My First Year as a Nurse - RN

New Place to Blog

Fri, 10 Oct 2008 01:18:25 GMT

Ok, everyone, my blog has a new home.....

http://jennerizer.blogspot.com/

COME VISIT!!!

As you all know

Thu, 02 Oct 2008 01:32:51 GMT

As you all know...or at least most of you know...AOL is getting rid of their journals. I will be looking for a new place to blog and hopefully be able to transfer all of my old entries over. If anyone has any suggestions, let me know. I'll be in touch.

The meeting and a story

Wed, 24 Sep 2008 01:43:09 GMT

Thanks to everyone that leaves me a comment or writes me an email. I really do appreciate your feedback! I went to the meeting today - it was more like a training session. It was mostly centered around our upcoming Joint Commission survey. They are the ones that give our hospital accreditation. I am sooooo thankful they don't visit at night...lol. Not that it really matters because we know the right answers to anything they ask - but none of us like being interrogated about our patients or their care. I'm glad I got the meeting over with. Now I have the next 2 days to take it easy.

I read this story on another web site and wanted to share it. It touched me and I'm sure it will touch others. I hope it's ok to post it here...

The Patient I Failed

She knew what she wanted.

She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.

So, she wrote a living will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

"I wish nature to take its course, with only medication to prevent pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

Snake Bites and Pizza

Sun, 21 Sep 2008 00:20:03 GMT

Well, the flood situation is over at my hospital. We still have a lot of water, but none of it is on the roads. Hopefully this will never happen again. As if it wasn't enough that we had a monster tropical storm and flooding...that same week AHCA made a surprise visit. AHCA is the Agency for Health Care Administration. As a result - we have a mandatory nursing meeting type thing to review what we are doing wrong. It's a 4-hour meeting...ugh. I'm going to try to go tomorrow afternoon just to get it over with.

The patients that stand out this week for me are the ones that got bitten by snakes. One of them for some reason decided to adopt a rattlesnake he found during the recent flooding. Not only did he decide to adopt it, but he considered it his pet & would play with it. Huh??? Who plays with a rattlesnake??? With their bare hands??? This guy did & sure enough - he was bitten. Luckily he responded well to the treatment and was discharged home a few days after getting bit. I asked him if he planned on keeping the snake...........nope.

The second guy that was bitten....well, let's just say the only people I've seen bitten by snakes have been males. Hmmmm. This guy's children found the snake and this guy decided to try to pick it up. Apparently he did not know what kind of snake it was. The snake bit him on the left hand. What does he decide to do? Call 911? Seek help??? Nope, he tries to pick the snake up with his right hand. Guess what...bitten again. Sigh! Turns out it was a pygmy rattlesnake. He ended up killing it & bringing it to the hospital with him. Apparently he's going to be ok & hopefully he's learned to stop trying to pick up snakes with his bare hands.

On a different note, I had female patient the other night that asked me something no one has ever asked me before at the hospital. She rang her call light & asked to see her nurse immediately....me. It was 1 am and I had already spent the majority of my time in the room with her that evening as she was a very needy type patient. I had given her a sleeping pill earlier and was fully expecting her to get some sleep any time now. So I go in the room & she's sitting up in bed & says "I need pizza now." Ummm, excuse me? She says "I am craving pizza and I need some right now. Can you help me?" Huh??? I looked at the clock & it's 1 am. I told her I didn't think any pizza place would be open this late on a week day. She asked me if I could please call around and find out. I told her I really did not have the time to be calling restaurants, but she was welcome to call or look them up on the internet (she had her own laptop computer in the room). She was ready to start crying...not from pain, but from possibly not getting pizza when she wanted it. I really didn't think she'd find any place still open....but I was wrong. Domino's was open until 1:30 & sure enough - she ordered a pizza. I asked my charge nurse if that was ok...because I've never had a patient order pizza or any other delivery type food while they were in the hospital. She said "We can't stop her." I just had to laugh because of the situation. She got her pizza and was a happy camper after that. Yay!

I'm trying to like the other hospital I work at, but it's tough. There are a lot of similarities as far as charting, but the flow of the place is just very different than my usual hospital. The staff is much different too. I feel disorganized & I don't like that feeling. The team nursing is not really being done even though it's supposed to be. I don't like the team nursing. I prefer to have my own 4 or 5 patients and not have to worry about anyone or anything else. After 5 patients, I find that it's hard to retain any more info. For them to think we can take up to 12 patients and do quality nursing care...well, it's impossible. So the night shift nurses have been splitting the teams/assignments. We're not supposed to, but the charge nurse doesn't seem to mind. I'm sure it's only a matter of time before administration figures it out and either gets stricter or listens to the nursing staff and changes things.

I'm debating about trying another hospital. The downside is that the other hospitals are further away and more traffic which means I'd have to leave earlier to get there and take longer to get home. Plus I don't want to burn any bridges. For now I'll try to give this other hospital more of a chance. I've only been there 3 times...so I will make more of an effort to be comfortable there. All I can do is see what happens. I would like to get into a bigger hospital and get into an ICU training program. Perhaps I'll do that at the beginning of next year.

I'm off until Friday...unless I pick up some shifts. Well, I do have that meeting tomorrow. I think I'll enjoy having the rest of the week off.

Have a good weekend everyone!

Another Update

Wed, 27 Aug 2008 01:02:53 GMT

The storm is gone, but the damage is not. My house made it through just fine - there are some minor roof leaks, but I know the roof needs to be replaced soon. What isn't fine is all the flooding locally. I've lived in Florida for 28 years and have never seen the St. John's River overflowing like it is. It's usually way low in fact. It's kind of scary to think of what could happen if "all" that water comes pouring out.

My hospital is continuing to look like an island. There is nowhere to drain the water because the river is obviously at full capacity. I'm not kidding when I say in some parts of the property, the water is up as high as a stop sign. I've enclosed a picture so you can see just how bad it is. Look at how high the water is on the guy that is simply standing in the hospital parking lot.

I worked Sunday & Monday nights...it was pretty easy - went by so slow though. I was supposed to work tonight, but they were cancelling people due to overstaffing. I volunteered to be off as I did not get much sleep today. I keep wondering what all this water sitting around the hospital can do. I mean...can a sinkhole start because of it? Can the building collapse? It scares me because I know to some degree - anything is possible & nobody knows for sure.

It's 9 pm and I'm heading to bed. I need sleep....obviously.

Update = Still Raining

Sat, 23 Aug 2008 03:44:06 GMT

When will this rain stop? I am not kidding when I say it has not stopped raining in the last 48 hours. Roads are flooded, schools have been closed for the last 4 days, my yard is handling the water - but I do have a few leaks in the roof. I am thankful though - I did drive around town a little bit and there is a lot of flooding. I have never in my life seen anything like it. I mean you see it on tv around the country, but this is the first time I have seen with my own eyes - roads closed due to flooding. I am thankful that it's ok around my home.

I've heard conflicting reports regarding my hospital. The news was reporting that the first floor was flooded and patients needed to be moved to different floors or transferred to other hospitals. I haven't been to the hospital, but according to their emails, none of that is true. I guess I'll find out on Sunday when I return to work.

Speaking of work, I have finally had enough with shiftchange report taking on average an hour to two hours because dayshift is so unorganized. I communicated (nice word) my frustrations with my manager and director. It seems the manager took it to heart because an email was sent to everyone yesterday regarding shift change report and organization. I doubt that will do the trick, but at least they are aware of it.

I have to come up with another strategy to decrease the lenght of time it takes. I think I will start using the Kardexes as my report sheet - that way they will be filled in & up to date at least. I am pushing hard for them to bring back "voicecare"...which is basically where you record the patient's history, what they are there for, who the doctors are, etc and then an update as to anything pertinent going on. That's all I need to know. I feel like the dayshift nurses I deal with fluff up report with many details that I don't need to know. It wastes valuable time. I can only wish that one day evening shift change will be as smooth and calm as morning shift change. I absolutely hate getting out of report at 8:30 pm (when I start my shift at 6:45 pm)...and I have a discharge to do, a new admit is being brought up from the ER and my remaining patients are wanting their medications so they can go to bed - not to mention the orders missed, the orders that need to be clarified, dealing with pharmacy, dealing with the lab...ahhhhhhhhh....I just want a nice start to my shift.

Dayshift may say nightshift is easier because the patients are sleeping.....which isn't true.....but nightshift starts out like crap because of all the loose ends we have to tie up that didn't get done during the day. Ok, enough venting & I am not generalizing or stereotyping. We have some good dayshift nurses who are organized and know how to use time management to their advantage. We also have those dayshift nurses that are looking to milk the clock and waste valuable time. I'm sure we have some disorganized nightshift nurses also. All I'm asking is for a decent shiftchange report that doesn't take 90 minutes on 4 or 5 patients. That's not asking too much, is it?

Maybe that's my sign to try out some other aspect of nursing. There's not a whole lot to choose from at my hospital.....but other hospitals have different fields. Perhaps ER or Labor/Delivery would be worth venturing into. I'm sure all areas have their problems & I'll gripe about something........but I can't see it taking 90 minutes to get report.

My other gripe for the past week...I come in last Sunday evening and see that there are 4 isolation patients on the floor. Three of them have c-diff (nasty frequent diarrhea) and one is on respiratory isolation until they rule out menningitis. I think "Ok, there are 3 nurses tonight, surely they will divide up the c-differs between us."

Ummm...wrong. Guess who got ALL FOUR isolation patients......ME. I immediately began to investigate who the dayshift clinical leader was & why doesn't she like me? I think for a moment that I could complain about this assignment, but figure...nah, we have a patient care tech who will help me clean up my patients when they frequently go to the bathroom. Wrong...another patient on the floor became a Baker Act (patient is threatening to hurt themself or others) and they pulled our patient care tech to be a sitter for him. So I lost our tech for about 5 hours. Luckily they found someone else to come in & help out. It turned out to be an ok night. The next two nights were also ok.

Time to get some sleep - have a good weekend every one! Say a prayer that the rain lets up here in Florida!!!

Tropical Storm Fay

Thu, 21 Aug 2008 12:53:38 GMT

Ahhh, it's hurricane season again in Florida and we have a live one! Actually, it's just a tropical storm - so nowhere near the power of a hurricane, but it sure is making up for the rainfall we were lacking all year. I posted a pic of it - I'm near Daytona Beach. The storm seems to be swirling around & around and not really moving much. We've gotten a lot of rain, but luckily it's not flooding near my house. And there's no lightning - hopefully no tornadoes.

I worked Sun, Mon and Tuesday - those were the days they thought it would hit my area. I am so relieved to be off of work until this coming Sunday. I think I have some kind of education class tomorrow at the other hospital - but if it's continuing to rain like this, I'm not going anywhere. I hate driving in the rain, plus I need new tires. I'm glad I don't have to be anywhere the next few days. Just rest and relaxation. I'll update more later!

Did I Do the Right Thing?

Fri, 15 Aug 2008 07:23:42 GMT

I haven't done a good job at keeping up with my blog. Sorry! It seems like the older I get, the faster time goes by. Let's do some updates...

I started my new job at the other hospital. It's ok. It makes me appreciate my hospital. I'm not sure it's so much that my hospital is better, just different and what I'm used to. Not to mention the other hospital just started the team nursing concept and the staff there is not very enthusiastic about it. So I have only been there 2 days for orientation - which really isn't much of an orientation since they are not even sure what they are doing yet with this team nursing concept. I think I actually would prefer not being on orientation so that I can do my own thing without having someone checking up on me every hour. This is what I like about nursing - the independence. I don't want someone looking over my shoulder or secondguessing my choices. I am not shy about getting opinions if my patients needs require more than my own opinion...but I don't want someone telling me what I should or shouldn't be doing. Example...I had a patient at the other hospital that wanted an antacid....at 1 am. Sorry, I'm not calling and waking a doctor for an antacid - it just isn't happening. My "preceptor" wanted me to call. I'm not calling...nope, never. So she discussed this with our medication nurse (another person on the team) and they decided to give the 9 am dose of Prilosec. Fine - it's your decision, I'm not having any part of it. Not more than 30 seconds after they gave her Prilosec - she was asking for food. FOOD! Now did she really have indigestion? Did she really need medication at that point? I would have offered her ginger ale and crackers or something of that sort. I think they ended up giving her coffee and who knows what else. And to think they wanted me to wake a doctor over this. @@

I have to call tomorrow and let them know when I can work again. My main focus is my hospital, this other hospital will just be to fill in. It works - and it shows me that I do have the confidence it takes to make it somewhere else. It also helps that they use the same computer charting that we do.

I appreciate my co-workers even more now that I have spent a couple of nights with virtual strangers. I spend more time with my co-workers than anyone else (isn't that a sad fact?), although I doubt I'm the only one that does this. Seems like anyone with a 40 hr or more work week can say the same.

We had a code last week that was just plain sad. I'm still thinking about this gentleman and it's over a week later. I had him as a patient on a Sunday. I had been warned he loved the call light and used it non-stop. I was hoping he would get some sleep that night, but as it turns out, he felt miserable. Nauseous, constipated, dry mouth, uncomfortable, etc. He wasn't a big guy, but he did have a big belly and no matter how we situated him in bed, he didn't look comfortable - his belly just seemed to make it difficult for him to breathe. I believe he was in with congestive heart failure and respiratory failure. I offered to get him some nausea medicine and he turned me down. All night long he was calling and reporting how miserable he was feeling, but no matter what I offered - he didn't want it. After 12 hours of that, I informed my clinical leader that I did not want him back as a patient the next night. We are allowed to do that - to request not having the patient again. Monday night he did much of the same with the other nurse he got. By Tuesday night, he was in worse shape than ever. The pulmonologist came in around shift change and ordered for him to be transferred to ICU.

Right as the nurse was getting ready to move him in his bed to ICU...his heart rate dropped from 115 to 52. A code was called and although they managed to save him, it was only temporary - he passed away about 2 hours later. His family was able to get there before he passed, but there are no words to really comfort them. It stopped me in my tracks and made me reevaluate my decision to not want to be his nurse after the first night I had him. Does that make me a bad nurse? Or a bad person? I know I'm human and one can only take so much...but was it fair of me? Was I fair to him? I reflect back on the things he talked about to me that Sunday night - about how he was the one that usually took care of his wife and that he was afraid he wouldn't be able to do that anymore - that he would end up in a nursing home and who would care for her? I tried to be encouraging and tell him that he would get better and be able to return to her, but was that the right thing to say? Should I have said anything? Should I have simply encouraged him to talk more about it? I don't know that there is a right answer. I guess, like life, nursing has it's learning curve....live and learn. Try to do better next time. This is the hard part of nursing - the emotional side - the stuff you can't learn from a book.

I've been off of work since last Wednesday - it's been a nice break. I've enjoyed the Olympics - go USA! If there's one thing I've learned about the Olympics...it's that the Chinese women sure do like to put a lot of hair clips in their hair...lol. Am I the only one noticing this? Michael Phelps is amazing - he makes it look so easy. I love the Olympics!

Have a good weekend everyone!

It's official!

Thu, 17 Jul 2008 15:23:19 GMT

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.

My Second Code Blue

Sun, 06 Jul 2008 12:25:08 GMT

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!