margaritas, Linda!
Work has been challenging. There are so many administrative changes and they don't seem to be stopping any time soon. I am getting more and more convinced that hospitals don't care about their patients or the nurses. I can't speak for all hospitals - just mine. They expect us as nurses to do so much, yet won't allow us the staffing that we need. So what it comes down to is basically hardly anytime to really spend with our patients or even speak to them...because we have soooooooooooo much charting and paperwork to do.
That's tough for me to accept. Especially this week as I was reminded that ultimately what most people want in life is someone to listen to what they have to say. That's it....time to listen. I think that is the key to gaining their trust and confidence....and yet we are very limited with the amount of time we can spend with our patients at the bedside. I don't totally blame my hospital because I'm sure it mostly goes back to the insurance companies and all the paperwork they require to be processed in order to pay the hospital for its services...but still. Something needs to change. We are nurses....we are trained to care for patients. Instead I predict in the next 20 years....the majority of nurses will be affected with carpal tunnel syndrome and bad backs because of all the charting we have to do on a daily basis.
The way I was reminded of how important the skill of listening is....I got a patient from the ER that was agitated due to the ER nurse's attitude. I shouldn't say that it amazes me how one person can affect another and change their total outlook on the entire hospital...but that's exactly what happened Sunday night. I'm not going to go into too much detail with why he was at the hospital, but the ER nurse basically accused him of trying to commit suicide and would not listen to why he came to the hospital. I could understand the patient's side of it and I also figured that the ER is busy and understaffed...perhaps the ER nurse didn't have time to listen either. Still though, it agitated this man and I felt bad for him. So I took the time to listen to what he had to say. It took 90 minutes to get through the admission, but he had calmed down and was able to sleep after I was finished. I left work 45 minutes later than usual in order to catch up on....you got it...the paperwork....but it felt good knowing that I diffused a situation simply by taking the time to listen and my patient was calm as a result.
It was a tough night that night though....I had 2 post-op patients......one that was nearly 500 lbs and could barely move, but was so uncomfortable in bed that we had to get him up to the recliner chair. It took about 30 minutes to complete that task, but as a result, he was feeling better...so it was worth it.
My other post-op patient was a type A personality - he wanted what he wanted when he wanted it and how he wanted it and that was that. I've dealt with people like that before and have learned it is better to just do what they want rather than upset them - because when you upset them, they become more demanding. Luckily he & I developed a good rapport and he really didn't call for me too often through the night....unlike what I heard from how he's been previously...very needy & always on the call light. When he did call, I was right there & did whatever he needed - to a degree. When he started asking for a back massage and to be iced down on his back....I declined. I'm not a massage therapist.
My third patient ended up being easier to deal with than when I had him the week before...thank goodness. He really didn't ask for anything, just was very unhappy with having to be in the hospital. I've never seen a patient with so many different consults...he had at least 9 different doctors following his case. He came in with septic shock.
My fourth patient had been a new admit at the beginning of the shift. She had been admitted with chest pain...but it wasn't actually chest pain. It was pain near the left side of the rib cage under the breast. She was calm and pleasant - went to bed around 11 pm. Then we got the call...that we had to move her into another room so we could put 2 male patients in the room. We woke her at 2:30 in the morning (ridiculous!!!!!!!!!!) and moved her into another room with another patient. Well, that set her off into crying for nearly 2 hours. When asked why she was crying, the reply was "Because you moved me to a different room." Does that really require crying non-stop for 2 hours? She complained of chest pain rating it a 10 out of 10.....yet was lying in bed reading a book. I don't know, I don't understand what goes through some people's minds.
And my fifth patient - the one that reminded me that listening is one of the best skills a person (not just a nurse) can have. He was admitted into the crying patient's previous room of all places. So while I was busy admitting him, she was still crying.
It was a busy night, but I think I handled it pretty well. Not much really gets to me anymore at work. I just tell myself to get through the night - it's just 12 hours - I can survive. It's not worth getting stressed out or upset.
I had a whole new set of patients last night as I was on my usual floor (the night before I had been transferred to 3rd floor). My group was pretty good. The first one was status post a heart cath. It had been abnormal, but the doctor was unsure of how to treat it and would discuss it with the patient in the morning. The patient was very easy to get along with - so much so I had him laughing at 5 am this morning. I like when I just click with a patient. Makes work much more enjoyable.
My second patient has been in the hospital for about 6 weeks - came in with abdominal pain and turns out it was stomach cancer. How scary is that? I swear...every time I have a headache or stomache...in the back of my mind I'm hoping it's not cancer. She had just finished up with her last round of chemo - so I imagine she'll be leaving the hospital soon.
My third patient was transferred to med/surg just after the change of shift - so I didn't know too much about him.
My fourth patient came in with chest pain, but it turns out it was back pain and more of an ortho problem than cardiac. He needed pain medication so I gave him 2 mg of Dilaudid. Within 30 minutes, he was itching everywhere! So I got him an order for Benadryl and Solumedrol - it knocked that itching right out...and the patient too...which would be a good thing later in the night. You'll understand in a few minutes....haha.
I got a new admit around 2 am - altered mental status and hyponatremia (low sodium level). What is strange is that in the last week...this is like my third or fourth patient to be admitted with hyponatremia....where it was at 122. Normal is 135 to 145. Usually when someone's sodium level is that low, confusion appears. My other patients weren't confused last week, but this gentleman definitely was. He kept repeating to me "I don't know what's going on." He must have said it 20 times in 10 minutes. Luckily he went to sleep. The only thing I did was hang a bag of normal saline. Well, 2 hours later he is awake...and totally alert and oriented. What the ???? He could answer all of my questions appropriately, he could stand & walk, he was cured....lol. Wow...I'm good! I don't know...I don't get it. I'm not totally believing that the first set of labs were even his. I mean he was confused....but listen to this (and those that know electrolyte levels will understand why I don't believe the first set of labs were accurate). His sodium went from 122 to 136 in 12 hours. Is that even possible just by hangingone bag of normal saline? No. On top of that...his potassium went from 3.1 to 4.4 with NO replacement. And his magnesium went from 1.5 to 1.8 with NO replacement. On top of that....his urine output in 12 hours was nearly 5,000 ml. If anything, his electrolytes should have been wayyyyyyy off after all that urine output. Like I said, I'm good....haha!
This poor gentleman though...he nearly broke my heart. He's 78 years old and his health is declining. He told me that he has been married for 50 years and that his wife recently told him that the marriage has not been what she expected, that she was unsatisfied with it and wants to put him in a nursing home so she can live out the rest of her years without him. OMG....sooooooo heartbreaking. He says she said this to him about 6 months ago...but for him to remember it now....sad. He says she is hateful towards him, but he doesn't want to go to a nursing home, that he still has a few good years left. I wanted to give him a hug! I mean what do you say to someone that is telling you this out of the blue? I didn't get to meet her and I'm sure there is way more to the story, but it still made me sad for him to have that on his mind at 4 am while he's in the hospital. I'm sure he fears that instead of going home on this admission, that they'll put him in a nursing home. So many of our patients have that fear. It's heartbreaking.
I almost forgot - the reason why it was good my 4th patient was knocked out for the night. We got the patient I had transferred to med/surg back around 2 am. A different nurse got him this time since I had just gotten an admission. None of us really knew what the med/surg nurse said to the doctor to get him upgraded to PCU...because he wasn't in any distress, his vital signs were fine, he was asymptomatic. She claimed that when she was suctioning his mouth, that fecal matter was coming out. I know...gross! Still though....no tests were ordered...just a transfer to PCU and some Reglan. It made no sense. When they brought him up....he stunk.....like really bad. So bad that I didn't even want to go into the room and he was put in the room where my fourth patient was. The nurse that got him said she thinks it's his breath that stinks. What? How can anyone's mouth stink so badly that the room and hallway were unbearable to stand in? I didn't send him down to med/surg like that! She suctioned him...nothing was there but clear fluid...no fecal matter. Then she pulled down the bed sheet & it was very apparent this patient had a GI bleed. Anyone familiar with what a GI bleed smells like? Picture that only a million times worse!
I've had my share of GI bleed patients and although the scent is unmistakable......this was the worst I had ever encountered. The nurse and care tech caring for him had to put on a mask & put toothpaste on the inside of it so they could smell the minty scent in order to clean this patient up. I, on the other hand, was tearing open alcohol pads & holding them up to my nose in order to survive because I had been sitting & charting near the room. I had to move...and even with the move, the smell was making it's way down the hallway. I sprayed the spray they have at the hospital - but that isn't much of a better smell and I gave another nurse a headache because of all that I was spraying.
I was praying my patient was ok, but I couldn't venture in there quite yet. I'm telling you - this was a bad smell. I figured if he needed me, he would call for me. I did check on him a little later and somehow he was sleeping through it all. Maybe the smell knocked him out...I have no idea. Our hospital is full, so I couldn't even offer to move him anywhere else. It seems like that is always the case. Anyways, the GI bleeding patient ended up being transferred to ICU....not so much because he needed to...but because at least he'd be in a private room. He probably could use the closer monitoring too - since he was actively bleeding. Ahhh, what a night.
I'm sure I have plenty more stories I could tell you regarding the patients I've had since I last posted...but I'm getting old & my memory is fading (lol)...plus this is a long post already. I am off now until next Wednesday. Not really sure what I have planned - but I do want to go to the beach. The weather is already unbearable - summer is here. Hopefully the hurricanes will stay away, but we do need the rain.
I got called off of work tonight...yay...actually I volunteered to be called off. My hospital has hired wayyyyyyyyyyyyy too many people and as a result, we're all being called off. They tell us that they hired all these people to prepare for when we are busy in the winter. Ummmm....that's a long way off! I'm sure it will be here though before I know it. I am getting closer & closer to venturing out of the comfort zone. In fact, I'm going to check out some travel nurse web sites online. Any recruiters reading my blog - send me an email! Jennerizer@aol.com
Have a good week everyone!
Written by jennerizer
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Wednesday, May 7, 2008
12:41:14 AM EDT
Feeling Happy
Happy!
Yay! I'm in a happy mood because I got to leave work at 11 pm this evening. They were downsizing and asking for volunteers to leave. This hardly ever happens and it's my last night working this week...so I quickly volunteered. This way I'll be able to get some sleep tonight rather than sleeping all day tomorrow.
This week the shifts were easy. The patients were pretty good. Today was the beginning of Nurses Week. One of my patient's families brought in a huge shopping bag full of chocolate candy and a card thanking us for all that we do. It's nice to be appreciated. In fact...they did more just by doing that than what our hospital is doing.
My hospital is having a breakfast for nightshift and a luncheon for dayshift......food courtesy of the CAFETERIA! That's it. I remember the times when they would do something unique each day/night and make a big deal about celebrating nurses week. This year....practically nothing. I don't get it. I mean our yearly bonuses went towards redecorating the doctor's lounge and buying them a big flat screen tv. It's obvious who the hospital caters to, but I didn't think it would get so bad that they'd blow off nurses week. Just more signs to move on I guess.
On an upnote...I got to see Michael W. Smith in concert last Friday. He was amazing. Words alone can go right to the heart and he knows exactly what to say. PLUS I get to see Tim McGraw in concert this coming Sunday. Woo hoo!!! I'm excited!
Have a good week everyone!
Written by jennerizer
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Saturday, April 19, 2008
4:08:10 AM EDT
Feeling Chillin'
Venting - for a few minutes
Sorry all - but I have to vent a little bit. I'm getting closer & closer to really thinking about travel nursing because:
My hospital is getting sooooooooooo very nit picky with all these insane things they want us to do. It's at the point that they truly must be off in fantasyland thinking we can achieve everything they want.
The latest is that they want us to bring our rolling (noisy) laptop computers into the patient's room.....chart in front of the patients- so that we can be "visible" & thus prevent falls (say what???). Sounds good in fantasy...but the reality is...I have 5 patients. Charting takes at least 20-30 minutes (I figure it's likely that if we are in the patient's room, there will be at least a few interruptions) and we have to chart at least 3 times a night on each patient. So....let's see....30 min x 3 = 90 min x 5 patients = 450 min or 7 1/2 hours.....that's just charting. Granted the first assessment should take the longest, but now they are saying the want full assessments charted at least twice a shift and one assessment where we just focus on why the patient is there. Again, more unnecessary work. See....what I don't understand...there is this one choice where we can say "No changes" if nothing has changed. You would think that would suffice so that EVERYONE understands there has been no changes, right? Nope, even when we get to choose "No changes"...we still have to chart the same exact things as the initial assessment. Does that make sense to you? It's like they are looking for ways to eat up our time - when really, that extra time could be spent actually with our patients minus the computer between us. Patient care...that should be the priority here, shouldn't it?
Now let's move on and add in the medications we need to give & the time to actually assess our patients....probably another 30 min per patient (by the time we check the charts to make sure the medications are accurate - and the repeated faxes & calls to the pharmacy to get the medications we need and also do a full assessment) = 2 1/2 hours. So now we're at 10 hours of our work day and all we've done is assess our patients, give medications and chart the basics. 10 hours!
We get two 15 min breaks and a 30 min lunch break. So it's 11 hours. And that's not including any time for the needy type patients, the family members, the patients that are unstable or crashing, the patients that are incontinent, in pain, nausea/vomiting, admissions, discharges, calls to the doctors, ambulating the patient, dressing changes, and most importantly...keeping an eye on the heart monitor screens, etc.
Oh AND now they want us...every hour to assess how much our patients have urinated (seriously, does this really matter every single hour? Who goes to the bathroom every hour anyways??? Especially at night?)
Plus make sure they reposition themselves in bed on an hourly basis - regardless of whether they are alert and oriented and able to move on their own. I see it going like this...ummm, excuse me Mrs. Smith, can you wake up (as if we don't wake them up enough at night to begin with), you were on your left side an hour ago when I last checked, can you please flip over to your right side so the hospital administration doesn't think I'm not doing my job??? How well will that go over? It's ridiculous.
Haha....oh AND they want us to always chart in the patients rooms. It's impossible. Our first assessment is at 8, but meds are usually due at 9 and 10. How can I complete all my charting and get the meds to my patients on time? Oh, and can you see me midnight and 4 am (our next scheduled times to chart)...rolling in my noisy computer & sitting next to my patient in the dark (cause they should be sleeping at those times) trying to type and chart without disturbing them or turning on a light? Most importantly, do our patients really want us next to them while they are sleeping? Doesn't that sound a little creepy?
AND THE MOST OBVIOUS QUESTION OF ALL ----- UMMMM, WHO IS GOING TO BE WATCHING OUT FOR MY OTHER 4 PATIENTS WHILE I'M IN A ROOM FOR 30 MIN OR SO? The same goes for the other nurses....who is going to be watching out for their patients if we're all in patient's rooms for extended times like that? It's like they never thought of that. So the quick answer was...utilize and negotiate with your patient care tech to watch your patients. As if the PCT's are standing around waiting for something to do. They are busy too at those times with vital signs and patient care. And yet another good question was asked - what do we do when we don't have a patient care tech? Not only that - at night we are lucky if we have a unit secretary, but they usually leave at 11 pm. So who is going to be answering the phones, putting in orders, answering call lights, etc.
If I didn't enjoy being around my co-workers so much, I would be out of there. Ahhh, the new ideas that "administration" comes up with. I'd like to see them spend twelve hours on the floor doing what they propose we do. It's obvious they haven't a clue what the real world of nursing is like.
If they want to prevent patient falls and increase our visibility to the patients and their families - why not work on getting adequate staffing ratios and more patient care techs? At times there is one patient care tech for 26 patients. How realistic is it for that person to truly take care of 26 patients? And many times there is no patient care tech at all - the nurse is expected to be both a nurse and the patient care tech. I don't think they realize (or care) how tough that can be. And why not get up to date beds in which the bed alarms actually work? I think that would be the one feature that would work best towards preventing patient falls. Combine that with adequate staffing and I would bet money patient falls would decrease.
Plus they have thrown in this paperwork that insurance companies are demanding or they won't pay the hospital for certain conditions...it's called quality measures. In reality, it sounds fantastic....if you do this, this & that for a patient - the outcome is usually better than if you don't. But it all needs to be documented and the doctors aren't doing it....so it's left for the nurse to do it. Just more work that really doesn't fall under our job role, yet they expect us to do it.
Sigh......ok, I'm done. I can only hope it's not like this all over the country. I have faith that there are some hospitals out there that actually value nursing care and allow their nurses to focus mainly on hands-on nursing care. I know charting is a must, but it shouldn't take up the majority of our time. Nor should we be expected to work past our 12 hour shift to "finish up charting" that we weren't able to do during our shift. 12 hours is a long day/night and most of us just want to go home and get some sleep after working. Sighhhhhhhhhh!
On a better note, I saw Lifehouse in concert Wednesday night. They are awesome. I could listen to them all night. It went by so quickly though. I'll be seeing Michael W. Smith in concert in 2 weeks. He's very spiritual and I definitely could use some of that right now in my life.
Work has been ok. I've been floating around to different floors. Nothing major has really happened with any of my patients. I've had a few that were a challenge. Like this one gentleman - he came in with congestive heart failure. For some reason, his blood sugar would not stay in a normal range. It was running low repeatedly and I could not figure it out. He started out at 70 one night, so I encouraged him to eat, gave him apple juice, peanut butter and graham crackers, whole milk, a sandwich...figuring that would keep him ok through the night. I got a call from the lab around 5 am with a critical glucose level of 44. I wake him up, luckily he's non-symptomatic, but I give him more to eat and drink - recheck it 30 min later and it's barely changed. So I gave him D50 through his IV. He was rechecked at 7 am and I think he was like 50 something. We want it at least 70 or higher, but after all that he had consumed and the D50....it should be well over 100. Throughout the day, he dropped as low as 31. The day nurse had given him more D50 and then Glucagon.
So when I got him...his blood sugar had reached 100. Yay! We rechecked it 2 hours later and it was 67. Grrr! I finally called the doctor to inform him of all that we've tried and he ordered D5NS. We don't usually like to give patients with congestive heart failure extra fluids like that, but he definitely needed it to keep his blood sugar up. Even with the fluids, he still floated around 75-98 blood sugar, but that was good enough for me to relax.
I had another patient that wanted me to help her fill out her living will paperwork because she was having a cardiac cath the next morning and was worried. It was 2:30 in the morning and I didn't think that was the best time to be making deicisions - but she insisted. So I sat down with her and helped her fill it out. After that she was able to go to sleep. Turns out she did have something major wrong and was transferred over to a bigger hospital that could handle her cardiac problems. I guess she just knew something was wrong and wanted to get her paperwork in order. Kinda eery sometimes.
It's 4 am, time for me to go get some more sleep. I must have been really tired yesterday as I slept for about 12 hours altogether (I would wake up for a little while, then fall back asleep repeatedly). I should work tonight for the overtime - I probably will...but I'll decide later.
Hope everyone is having a great weekend!
Written by jennerizer
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Friday, April 11, 2008
10:10:49 AM EDT
Feeling Happy
"Being a Nurse..."
"Being a nurse isn't about grades. It's about being who we are. NO book can teach you how to cry with a patient. NO class can tell you how to tell a family that their parents have died, or are dying. NO professor can teach how to find dignity in giving someone a bed bath. A nurse is NOT about the pills, the IVs and the charting.
It's about being able to LOVE people when they are at their WEAKEST moments and being able to forgive them for ALL their wrongs and make a difference in their lives TODAY.
Nobody can make you a nurse...YOU JUST ARE."
~Author Unknown~
Written by jennerizer
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Saturday, March 29, 2008
10:26:26 AM EDT
Feeling Chillin'
You just never know...so scary
I got a call on Thursday telling me some more sad news. One of my nursing school classmates that I graduated with had passed away at my hospital's ER last weekend. I was shocked! She was 36 years old and I was told that she died from a pulmonary embolism (blood clot in the lungs). It's another reminder that life isn't fair and your entire world can change in a second. You just never know when that will be....soooo scary.
Carlene - I don't know why I thought about that patient from earlier in the week the way I did. I didn't connect it to myself or my family at all though. Maybe I was overly tired & things got to me more than usual. I'm not really sure. It can be a tough job sometimes - having to deal with critical situations, death and grieving families. I can usually separate what needs to be done at work from what I take home at the end of a difficult shift. For some reason...that day I wasn't able to. Sometimes it doesn't always make sense and I'm ok with that. Like anytime in life...there will be some good days and some not so good days.
I'm doing better now. I've been off since Monday and have been doing a variety of things including getting some rest & relaxation, getting back into working out & balancing between staying busy socially and having time to myself. I work tonight and tomorrow night and then will be off until Friday and work 4 in a row...eeekkk...lol. It's spring break for my youngest niece and nephew so I plan on making sure they have some fun. Being around kids is always refreshing....as long as I can send them home after a few days. :)
Enjoy the weekend everyone!
Written by jennerizer
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Tuesday, March 25, 2008
4:15:19 PM EDT
Feeling Hopeful
Weird coincidence???
It's nearly the end of March. I cannot believe it. I swear each year flies by faster than the last. The hospital continues to be at max capacity. I don't recall it ever being like this before & that is even with all the people complaining of chest pain via ambulance are diverted to the bigger cardiac type hospitals. I have heard a rumor though that our hospital is going to start focusing on increasing their cardiac procedures - as obviously the need for it is great. I wish we would open up a cardiac only floor. I would love to work in that specific area. Maybe my wish will come true one day.
Speaking of cardiology, I had a patient last week who had multiple things wrong with him - the main one being that his cancer had spread all throughout his body. His blood pressure sat in the 150-160 range systolically and the doctors seemed comfortable with those results. The last morning I had him, his blood pressure rose to the 180's systolically. It was nearly 4 am & I questioned whether this result could be delayed by say an hour - before calling the doctor. I mean it wasn't like his blood pressure was normally 110 or 120 & jumped up to 180. It was 160 to 180...not a huge increase. So as I sat there & debated with myself whether to call & wake up the cardiologist...the phone rang. I answered the phone & guess who....the cardiologist...calling me out of the blue...lol. He was asking me what the first name of this patient was - the same one that had the higher blood pressure. I laughed to myself & thought "how weird is this right now???" I gave him the answer & said "By the way - while I have you on the phone, his blood pressure is this..." He said that was fine, leave it alone. I hung up the phone wondering...seriously...what are the chances of this ever happening at 4 am?
This week was going well...I worked Sat & Sun nights. It was pretty uneventful. Well - until Monday morning. A co-worker & I were waiting to get our yearly PPD shots. The reason we were waiting was because a code blue had been called about 10 minutes earlier & whoever was doing the PPD shots - ran to the code. So we waited & eventually I could tell by the looks on other co-workers leaving the floor that the code was not a success. Another co-worker quickly updated us on who had coded & although she wasn't my patient at the time - I did have her as a patient back in December. I didn't write about it at the time as it was right before Christmas & very sad. She was in her early 30's who came to the hospital because she had trouble swallowing. They initially thought it was pneumonia...only to find out it was 3 or 4 large tumors on her esophagus. Basically she had stage 4 cancer...that is the worst stage there is. She was married and had 3 children at home. Her room was decorated with a Christmas tree & presents back then since she would be spending Christmas in the hospital.
Fast forward approx 3 months & she is the one that they called a code on. As I was processing all of this information, her sister was being led by the ICU nurse to the waiting room and I heard her crying on the cell phone to her mother while saying "She's gone, Mom, she's gone." I keep hearing those words over & over. I came home & couldn't stop replaying those words in my head. I felt miserable. I tried to sleep...took 1 Tylenol PM. I had a sore throat, headache, still not sleepy. So I took 1 Sominex and layed down again. I could not sleep. I ended up calling off from work - because I can't go in with no sleep in over 24 hours & then work another 12 hours. I was tired, but couldn't sleep. Eventually I did fall asleep around 5 pm until 11 pm. I ate, watched tv & went back to sleep & woke up at 7 am.
I feel better today. I'm getting some things accomplished, but still think about that family who lost someone at such a young age. I don't know why it's affecting me - I usually am so good at keeping everything at work. Maybe I'm just more sensitive at the moment. I don't know.
It's just a major reminder that life isn't fair and you have to make the best of it while you still can.
On a good note - I have tickets to see Tim McGraw on May 11th. I cannot wait! I'm also seeing Lifehouse on April 16th. Soooo looking forward to getting out & hearing some good music.
I hope everyone is having a good week!
Written by jennerizer
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