Caffeine and Xanax

admit/discharge

2012-01-27T22:43:00.002-05:00

Today I admitted a rapid response patient from the floor. He was struggling for each breath, and decided he wanted to be intubated. He was a cancer patient, age 60, and had previously been a DNI/DNR. When they can't breathe, it's so scary many patients change their mind. As we were preparing to intubate, he told us that he did not want ACLS, compressions, defibrillation, etc if for some reason his heart couldn't take it.

I explained everything in a calm voice while chaos swirled around him. I told him we were going to put him to sleep and he wouldn't feel the breathing tube being put in. That he wouldn't remember it and would wake up later. But he didn't wake up later. Anesthesia intubated, he bradied down, dropped his pressure... we gave fluids, 1 of epi, and 200mcgs of phenyl. He lost his pulsed. We stopped. He was pronounced.

It doesn't usually happen like that in my unit. People usually come to us almost dead, or they slowly slip away throughout their stay with us. They aren't usually talking to us one minute, dead the next.

The daughter almost threw up when she came in, she was crying so hard.

My other patient's daughter said to me later, "I think I saw a dead body being wheeled out of here, oh my god that was horrible." I said, "yes, that was my patient from this morning. He didn't make it." Her jaw dropping, "How do you do this job?!?!?! I'm so glad I'm a teacher!"

by the way

2012-01-26T21:37:00.001-05:00

I just realized that I never mentioned that I passed my CCRN. With a terrible migraine, I might add. Wow, it's a hard exam. About half way through I started making guesses, because my head was pounding. It's a miracle that I passed, but I did. Damn, I must be smart! Heh heh...

I've been making some sweet overtime money, but I'm about to go on a four day stretch, which I haven't done since Thanksgiving, and man that was rough. I just go into it like a soldier going off to war. If I'm lucky, I'll stay at a friend's house near the hospital for optimal sleep time.

Yesterday, I was singled with a patient with a wound vac. The wound vac cannister was filling up hourly, she was weeping from everywhere, and leaking from her Dignicare (rectal tube). So, she was busy. But for some reason known to the charge nurse only, I was given a second patient at 3pm. I guess I didn't look busy enough with the one. The 2nd patient was also very busy. Bleeding out, in fact, with a case of refractory ITP that no one knows what to do with anymore. So JUST because she was a DNR/DNI, did NOT mean that she was comfort care! Which means she was still a lot of work because I was massively transfusing, using pressure bags for the blood products and fluids, just to keep her pressure up. Because of course it bottomed out, and the family started arguing about using pressors, and I had to stop the whole show and get the (still mentating) patient to make her own wishes known. She didn't want pressors. Which is fine, but that's actually MORE work for me, not less, because that meant 6 liters of fluids to pressurize into her lines. All the while delegating everything for my other patient to other very helpful co-workers.

Anyway. She stabilized but I don't know what ended up happening. All I know was that I got out a half hour late. And that annoys me. Also, the honey nut cheerios I finally opened, and had a mouthful of when her pressure tanked, were just a cupful of soggy mush when I finally got out of the room.

Just another example of a day in the life of a nurse like MOI!

Anyway.

a little bit about me

2011-11-17T19:55:00.000-05:00

I have had a fever of viral origin for over a week, continuously. This morning I woke up fever free, but found that I could not blink or close my left eye. I had a dentist appointment, and he found weakness of my cheek, eyelid, and lip muscles on the left side when grimacing, smiling, puckering, and squinting. I had no right-sided weakness on the rest of my body. My eye is very dry from not blinking, and I also discovered that I cannot taste anything on the top or left side of my tongue. What I can taste on the right side has a strong metallic aftertaste.

I'm lucky that it's mild enough that I don't look completely odd, I can still make facial expressions with just a bit of droop or stiffness on the left side. Such a mild case should be totally resolved in two weeks. I'm on an antibiotic in case an infected tooth nerve root led to the inflammation, but it was probably the virus with the high fevers.*update* A family friend just happens to be a facial paralysis specialist. She started me on a steroid burst and antiviral.

From The National Institute of Neurological Disorders and Stroke:
http://www.ninds.nih.gov/disorders/bells/detail_bells.htm

What is Bell's Palsy?

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to the facial nerves. Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. The facial nerve also transmits taste sensations from the tongue.

What Causes Bell's Palsy?

Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus—herpes simplex—causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the Fallopian canal and leading to ischemia (the restriction of blood and oxygen to the nerve cells). In some mild cases (where recovery is rapid), there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.

The disorder has also been associated with influenza or a flu-like illness, headaches, chronic middle ear infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma such as skull fracture or facial injury.

updates

2011-11-17T19:53:00.002-05:00

- My CCRN exam is set for the 28th of November.
- We ratified our nurse's contract. I think our show of numbers and solidarity really made a big difference.
- The virus I had with continuous fevers caused me to miss three days of work and ate up all my PTO. And I feel really, really out of sorts without going to work.

they don't make this easy

2011-11-13T14:28:00.002-05:00

I've had seasonal influenza for the past six days. I had to call of to work this weekend, that's 24 hours of paid time off. I'm supposed to work Monday as well, which is tomorrow. If I don't go, I will only have 4 hours of PTO left. In our institution, you absolutely CANNOT call off without enough PTO in your bank to cover you. So I'd be ok, but god forbid something else happen this month.

I have been feeling better, and would like to go back to work tomorrow (get me out of this house!!!), but I spiked a fever last night, again. And I know that I shouldn't be returning to work without it having been 24 hours fever-free. Which means if I don't spike a fever all night, I'd be fine. But if I did, it would be too late to call in!

And most importantly, I take care of patients who are severely immunocomprimised. It could kill them. I guess that settles the whole argument.

Isn't it sad that administration can put such fear into their employees for calling in, when it can be a life or death situation?

the good fight

2011-10-30T14:39:00.004-05:00

Soooo my nurse's union, part of National Nurses United, has been struggling to settle a contract with our administration. We've been picketing (not striking), marching, rallying, and showing up to every meeting and press release we can. The administration wanted to slash raises, double healthcare premiums, limit scheduling flexibility, ramp up disciplinary actions, take away healthcare coverage for those on extended childcare leave and disability leave,raising the age of retirement, and other unmentionable acts. They claimed that the current state of the economy leaves them no choice but to slash the nursing budget. And yet our health system has been making money and increasing bonuses and salaries to those at the top for the past three years.

Our bargaining team has announced that a tentative agreement has finally been reached. The administrative seems to have backed off of some of their demands... in response to nurses showing up in the THOUSANDS to protest! YAY nursing power! Yay to the little people! Yay to patients who have happy nurses who are proud of the work they do and the people they work for!

Will I vote yes on the ratified tentative contract? That remains to be seen.

raising the bar

2011-09-30T14:54:00.002-05:00

I'm going to take the CCRN... I paid the money, I've been studying (sort of), and I got my authorization to test in the mail. And then I lost it. So I am now trying to get a new one, even though the card said "DO NOT LOSE THIS NUMBER". Hopefully the receipt for the huge fee I paid to take it will be good enough to get another card.

By the way, I'm just a sucker for certifications. And tests. It makes me feel better about myself. It's just a test, doesn't make me a better nurse! But does provide a great learning opportunity. Oh, and I don't get paid more.

scared of the SICU

2011-03-27T23:38:00.002-05:00

MICU vs. SICU... is this a problem anywhere else?

MICU says... SICU nurses are uptight, snobby, picky, and generally assholes. This may be attributed to the fact that surgeons think they are gods, therefore SICU nurses think they are demi-gods.

SICU says... MICU nurses are too laid back, give too much fluid, deal with too much poop, and have patients who are generally too whiny, uninteresting, and die too often.

Yesterday I was super tired, so went downstairs for a cup of coffe with an extra shot. Went back up the elevator, got off, went around the corner into the unit. Noticed a new sign above the badge swipe-in. Then noticed that the lighting seemed different, and the blinds on the break-room window were closed. I stood there blinking and feeling disoriented. Then noticed that the people around me looked "uptight, snobby, picky" and busier than usual. Then noticed I didn't recognize a single one of them. OOPS, I walked into SICU, not MICU. Got off on the wrong floor. And I high-tailed it out of there. WHEW... that was a close call.

finding my talents

2011-02-02T23:54:00.002-05:00

I came to the ICU because the thought of sedated, intubated patients filled me with warm, fuzzy, relaxed feelings. I settled right in, turning my patients and giving meds without any arguments or cajoling or convincing on my part. Hey, this is the life, I thought. But after 8 months of mostly comatose patients, I was startled to find where my real talent (and passion) lies: interacting with families (and the occasional patient).

From an earlier note:
A patient I had recently, dying of cancer without treatment options, leaving a young son behind as an orphan, grabbed my hand and looked me in the eye at about 3am, and said to me, "Every moment of this life is precious. Live EVERY day as if it is your last." Those are a dying man's last words, and when I said thank you to him, he said "don't thank me, those words come from God". And I believe he may be right.

That was an awesome experience and reminded me of my old floor days, when I was always pre-selected to care for "especially difficult" patients and families. I think I did a good thing, even if all I did was listen and hold his hand. It was a unique gift to give.

I've also found another strongsuit of mine- helping families come to terms with choosing comfort care over continuing aggressive treatment, comforting family members during codes, explaining treatments and outcomes sensitively to overwhelmed family members, etc. For someone who wanted to get away from a lot of "people-interaction" by coming to the ICU, I've found that family-interaction is always the most rewarding part of my job!

Just the other day, a co-worker received a coding patient from the floor. Her very nice family waited nervously in the hall while we tried (and tried, and tried) to place a line so we could get a blood pressure. Pressors were maxed. Her family very appropriately changed her to a DNR. She was intubated, had a heartbeat, but no blood pressure that anyone could discern. The patient's daughter stood by anxiously (the rest of the family waited outside) so I went to her side and gave her a realistic, but sensitive, update. I immediately discerned that although she had wanted us to try, if our efforts weren't successful, she was ready to let her mother go. I was the one who pulled aside the senior resident, and said "the family is ready to discuss withdrawal".

The whole unit breathed a sigh of relief. The nurses and doctors had all been muttering under their breath about our wasted efforts, but no one had gone to the family members to give them a realistic picture of the patient's condition and assess them for their readiness to withdraw. The family chose to withdraw and extubate 20 minutes later. Both daughters cried and asked to hug me. She was not my patient, but I felt like the family members were all my patients.

Another man I admitted by jet (yes, I love our huge, rich hospital!) was being placed on ECMO after coding and maintaing a PO2 of 42 for more than 2 hours, without a blood pressure compatible with life. Although the surgeons refused to stop cannulating for ECMO (gotta love those surgeons, they just never give it up!), I went to the waiting room to talk to the family members, who I'd meant when he was admitted three nights ago. I knew he wasn't my patient anymore, but I felt the need to check on them. I brought tissues, and asked what additional questions they had at the moment. I explained what was going on at the moment. I only gave them the info they were ready to receive. I hugged the wife and then left. I hoped it made a small difference.

I also had a wife of a patient, who was a nurse, tell the other nurses that I was her favorite and a wonderful nurse. How sweet!

I'm moving to day shift, and I'm excited to have even more interaction with family members, and participate in rounds and plans of care in the morning. Oh, and finally having a normal sleeping schedule.

striking out and digging in

2010-11-08T20:35:00.002-05:00

The last few weeks saw me taking on patient's who were extremely difficult to handle- not medically, exactly, but emotionally. They demand your constant attention, they are uncomfortable and painful and miserable every second and there's nothing you can do about it. In one case, I had a patient crying out "I'm dying I'm dying" every few seconds (he later coded and died), and on another day I had a guy in 4 point leathers begging me to just let him go down to the police station.

Finally, on my first night of 4, I got every ICU nurse's dream patient: sedated, intubated, no talking, no struggling. It was a GOOD four nights.

Lately I'm having trouble more with my personal life at work. You see, I told a wee lie to my co-workers about my home life, because it was way easier than explaining the complicated situation I'm really in. Now the lie has gotten carried away, and I'm close to being found out. It's important to me to have good personal, or at least good working, relationships with my co-workers, because I had none of that at on my last floor, and I was bullied and treated like shit, causing me to cry every day at work. I want to come clean with my co-workers about what's really going on, but I don't know how. I'm ashamed of my white lies.

drawing the line on compassion?

2010-10-09T00:18:00.002-05:00

The other day I was taking care of an 82-year-old male who had been intubated for a couple of procedures and was quite agitated in the bed, requiring restraints. His son was very concerned and always stayed with him to comfort him and watch over his care. Everyone kept saying that the son was extremely annoying and high-maintenance, but as the ICU nurse who admitted the patient, I had no trouble with him at all and thought the patient was lucky to have such a caring and concerned son. I took him back a couple days later and was informed that he had been asked not to come in at night and his chair had been removed. The day nurse was annoyed with him, saying he "kept coming out of the room to ask questions".

This night, I allowed him to sit in the room all night if he wanted. I didn't want to undermine the other nurses, but he wasn't DOING ANYTHING WRONG. He sat quietly and asked an occasional question, as a family member should. He stepped out when I asked him to step out. He was grateful for everything I did. He did come find me once to inform me that his dad was very agitated again, and I appreciated it because the patient was in pain and uncomfortable and was unable to speak for himself, so I prefer to do something about it! The son was getting very teary-eyed, and trying to hide it, and said to me "please, don't leave me alone". He was sincerely upset and overwhelmed, and my job is not only to keep a patient alive and as comfortable as I can, but also to help the family members cope. So I was singled, doing nothing but watching Lost episodes on Hulu.com, and I pulled a mobile computer up to the room and sat just outside the doorway. It was an act of kindness that I had the time to perform, and I don't regret it.

However, the day shift nurse immediately says to the day charge nurse: "Look what she did! She put the chair back in the room! She sat outside the door!" So sue me. This was a family member who was not being inappropriate or interfering with care, and I chose to give him the comfort that other nurses presumably didn't have time to. I don't think that just because it's an ICU we have the right to treat family members as if they have absolutely NO rights to be there, to ask questions, or to express their concerns. The other nurses told me it's about "setting limits". I sometimes think those "limits" are really limiting our compassion and the other people we are supposed to be caring for- the family members.

What do you other ICU nurses think?

Mr. Grouchy Pants

2010-07-29T08:05:00.002-05:00

I admitted a patient from the floor in "respiratory distress". I was excited to get a hit, hoping it was something juicy, something challenging.

Well, challenging it was, but not in the way I had anticipated.

First of all, the patient in respiratory distress, was brought up on room air. Room air people! No trach mask, no nothing. His sats when we plopped a pulse ox on his finger? 76%. He recovered nicely to 96 though once we got his trach mask on. On 50% trach mask he was fine. He was fine alllll night long.

So besides not being appropriately sick enough for the ICU, our biggest problem was that he kept throwing his O2 and pulse ox off. He refused to wear them, even after threatening to be restrained, explaining the grissliness of a code (including cracked ribs). He wrote on his paper "leave me alone" and "this is a 3rd rate ICU". Meanwhile, the O2 mask he kept throwing on the floor left him satting somewhere around 75%. You know, if someone really doesn't want our most basic care, let him check himself out, right? I mean, he was totally with it (arguably, I suppose), and even wrote our names down along with our positions (he's a practicing attorney), I guess so he can sue us later for trying to save his life.

At the end of the night, I was SO DONE with this man. If you want to die, fine. Make yourself a DNR/DNI, we'll make you comfortable. Don't call us names, threaten to sue us, and just basically act like a total ass. Just sign yourself out AMA and get the hell out. I'm not going to bend over backwards anymore to be nice to someone who is so obviously a jerk.

night shift takes its toll

2010-07-24T09:26:00.002-05:00

For the first time, I got in trouble. The day shift nurse who took my patient made a list of complaints of things I didn't get done and submitted them to our supervisor. I got an email asking me why I "failed" to change expired tubing, ET tube tapes, and a bag of insulin that had expired. I have no excuse or good reason, either. I should've done all three things, and the honest truth is that I just forgot to check expiration dates all the way around. I told my supervisor exactly that, and that it will not happen again, I will add expiration dates to a list of reminders for myself on each shift. Maybe he will still write me up, I don't know. I feel horrible, like I should be sitting in the corner of the unit with a dunce cap on my head.

See, I always try really hard to do everything at night so that day shift doesn't have to: baths, IV dressings, tubing changes, new yaunkers, new feeding tube bags, new EVERYTHING with a new date. I take pride in handing patients over to the next shift completely caught up. This is seriously the first night I forgot to check tubing dates, and OF COURSE, a tattletale has to take the patient.

I'm just not a big fan of running straight to managers with complaints about other nurses. It was a huge problem on my last floor, and I didn't expect to see it here. I was hoping that if I made a mistake, my co-worker could talk to me about it first. I thought I would at least be given the benefit of the doubt... but I guess not.

I have been miserable on nights since my last post. Extremely tired, cranky, emotional... brought to tears many times by practically nothing. I feel sick when I leave. It's hard to concentrate and I feel like I'm moving around in a fog. I feel like it's hard to be a good nurse because I get so annoyed at little things. I'm glad I switched to ICU, but I don't LOVE my job like I thought I would.

Is it even possible to have a job you love?

that was good times!!!

2010-07-11T17:08:00.002-05:00

I'm on night shift now, and it's not as terrible as I thought. I had a crazy day when I was withdrawing on one patient (only 53, very sad) and he was quite difficult to sedate, the new interns don't know which orders to write and need hand-holding, and he wanted to die NOW. I asked him if he wanted me to put him to sleep, and he said yes. I didn't have orders for fentanyl or versed drips, so I kept pushing them plus ativan and morphine. While I waited for pharmacy to make me drips (after I insisted the docs write for them), I had to keep running in there and push more because he kept waking up. It was horrifying, really, because who would want to wake back up and see your loved ones all hovering around crying???

In the meantime, my other patient was in respiratory isolation way down at the other end of the hallway, and I couldn't really keep my eye on both of them at the same time. To make matters worse, this patient was very unstable, and I would get stuck in his room for long periods of time and couldn't tend to the grieving family or dying patient the way I wanted to. The unstable patient had a blood pressure that bounced around from 60s systolically up to 220 in a heartbeat. I was chasing my tail all night with pressors on, pressors off. I got very frustrated by the end because I kept thinking, am I doing something wrong?? But another nurse came and looked over everything and assured me I wasn't.

The last three nights I took care of one patient, mainly, who wasn't quite as exciting, except for one 5am episode when his trach site started gushing blood. Next thing we know we're getting blood in the vent tubing, blood out of his mouth, he's spewing huge clots across the room, everyone is covered in it. The surgeons who did the trach and anasthesia are all at the bedside, while we're bagging him, considering cutting him open right then and there! My co-worker, who was a godsend, was guiding me through it. She was like, oh we're doing surgery right here right now? Here's some propofol. No, just push it. Let's give him a bunch of versed while we're at it. More fentanyl. She gently nudged me in the right direction throughout the crisis and eventually the patient was whisked off to OR where they found.... nothing. But the bleeding stopped with no more events.

calling all angels

2010-06-27T13:16:00.003-05:00

Yesterday ended up being not so great. I worked with the family of my patient to help them realize that the future of their loved one included an extended period of time on the ventilator, 24 hour dialysis, and a poor prognosis anyway. They immediately decided he wouldn't have wanted that, and told us to withdraw. I went into the quiet room before they came back, and took away anything extra. The compression devices on his legs, the bair hugger keeping his temperature normal, turned off all the IV pumps except for his fentanyl, versed, and pressors. I arranged the spaghetti of tubes on his bed so they couldn't be easily seen. I turned up the rates of his sedation and pain meds, and I cut the restraints off of his wrists. I dressed him in a clean gown, put a clean blanket on him, and lowered the bed. I pulled the chairs up next to him and put the siderail down so the family could sit beside him if they wanted. I cleaned the rest of the room, put a tray of snacks and juice off to the side. I turned off the bedside monitor so they couldn't see his wave forms on the screen.

They came and told me they were ready. The respiratory therapist and I cut the tape that held his ET tube in place, and removed it. Then, I watched my hand turn off the IV pump running his levophed. They asked me repeatedly how long it would take? I told them we simply couldn't predict, but in our opinion not very long. A couple hours perhaps. I told his son, you can hold his hand if you want. He didn't.

I went out and sat at the nurses station, to watch the monitor. Without the levo, his blood pressure was 48/32 within 5 minutes. His O2 was 80% for a while, before falling to 70%, then 60%. His heart fought valiantly, before becoming brady, then asystole, then the purkinje fibers throwing their last struggling beats in at about 20-30 beats per minute. The daughter and granddaughter put on the light. I went in, and they said "he's gone isn't he?" They were sobbing. I explained that the doctor couldn't call it yet, because there was still a small amount of leftover electrical activity in his heart, but yes, he was gone. The daughter hugged me, and they left. There was no one in there. So I took his hand in mine. No one had touched him while he died, and I hummed "calling all angels" while his heart finally succumbed. And then I left.

Not only did I perform his post-mortem care after that, but a young woman down the way lost her battle with lymphoma earlier that morning. She passed around 8am, and the family didn't leave her side until about 1pm. I helped with her post-mortem care too. The nurse told me that she had suffered immensely, crying, whimpering, never comfortable, always in great pain. Her mother had held her in her arms every day and night. I looked at the face of this deceased woman, 31 years old... in death, her face had relaxed into a smile, yes a SMILE, of relief. I had never seen such a smile before.

The following song always reminds me of nursing, and how we have the honored but very overlooked position in society of helping people through death... either to wellness, or to the great beyond.

a man is placed upon the steps, a baby cries
and high above the church bells start to ring
and as the heaviness the body oh the heaviness settles in
somewhere you can hear a mother sing

then it's one foot then the other as you step out onto the road
how much weight? how much weight?
then it's how long? and how far?
and how many times before it's too late?

calling all angels
calling all angels
walk me through this one
don't leave me alone
calling all angels
calling all angels
we're cryin' and we're hurtin'
and we're not sure why...

and every day you gaze upon the sunset
with such love and intensity
it's almost...it's almost as if
if you could only crack the code
then you'd finally understand what this all means

but if you could...do you think you would
trade in all the pain and suffering?
ah, but then you'd miss
the beauty of the light upon this earth
and the sweetness of the leaving

calling all angels
calling all angels
walk me through this one
don't leave me alone
callin' all angels
callin' all angels
we're tryin'
we're hopin'
we're hurtin'
we're lovin'
we're cryin'
we're callin'
'cause we're not sure how this goes

I love when I love my job

2010-06-26T08:11:00.002-05:00

I've been sooo happy at work yesterday and today, because finally, FINALLY, I have a sick patient! I'm not a total weirdo... that's just what I came here to do, take care of patients who are in a life or death situation. Not patients who are ready to go home! This poor gentleman aspirated his own stomach contents during a GI procedure, which got him tubed. Good reason to take that pre-procedure NPO rule seriously folks! But now everything else is going downhill. He's on pressors, unable to tolerate tube feeds, and making no urine. I feel like I'm learning again and enjoying myself immensely. I feel like a real ICU nurse!

Today is my last day shift. I will go to nights on Tuesday. I feel kinda sad, because I feel that I've really built some good working relationships with the day nurses, the interns, and residents.

can I go back on orientation please?

2010-06-23T09:42:00.002-05:00

It's not that I feel I need more orientation. I don't need special help or more time adjusting. What I need is: INTERESTING PATIENTS. Since I've been off orientation, I have been bored stiff. Things that once excited me, like vented patients, art lines, blood gases... they do not excite me on the patients I have been given, easy patients, failure to weans or patients ready to be extubated. These patients are not sedated, they write on paper or mouth words to me (I am terrible at reading lips). Or they bang on their side rails with whatever they can find. Or press the call light 20 million times. Medically they aren't on the verge of coding or needing pressors or anything at all interesting. I've run out of things to google, people to call, appointments to make, things to eat, because I'm so damn bored. On the floor I had patients like this, but I had three of them. Now I have one of them, maybe two, and don't know what to do with myself.

Everyone keeps saying "oh be careful what you wish for" but I'm seriously trying to temp fate. Give me a learning opportunity! A juicy hit! A patient on pressors, paralytics, sedation! Something, anything. I'm in one of the most critical ICUs in the whole country, how can I possibly be this bored???

on my own

2010-06-10T20:22:00.002-05:00

I started out on Monday without a preceptor for the first time. I had a really easy assignment, a guy that we extubated and a sweet lady who was tubed but totally with it. The next day I had the easiest patient ever, who could've gone home. Finally at 3 I picked up a very sick patient, who immediately started desatting on me. We started turning up the peep and then cranking up the 02. She was too awake so I had to put her down farther, starting with fentanyl boluses and then I was thinking about hanging up the propofol again. When I double checked with another nurse, that's exactly what he would do! Yay, I was so excited! I was thinking the right way!

We'll just have to see what tomorrow brings.

the graveyard shift

2010-06-04T00:32:00.002-05:00

The last three nights have been midnight shifts for me. Talk about slow, and boring. I have been reading a book, surfing the web, trying to keep myself awake. Nothing happening. Nights are totally different from days, where I was so busy that 12 hours felt like 5 minutes. After a long night of just sitting around, I can barely drive home, my eyes are closing and my car is swerving. I feel like these can't possibly be the same patients that we have during the day! Everyone assures me that usually nights are very busy, but I've yet to see that. At about 6am docs and administration starts to arrive, the lights switch on, suddenly the place is hopping. But until that moment, it's dark and quiet, nurses sitting around with blankets wrapped around their shoulders, reading novels, eating, chatting on facebook. Doobey doobey doo.

Finishing up orientation

2010-05-29T20:10:00.002-05:00

I've been in a lot of classes, some interesting, some not. I've also had some very interesting patients. Like the patient who was brain dead but whom we couldn't 'pronounce' braindead because he was on 'innercool', a hose that brings his body temperature down to 33.0 celcius. I had a patient that we withdrew care on, and I got to watch her cardiac rhythm go from sinus to all sorts of arrhythmias to asystole. I do feel that for the most part I'm independent, and I have learned a million things and gotten SO much smarter in this short time. I'm going to nights for a week and then hopefully I'll be let loose to be on my own.

4th week ICU

2010-05-15T20:51:00.001-05:00

I'm definitely getting more comfortable on my new floor. There is still SO much I don't know, but it will be that way even when I'm off of orientation. I find myself now getting a bit annoyed with having a preceptor. I don't like anyone else adding things to "my" flowsheets, or I sometimes disagree with the way we are titrating the insulin, etc. I guess I'm a bit anal, and fit right in with the rest of the ICU nurses!

Last week I had classes, some interesting, some not. Most of what I got out of it was a sense of comeraderie with other ICU nurses, new and old, and a profound respect for the nurses who have been in it for decades. They are so amazing.

I have been having a lot of difficult discussions with family members about their dying loved ones. It's hard to know what to say to a family that is faced with the most difficult decision of their lives: when to pull the plug, or just stop life support. But as hard as it is, I find myself jumping right in and being willing to have that conversation with the family if they want to. They seem eager to talk to the nurse, to know our opinions, to share their feelings. I don't have the right way of explaining things down pat yet, but my preceptors are good at helping me out with ideas. I didn't realize what a huge part of ICU nursing it would be, dealing with grief and decision making with the family members.

This weekend I tried to relax, sleep in, and work on the yard. I do feel very proud of myself for advancing in my career and being willing to take the plunge into a totally new area in order to learn and grow in my profession. I feel like I am becoming a better nurse, even when it's hard. Add that to the small gardening projects around the house (I'm not a gardening person) and I feel more proud of myself than ever. It's nice to be able to give myself a pat on the back, when I feel so emotionally down.

2nd week ICU

2010-05-01T19:14:00.002-05:00

This week I felt pretty independent. Not that there wasn't a lot to learn, but for the most part I felt like I could've done a lot of it without a preceptor. I have to admit- I thought it would be harder than this. The vent and ABGs and pressors and paralytics are really the newest things... for the most part though, it's business as usual. I draw labs myself, and get bladder and central venous pressures, and bag people occasionally. But I had a CF patient that made me feel at home- always on the call light, and in pain. We ambulated her and I bagged her the whole time!

Today my patient had a 1 in 2 million rare lung disease called alveolar proteinosis. It can only be fixed with whole lung lavage. Only trouble is, he can't oxygenate well enough to undergo the procedure- so he is going to placed on ECMO and then they're going to try. This is a ground-breaking surgery, that's never been done on someone this sick, and that could only be performed in a very small handful of hospitals by only a few pulmonologists in the world. I got to listen in on the meeting with the family, and I felt like I was part of a discovery health special.

Of course, this lavage on ECMO crazy revolutionary procedure can't be done tomorrow, because the president is coming, and specialists are prohibited from performing intense procedures that may tie up precious resources... just in case Obama develops a chronic lung condition in a matter of hours!

4th day ICU

2010-04-22T21:04:00.000-05:00

I feel like I've learned so much more in the last 4 days than I have in a year on cardio-thoracic surgery. Today my patient from yesterday was doing worse than before, in every way. My preceptor left me alone for 5 minutes, and of course the patient's BP went from 105 systolic to 60. I got another nurse to help but told him to NEVER leave me alone again! All we did was bolus him fast but it all leaks out of his vascular system as quick as we could put it in. I mixed up levophed for the first time, just in case, but we didn't need it. I've never mixed up an IV med before.

I also did all of the charting and meds and organization of the day. The family was distraught because basically their dad/husband is going to die, and everything we're doing is just prolonging the fact. A half hour before I left, I checked a residual on the NG tube and got back blood. So we set up and did a gastric lavage. Oh, and nurses also place the dophoff tubes. So take that all you cardio-thoracic PAs who think you're so hot that no one else can drop a tube!

Toto, we're not in surgery anymore

2010-04-20T20:59:00.000-05:00

Cardio-thoracic: The doctor tells a PA what order to write. The PA writes it, and the patient asks the nurse "why?". The nurse asks the PA "why?" and the PA either ignores the question or rolls their eyes and says they're busy.

CCMU: The doctor makes a suggestion for plan of care. The nurse says "I don't that will work because...", the doctor says "oh yeah, that's true", the resident writes orders according to what the nurse dictates.

Cardio-thoracic: You need stat labs. STAT usually means between 1-2 hours, even though you've paged the floor phlebotomist, and the charge phlebotomist twice. You try to find someone on the floor who actually knows how to stick a patient. Respiratory therapy ends up taking pity on you and trying to help you.

CCMU: You need stat labs. You go to the draw, take out the syringe and tubes, and draw the labs from the art line. The respiratory therapist says, hey will you grab some blood gases too? And you do. Then you print the label, walk 8 steps to the lab, and drop the labeled tubes in their bucket. They hand deliver the results to you 10 minutes later.

Cardio-thoracic: The doctor's name is "Dr. Pagani". In two years, he has not made eye contact with you, addressed you in any way, and ignores any comment you might deign to make in his presence. When he walks down the hall, you are expected to move immediately out of his way, or risk the withering glares and cold shoulders of his PAs for the rest of the week.

CCMU: The doctor's name is "Jack". He sits at the desk with the nurses, making chit chat. He shakes the new orientee's hand and introduces himself. He asks the bedside nurse if she agrees with his plan. He is grateful for her input, even though she is directly contradicting him. He remarks on the high acuity of a patient given to the new orientee. He seems, um... human.

first day in the ICU

2010-04-19T20:56:00.000-05:00

I was given a room number and a time. I showed up in scrubs, with my chai tea latte, looked around and thought "why do none of these other people look like orientees?" OMG, they were all the staff nurses and we were doing report! This guy says "hey you're with me today" and then next thing I know I'm signed up for bed 4. There's my name, next to the patient's name, as IF I have one single clue what I'm supposed to do! I thought, well, it's time to just get up and walk out of here because I have made a BIG mistake and I'm not about to kill a patient today!

Luckily, the nurse educator happened to be staffing, so he sort of showed me some stuff, intro'd me to the unit, made me do some competencies online, introduced me to people, and I went to a staff meeting on sentinel events (which included pizza). Basically, all I learned to do was draw blood off an art line, and even that I managed to screw up the second time.

Vents? Totally puzzling to me. 8 pumps with 8 meds that have to be juggled, if one goes up the other goes down, how will I ever remember that??? CVP pressures, why are we doing this again? Oh god, what have I gotten into. I feel like I never went to nursing school for a day. I'm totally lost.

countdown to ICU continues

2010-04-06T10:21:00.002-05:00

My last few weeks on the only floor I've ever known as a nurse have not gone well. I have had one big confrontation with a busy-body co-worker, and 90% of the rest of the nurses pretend I don't exist.

For example, Saturday I took a post-op day 1 esophagectomy patient, whose attending happens to be my very favorite. I started at 3 with a dismal report- very low urine output, even after 1000ccs of bolus and maintenance fluid at 125 cc/hr. BPs super low, pain super high but couldn't do much because of the low BPs. Patient couldn't get out of bed as she was suppose to, and lungs sounds were crappy. I took the patient hoping it would be a challenge that might help prepare me a little for the ICU.

I was managing alright, even got the BPs to stabilize and the PCA and epidural back on, getting her pain down from 10/10 to 6/10. The family liked me and felt confident in me enough to go home for the night. I spent almost every second of my shift at her bedside, only dashing in and out of my two other (stable) patients' rooms, or delegating their meds to the two other nurses who were actually offering me help.

At about 8pm, respiratory showed up to do a breathing treatment. I'd been playing around with the pulse ox for about 45 minutes, warming up her hands, trying her ears, toes, etc. Respiratory tried to help me, and finally got an ok reading, 92% on 3L nasal cannula. BUT- in the process she went from A&O x3 to A&O x1. I was like, oh shit... what is happening??? Urine output for four hours was 25ccs. Resident on call wanted to bolus her AGAIN. I regret not saying NO way. I regret not turning all of her damn fluids off right then.

Suddenly, her sats started dropping. I stat paged respiratory. I told my charge and assistant charge nurse that I would need help with a driveline and meds because I could see this was not going to be good, and I got a great rolling of eyes from them and nothing but reluctance, so I just left. I was stat paging phlebotomy now for labs, and they weren't showing up. Respiratory and pain service were my only help at this point, and they started drawing ABGs and said they'd fill my other tubes for labs.

Now you have to realize, I've never drawn labs in my LIFE! I again went to the charge nurse, asked her for help, she refused, and I said "should I call RRT? (rapid response team" (Resident on call STILL wasn't there, patient now on a rebreather with 100% O2). She says "Call RRT just for labs Edith?" as if it were the stupidest question ever. I went back to respiratory, the supervisor was now there, and said "should I call RRT?" I'd paged the resident on call about a hundred times by now, respiratory said to call RRT, so I paged him one more time and said "If you can't make it now, I'll get RRT".

Guess what? He shows up one hour and 45 minutes after the crisis began, and said "Bed 14, nurse Michelle, call report." I went to the charge nurse and said "She's going to the unit". Her snotty response? "What? I can't even understand you." The other nurses around were listening now. I said, very slowly: My. Patient. Is. Going. To. The. Unit. Did you get that? Because our charge and ass charge didn't step foot in that room the entire time, and I never felt so on my own before.

Grrrr. Now my patient is on a vent with major hypervolemia. Her daughter saw me and hugged me and told me thank you, thank you but I felt like a fraud because I wish I had turned off the fluids. I left the unit with tears in my eyes.

watch out ICU world, here I come!

2010-03-05T16:47:00.002-05:00

So, I hatched a plan to get off of my floor at any cost, and Wednesday I interviewed in the CCMU (critical care medical unit). The sickest patients in the hospital, or for that matter, the whole region. Multi-organ failure, highest deathrate in the hospital, vents and bedside dialysis and drips to keep practically every body system functioning... you get the idea. And I have this crazy idea that the nurses there are super smart, smarter than practically anyone else in the whole hospital, and I would like to be one of them.

My interview went great and I met a few nurses on the floor who had great, sarcastic, somewhat morbid senses of humor (fabulous!) They were fascinated by the fact that I was switching from surgical to medical, and did I have any idea what I was getting myself in to? They said nothing would be more important than my critical thinking skills and getting the big picture. Gulp. On the other hand, they absolutely love their jobs and the few times someone has actually left, they usually come back. So I said, sign me up. This sounds like the adventure of a lifetime!

And then came the true test... will my manager let me go or not? I waited two days and just got the email, I start in the CCMU on April 18th! It's going to be a whole new ball of wax and I feel like I need to go back to nursing school first. Or maybe med school. They tell me it's going to change me not just as a nurse, but as a person. I guess that's true. It's not ever what I imagined I'd be doing (I grew up wanting desperately to become a midwife), but it sure sounds like one hell of a challenge, and I feel up to it! (And scared to death...)

More to come!

caffeine and xanax

2010-01-07T09:53:00.003-05:00

This is going to be the new title for my blog. At almost two years, I guess I'm not a "brand new" nurse anymore, just a relatively new one. I started my career on this cardio-thoracic surgical unit very excited and enthusiastic about my co-workers, my profession, and what I did every day. Now- not so much. I have lost faith in my co-workers, my trust in management has been completely smashed, and I find that I do not enjoy my patients either. I feel like a pill-pusher, an ice-fetcher, and a bed-maker. I'm so grateful just to hear a "thank you" once in a while. People say "well it's your job". No, actually, ordering tuna sandwiches and making sure you have not-too-much or not-too-little ice in your cup is NOT my job! But it has become my job, and it is very disasatisfying.

Management has turned into the "mistake" police. They make it extremely hard to relax when you finally get 10 minutes of downtime. Gotta look busy ALL the time, you know! People on other shifts will write you up for every little thing. If you're sucking up to management, life is good. If not, you're on the shit list and watch out!

So I tried to make a graceful exit to L&D, was offered an interview... and guess what? They can technically hold me at this shithole job until September 2010 because our floor downsized! So the whole time the boss has been telling us that if we don't like our job, leave.... but we can't leave. We are stuck. So what does she have on her hands? A bunch of stuck employees who want get the hell out of there and don't have a voice on the floor.

BS and more BS. I could go on, but I think you get the drift.

I'm not sticking my finger in there!

2009-12-18T00:26:00.003-05:00

I am currently enjoying a three day in a row break from work. I think it's the longest I've been off in one stretch since coming home. I love, love, love it. I have been there a lot lately, even curling up on the couch in a meditation room for a night. Then there were a few days with really horrible roads, where it took me two hours to get home.

I have had some interesting, and really sweet patients last week. Patients who hug me and tell their roommates that I'm the best nurse in the hospital. Flattery will get you everywhere with me! I heard another nurse mention that she had to digitally stimulate a colostomy q4 hours. I thought, thank god I don't have that patient, because I am just not going to stick my finger in there! Plus, he kept asking the night nurse to "finger him". And who do you think I ended up with the next morning? Same guy. And the first order of business that day was to explain to him that it was almost time for him to go home, and if he needed to stimulate his colostomy (which was 5 years old by the way, not a new thing!) he could do that himself, with a glove. Then I had to empty his colostomy bag which was full of completely formed stool, and doing it reminded me of squeezing frosting out of a tube. So gross. I hate ostomies, especially colostomies, with a passion.

fate is making all the decisions

2009-12-14T21:17:00.002-05:00

After returning from Nepal, I found it very difficult to care for our patient population. Grown-ups who whine and complain about the amount of ice in their cups, the hardness (or softness) of the beds, the kind of foods on their plates, the medicine that's saving their lives is constipating them, the pain from surgery is too much... etc etc. I found myself wishing more and more for intubated, ventilated, sedated patients. I look at these people and think, you came to us for medical help. YOUR choice to have the procedure, to come to this facility. It's not the Hilton. We're not here to make sure you eat delicious food and sleep comfortable and undisturbed. We are going to poke you and prod you and wake you up every hour, we're going to serve mediocre food, the beds might not be top-notch in comfortability, but they do flatten in 3 seconds so we can do CPR and save your ass.

So I applied to every job I could in the hospital, and still haven't heard from anyone. No one. Nada. I guess it's not meant to be, but surely I'm not meant to play waitress for the rest of my life?

Working in the field!

2009-11-08T18:35:00.002-05:00

I finally got to carry out one of my lifelong nursing dreams... do a service trek and serve rural communities! Of course, I did it in Nepal, where I speak the language, and so had the added experience of being a translator, which I loved. Now I'm hoping to lead a group every year to the clinic we worked at, and start to make a little progress in the area. I loved it there, the community of Sherpas was wonderful. Nursing there was more like being a doctor, though. I diagnosed and treated just using my own brain and the rest of my team. I was terrified at the thought, at first, but after a while I got kind of used to it.

We had some severe cases, like an infant suffering from hydrocephaly, looked like it was going to die soon. We had a guy with a GI obstruction, most likely, a woman who swallowed something sharp when she was drunk, and a woman coughing up blood with TB-like symptoms. But mostly we saw a lot of GERD, aches and pains, babies with diarrhea, dehydrated adults, and wounds and skin infections. The clinic could use a lot of training with the workers, more reference books and drug books, and some programs on ergonomic lifting, hygiene, and birth control.

I'm excited to really be a leader and take group after group. It's totally my niche in life!

In other work-related news, my love affair with cardio-thoracic surgical tele unit is over. I no longer click with management or my co-workers, and I'm a little bit bored with the patients, too. I think it's time to move on, and re-stimulate my brain again. I applied to the baby NICU, L&D, and visiting nurses. I haven't heard anything back, so we'll see what happens. I want more experiences so that I can be a better clinic nurse in Nepal!

reconfiguration

2009-08-29T20:35:00.002-05:00

I nearly lost my position in the "unit reconfiguration" that is taking place. They are taking beds from our unit, the cardio-thoracic surgical stepdown, and beds from next-door neurosurgery, and creating a middle unit for otolaryngology and plastics. The positions on all floors were bid on by seniority, and by the hair of my chinny-chin-chin I managed to grab the very last day/eves spot! I would've cried. Not a single cardio-thoracic nurse volunteered to become a plastics/oto nurse. No thank YOU. This whole split cause us to lose some fantastic nurses, and was just unfair and unpopular all around. Everyone had a stomachache, for weeks.

So it is back to business on my unit of choice. I'm ecstatic even if it means being lowest in seniority. But hey- I wanted to work Christmas anyway. Triple time here I come!

patient stalkers

2009-08-03T20:15:00.002-05:00

I took care of a very difficult patient, or should I say a patient with a very difficult family, for two 12 hour days. I bent over backwards to keep the family from going over the edge, and to keep from calling security (as the night shift had done). I went out of my way to deliver on all kinds of bizarre requests, and tiptoed around their ever-changing moods. I was exhausted by the end of those two days, but I was also tired because the family stalked me around floor, trying to convince me to join a Jewish group and go to Israel. I told them several times that I wasn't Jewish, but they didn't believe me. The stalking got out of control, to the point where if I left the conference room they would be standing outside of it, waiting for me.

I spent the next two days at work under an alias, at the opposite side and end of the hall, because they were looking for me. I think I did really good work with them, considering how hostile they were to the rest of the hospital staff, and I'm glad that they liked and trusted me. I also got much closer to the PAs on the cardiac surgery team, and one even gave me a hug at the end of the day and told me I did good work. Still, I'm more than relieved that they'll be gone the next time I go back!

that's what it's all about

2009-06-24T19:24:00.003-05:00

I made a bond with a patient we shall call T. Patient T came in for an esophagectomy and removal of the stomach. He has been through three J tube placements, and last week, on one of my days with him, he developed a huge leak around the 3rd tube, as he had with the first two. Large amounts of tube-feed BM seeping out and all over his skin. He was miserable. I was miserable. It was a Sunday and the thoracic surgery team was being manned by everyone's LEAST favorite resident. I was upset by their response but I didn't know what to do about it, either.

In the afternoon, the leak progressed to a constant gushing of acidic fluid and BM. I went upstairs to the GI floor and got ostomy supplies, and attached an ostomy bag around his tube's insertion site. For this I was pronounced a hero by his wife. Patient T texted his whole family to tell them that for the first time all day, he wasn't covered in goop. It was a victory for everyone, but it also allowed me to measure the output, which up until now the team had been pooh-poohing. His tube feeds were stopped, a dophoff tube was surgically placed, and he is now being evaluated for a small bowel obstruction. ALL of which I had suggested in the morning!

I have grown close to him and his family during the weeks he's spent here. Even though he wasn't my patient yesterday, I stopped in and did a cervical dressing change for him. I know that this is why I went into nursing- the ability to really play a major role in someone's healthcare, in the way they get through their day.

pulling the plug

2009-06-18T12:54:00.003-05:00

Life on my unit has been relatively uneventful. Just the usual requests from constipated patients to just "reach up there and get that piece out" (ewwwww) and cute little old ladies with inguinal hernias that pop out at random times.

The other night, however, I was selected to take care of a patient who has decided to turn off his own LVAD and die naturally. He has been a favorite and a regular on our floor for the last four years, and many nurses were shedding tears over the news. I had not taken care of him much, so I was a good pick because I wasn't sobbing every time I passed by, but it was still very sad. I do enjoy palliative care patients, because I like to think that I had a hand in making their deaths more comfortable and dignifying. I would consider working for Hospice or a palliative care team at some point in my career.

As far as going to grad school, I always thought that I would get a year or two of nursing experience and then immediately go for it, but after just one year of nursing I realize that becoming an NP at this point would only limit me. There is so much out there for nurses, there's L&D, emergency medicine, geriatrics, ICUs... a lot to do and learn and experience. So for now, plans for grad school have been put in the "someday" bracket, to be revisited at a much later time.

good nurse, bad nurse

2009-05-18T08:58:00.002-05:00

I got banned from a patient's room, by the patient. She had mental status changes, and was being just goofy... so the service asked me to get a urine sample for a drug screen. She went into the bathroom for a long time, and then I heard her flushing, flushing, flushing. I was getting concerned that she was trying to flush something down the toilet, so I knocked and poked my head in, said "are you ok?" She flipped out, told me I was very rude for opening the door, and that she didn't want to "call the authorities" but she would if she had to.

From then on, she wouldn't let me in the room and I had to have other nurses go in and do her meds. She complained about me to everyone who went in there. The first time she yelled at me I felt like crying. I need some thicker skin, I know. I'm just used to patients really liking me, and not used to dealing with people who aren't at least somewhat polite.

Needless to say, I gave her up to someone else.

the grim reaper

2009-04-29T11:31:00.002-05:00

Yesterday I was taking care of a healthy looking 58-year-old man just diagnosed with terminal lung cancer. Supposedly, the service had already told his wife about this. She asked me, suddenly, how many stages to cancer are there? Without thinking, I said "four". She about collapsed into my arms. I held her while she sobbed into my shirt. I had no idea what to say, what to do. I tried my best. She went over to him and hugged him and said she loved him so much. I had to get out of there. Later, the team came in and told her she should take him home, there's nothing more to be done. I had to step out of the room lest I burst into tears, too.

See, I work on a floor where we usually send people home, healthier than they were before. I haven't built up a very thick skin for this kind of stuff.

The charge nurse bought me a cookie. Cookies do help.

houston we have a problem

2009-04-16T10:44:00.002-05:00

They are taking some of our beds to form a new unit full of yucky services like oto and plastics. We will go from 48 beds to 36. This is horrible, horrible news because it means our group of nurses will splinter and scatter to the wind. We are a great group that works well together. We are notorious for having the best teamwork in the hospital. Now many of us will be put in a position where we are forced to choose between working on a different unit or finding a job elsewhere, or even switching shifts.

This is terrible. People were in tears. And the kicker is that they are doing it because we complained about having off-services. Actually, we complained that we were taking off-services when cardiac patients were ready to come to the floor. BASTARDS.

good news on the floor!

2009-04-13T10:35:00.002-05:00

One of our patients is a fairly young guy (in his 50s) who has been here for 55 days with heart failure, a heartmate (left ventricular assist device), and kidney failure. He was not going to be discharged until he got a kidney and heart transplant. So he was just sitting around every day on top of the transplant list, waiting for a donor to pop up. We took a long walk the other day and he told me all about how he felt perfectly healthy until 10 years ago, and then he was diagnosed with CHF, although he was asymptomatic. He developed a 3rd degree block, and was implanted with a pacemaker, only the small hospital who implanted him put in the wrong kind, which only exacerbated his heart failure. Since then he has had two LVADs and one RVAD and his kidneys have gone into failure.

The day before yesterday his AICD fired several times when he went into sustained VTach. He spent the whole evening scared to death of it happening again.

Yesterday the big news came... a heart and kidneys were on their way! He was wheeled off to OR with this stunned look on his face. I hope he's doing alright. Everyone on the floor is so excited for him!

opportunities for overtime

2009-04-07T16:03:00.003-05:00

The nursing world continues on... I have friends now that make work enjoyable, and with whom I can talk about work stuff. Nothing thrilling has happened as far as patient care, nothing noteable, except that I've continued to have nursing students who all seem to like me a lot. It's really gratifying to help others grow in nursing and see how excited they are with what they did at the end of the day. I still remember what it was like to be a nursing student, and I try to be the preceptor I never had but wished for!

The other day was horrible, when three of my patients were off the floor and all came back at the same time. I had a migraine, too. It was a nightmare. I ended up leaving at 7 but made up for it with 16 hours of overtime ever since! In a place where jobs are hard to find for most, I'm really grateful for a job where I can work extra pretty much every week, and get paid nicely for it!

from admit to discharge

2009-03-06T12:42:00.002-05:00

The patient I'd taken care of for 8 days was finally discharged to hospice yesterday. It's a rare thing to have someone for more than one day on our floor, let alone 8. I hope that I had some impact on getting the family to understand her desire to be comfortable in her last days and to stop fighting a losing battle. I hope I was able to convey kindness and compassion to her in her last days. That's what being a nurse is all about, afterall.

I actually had three patients whose families loved me and thanked me every day for being there with them and for helping the medical team to hear and recognize their individual concerns. I learned a lot about being a patient advocate and helping someone to either heal, live, or die with dignity.

knocking on death's door

2009-03-01T09:30:00.003-05:00

On the first day of four days in a row, when choosing my patients I skimmed the list for the oldest patients up for grabs, per my usual habit. I ended up caring for an 81-year-old stage IV cancer with mets patient who's husband of 64 years had passed away three weeks prior. Over the four days I cared for her, I watched her go from adamantly insisting she be a full code, to begging me to knock her out and let her die. Yesterday I pulled the daughter aside and offered to refer them to palliative care. She didn't seem open to the idea. I called the primary oncology physician who told me she'd "already had this discussion with the family". I said I knew that, but today things were different and per the patient's wishes she should probably reassess. The other children came in later and spoke with the physician about their desire to comply with their mother's wishes and allow her to be comfortable in her final days.

I stepped into the conference room as all the kids started to cry. I felt an obligation to be someone strong in their presence. I fought hard to get this patient morphine from a resident, and then sat with her holding her hand and asking her to tell me about her trips to Europe, to take her mind off of the pain. The morphine didn't work and her begging to be shot and knocked out bothered me a lot. I was grateful that her family members arrived and understood that she was ready to go.

I also had a patient a few days back who came to the psych ER with panic attacks, but because of "chest pain" had to be ruled out for an MI per protocol. It was ruled out, and then some asshole of a doc on cardiology service didn't want to give him ativan, so as punishment for the patient ordered it q4 hours IM. I told him I wasn't going to give it IM when he had a working IV and could swallow pills. I gave it IV and continued to page this guy to change the order. Eventually, he did. I know what it's like to have panic attacks, and I'll be damned if I'm going to stab the patient in the ass just because some prick of a new MD thinks he's drug-seeking ativan because he's never had a panic attack before.

Two words: Patient advocacy.

high times

2009-02-21T17:03:00.002-05:00

I had some learning experiences at the beginning of this week. On Tuesday I had a patient who's BP bottomed out. I had to get our Rapid Response team to come, and we had a hell of a time getting the service there. In the end, he went to the unit. The rapid response nurse was awesome, made we want to work in the unit just to get a better handle on things.

I thought no day could've been worse than that, but the next day was. I had a THE patient who developed a leak in her cervical incision, and also threw a fit and refused to cooperate with me when I told her we needed a new IV. Then there was a different patient who appealed her discharge, and I had to get patient relations and social work involved. I requested out of that team and had a calm, relaxing two work days after that. Patient's who are nice, cooperative, and stable. Ahhh.

I'm most excited about getting together on March 7th with my trek nurses. I can't wait to see the group dynamic and get everyone excited about Nepal.

escape artists

2009-02-16T08:51:00.002-05:00

On my second twelve in a row, I had a patient with declining mental status and hepatic cirrhosis. He was also a 'code brown-er' (meaning poo, and lots of it!). But just as nice as could be. I'd requested a sitter but no one was available until 3:00. He had yanked out his IV and his Foley bag was full of blood. I would have to keep a close eye on this one. I asked a tech to take him for a walk while I discharged someone else. I came straight back from the discharge to check on him... not in his room. The tech said he'd left him there a half hour ago. His tele monitor wasn't picking up, meaning he'd left the floor. He'd removed his brief (diaper), which meant somewhere in the hospital was a confused 47-year-old in a gown with his bare butt hanging out the back, a walker with a big 'ole 'Property of Hospital' sign on it, and a telemetry monitor to boot.

I called security while the techs searched the floor. I felt like a big dope calling the physicians and saying "I lost the patient". He was found outside of the hospital, starting down the road, in the snow, in his little hospital footies. His feet were like blocks of ice. I felt like a parent saying "Where were you? I was worried SICK!"

Needless to say, I got a sitter.

Ah, adventures!

gift upon gift

2009-02-09T14:09:00.002-05:00

I think I would actually like to do home health nursing for a while. My mother did it when I was growing up, and I think I would like it. I will stay where I'm at until the two year mark, I think, but then we'll see. I do know one thing- before I go anywhere else, I'm taking time off and traveling! To Nepal of course, but I will do a few other things, too, while I'm at it. Bangkok, Lhasa, India... I'm in dream world, but I can't help it. I feel so trapped in this nursing job. I can't take time off without pay no matter what I do.

I got a starbucks gift card from a patient I only had for a few hours before sending her to OR. She and her family really liked me, I think because I was in a funny mood that morning. People like to laugh, right?

My french-speaking patient's grandson-in-law wanted me to come over for dinner. But when I got there hours went by and dinner still wasn't ready, and I had to leave. I wanted to do good by this patient as far as lowering his sugar, but I don't want to become too entangled in the family. I've done that before and it's not good for anyone. I am still "the nurse" and I am there for one reason only. I have to keep reminding them and myself of that.

I got several nominations from patients who filled out a form, basically a kudos award. You don't really get anything for it but a certificate, but it looks good in your file. And it makes me feel good.

I believe

2009-02-02T20:52:00.002-05:00

I believe I will remember this patient for the rest of my life. I believe that I am doing the right thing, even if I'm breaking the rules.

Today I called the outpatient clinic and scheduled an appointment and interpreter for the French-speaking patient I mentioned in the last post. Then I called the house, without response. After work I drove out to the address listed in the patient's file. It was in the poorest area on the outskirts of a small but diverse university town. The apartment complex was crowded in next to the freeway, and almost every apartment had plywood for windows, except for the patient's. The apartment was being rented by his granddaughter, with whom he is staying, as well as her husband (I assume) and four small children.

I was greeted at the door by a shy but friendly five-year-old and an 18-month-old (by my estimate) wearing a dirty shirt and a diaper. She put her arms up and clamored to be picked up, so I did. The granddaughter, her husband (or who I assume to be her husband), and the patient all came out and hugged me, kissed me, shook my hand, and hugged me some more. I was offered a seat on the couch where the small toddler sat contentedly on my lap and drooled away. I made small talk in my very limited French, and in English with the little girl who told me her name and that she went to kindergarten. There was a basinet set up in the livingroom, where the seven-week-old baby sleeps during the day. The little girl brought me a bottled water.

The patient appeared healthy and well, much to my relief. He told me via the grandson-in-law, the only English speaker in the house, besides the kindergartner. His blood sugars had remained in the mid to upper 200s. A look of worry passed over the young man's face when I said that the patient had an appointment tomorrow afternoon. I then asked, quickly "can I pick him up at 12:30?" He responded with a huge smile and translated for the patient. After a few more minutes, I told them I had to go, but would be back the next day. "Demain!" I said in French, reaching to shake the patient's hand. "Demain!" He exclaimed, and gave me a big hug and a very French pecks on each cheek.

This family is the essence of goodness, I feel. And I wonder what took me so long to realize that this is my calling. These people live in our backyards, people with no one to look after them. People who are sent home from hospitals as lost causes. People who open their doors with complete trust, hoping against hope that in this hard country where everyone lives behind locked doors, and no one speaks to their own neighbors, that a good person will show up and do the right thing.

It's not just me, either. Over the past few days, I found nurses on my own floor who told me stories of dropping by an elderly patient's house a few days after her discharge, to check her wounds. Nurses who invited patients living nearby to come to their apartment to learn how to use their glucometer. I felt extremely proud of them. Going out on a limb, risking your own neck, sweeping aside rules set up by big business and beaurocracy in the name of good, that gives me hope. Our humanity gives me hope.

health disparites enrage me

2009-01-29T10:04:00.004-05:00

Here is a copy of the email I wrote to the nurse educators on our floor about the patient I took care of yesterday:

Hi [nurse educators],
I would like to pass along the plight of a patient who was recently discharged from our floor. Because you are a nurse I very much respect, I thought I would share his story. This gentleman is 66 years old, a military official from Guinea, Africa, recently arrived in the US to visit his daughter and grandchildren. He collapsed in their home and was brought [here] by EMS. Unable to afford missing work, and caring for four young children, his family did not accompany him to the ER and did not arrive until the next day. He speaks no English, and required a French translator for all communication.

The patient was found to have a blood sugar greater than 500. He was re-hydrated and put on a sliding scale and intermediate acting insulin for meal coverage. Even this did not control his blood sugar, he still had chemsticks consistently in the 200-300s. He told us via interpreter that he took insulin in his home country of Guinea, but did not know what kind, and had not brought it with him to the US because he "felt fine".

His service was Medicine Newburgh, and they decided to discharge him the same day, but had to wait for family members to arrive before he could go. I took care of him both days. When his granddaughter arrived to take him home, she also spoke so little English that she required an interpreter as well. I paged social services and the MN service to come in and talk with her and the patient. The resident came in and told the patient that he could go home now. He did not mention to the patient that he would require insulin injections and frequent blood glucose monitoring. He did not explain to the patient what diabetes was or its consequences. After the physician left the room, I asked him about patient teaching. I was told that it "didn't matter", he was going to "end up in the ER again anyway". His discharge paperwork included prescriptions for a glucometer, insulin syringes, and novolin insulin to be taken 10 units BID.

I brought our glucometer, and insulin to the patient's room and with the interpreter present, I spent more than an hour and a half discussing and demonstrating how to check the blood sugar, what is normal and what is not, what to do if sugar is very low, or very high, what symptoms he might expect, to test and write down his glucose levels four times a day, how to draw up insulin, where to inject it, what to do if he misses a meal, the importance of eating consistently and a healthy diet... etc. I taught everything I'd ever learned and remembered about diabetic care. The patient and his granddaughter are very intelligent, he demonstrated back to me how to check his sugar and inject insulin correctly on his first try, and they both asked intelligent questions. I gave them written materials in French. I could tell that they were very concerned about money, and social work was working with them on temporary insurance. I sent them down to our pharmacy with the interpreter.

The patient is supposed to have a follow-up in the clinic within one week. I asked the physician for the name of his clinic nurse, so I could let her know ahead of time to speak slowly and clearly when scheduling an appointment with the family. I was told that he has "no clinic nurse". I worry that the patient will not receive an appointment time, or that he will not understand instructions on the phone. I also know that the insulin coverage he will administer to himself will not adequately control his blood sugar, and the long-term consequences will be devastating. I am disgusted with the care he received from the MN service, and wonder how it might have been different if he had had insurance, or had a been a white English speaker. The way I see it, those patients who face the great challenge of communicating across a language barrier, or who are unfortunate enough not to have insurance, ought to be given extra attention the best care that we are able to give, not simply sent home as though we do not care what happens to them just because they have no money, or don't speak English.

I have discussed this case with [our nurse manager]. I know that disparities in healthcare for minorities exist, but was shocked to see it playing out right under our noses on [our unit].

Thanks for reading.

language lessons

2009-01-27T19:13:00.002-05:00

I had a patient today who spoke no English, only French. His family was not around, so I spent the better part of my day trying to remember high school French. I did ok... I guess. The interpreter came for the important stuff. My friend had a guy down the hall who only speaks Hindi... I did much better interpreting for him. I just love the fact that we are a hospital in such a diverse area, with so many beautiful cultures and languages flowing around us. It's refreshing.

So my Pod, or the section of our unit that I'm assigned to, has been nicknamed 'The Pod of Death'. Our acuity level is sky-high, with a ton of off-service total care patients. All these broken bones, and ostomies, and seizures... they need to go! We want CABGs, esophagectomies, and lung biopsies! This is other stuff is just... crap. And we're working like slaves.

what a day, what a day

2009-01-24T19:38:00.002-05:00

I never knew it was possible to do a 12 hour shift like I just did. Two discharges before 11, two admits before one. My first experience with a foley irrigation system, and a fresh esophagectomy who yanked his NG tube out 10 minutes before I was supposed to go home. Coffee, coffee, more coffee, and not enough time to pee.

My feet flew all over those halls, the hour hand on the clock was spinning out of control, but in the end I had a couple of satisfied patients, I think. At least, I'd like to think it made some difference.

knock me down a few pegs

2009-01-22T10:00:00.002-05:00

My manager was extremely impressed with my email from the previously mentioned world-famous surgeon who paged me with a kudos. She even showed it to my supervisor. After my stellar weekend, though, I took a patient with a fistula-turned-ostomy that kept leaking. The resident came and did the dressing change when it leaked, much to my relief. But an hour later, it leaked again. I've never changed an ostomy bag, especially one this complicated, and had to scramble to find someone to help me. I found someone and we got it done... in about 45 minutes, dressed in extremely stifling plastic gowns because the patient was VRE precautions.

Still, the patient was very grateful and wanted to fill out a 'You're super' for me (patients can fill these out and we get a certificate and a pin each quarter if we receive one).

I think I have my team for the Nepal trek. I'm hoping for permission to take a total of four nurses, including myself, from day shift, and at least one from night shift. I also have three nurses from other units.

The inauguration of our new president brought hospital staff together... I bonded with the transporter over our mutual excitement. Usually, they don't even talk with us nurses. I think it's been an amazing experience, and so many african americans have been talking with everyone now, instead of just with each other. It's made me happy that we are uniting like this, and crossing racial lines.

getting things done

2009-01-20T18:50:00.002-05:00

I worked three days in a row, without switching patients. I find this the be the best way to move a patient's progress forward, consistency in nursing that leads to follow-through. I think it gets a nurse fired up to see improvement the day after she put in a lot of hard work. At least, it does me. I had some arguments with interns and residents, and really stood on my own two feet as a patient advocate and equal member of the health care team. I was proud of myself, proud of the flower that my patient gave me, proud of the message from our best surgeon that said 'Good Job!' on my pager, and proud of way I handled a particularly difficult patient, one that no other nurse could stand.

I am thinking about doing a self-defense program for the nurses on my unit. Not now, but later.

my unit, my ball and chain

2009-01-15T02:14:00.002-05:00

I'm frustrated. As interested as regular nurses seem to be in doing a service trek, management (especially senior management) is not that excited. Well, we've never done it before so I guess it's to be expected. We will just have to will it into being, without any extra support. Maybe when we do it again, it'll be different.

I feel very tied down in this job, the schedule is so rigid and I know that it has to be, to maintain order with such a large collection of employees. Still, it's stifling.

It's still amazing to sign my name with RN, BSN after it.

ambitious projects afoot

2009-01-06T19:30:00.002-05:00

Yesterday was a long, tiring, yet worthwhile day at work. Near the end of my 12 hour shift, I had a patient wheezing loudly and desatting rapidly. Respiratory was paged, without response. The supervisor was paged. No response. 20 minutes later they showed up to give this guy his albuterol treatment. I was fuming mad. Only a few minutes later, I gave a scheduled dose of IV metoprolol to 73-year-old patient with a HR of 77. Less than a minute later, she was bradying down to 42. I stat paged our assistant charge, and then paged her service. She was asymptomatic so I wasn't panicking, just concerned. Everything worked out fine with both patients.

I spent much of the day working out the details of our unit trek to Nepal this coming fall. Springing the idea on my supervisor was nerve-wracking. She seemed cautious and I hope the idea will grow on her. We will be able to put a lot more in stone when the holiday schedule and vacation schedule comes out.

Today I met with the program coordinator for the Alzheimer's and Dementia certificate program at my alma mater. She was ready to sign me up for classes right then and there! Unfortunately, financial and time arrangements prevented that. I am hoping to get started right away and can't help but feel SO excited about it. Just working towards another academic goal thrills me to death.

mandated, schmandated

2009-01-01T11:53:00.000-05:00

It's not cool that they mandated me off on my ONLY holiday. I'm pretty sure it's an issue because I was already mandated in September. Totally didn't follow the rules on that one. I wanted the money, dammit!

nurse-patient relationships (and the ambiguous line)

2008-12-17T14:57:00.003-05:00

I had a patient going in and out of afib yesterday. When she was out of afib she was generally bradycardic (in the 50s), however this was quite dependent on her positioning. When lying in bed, she would get down to the 40s, when walking she would be up in the 70s. Cardiac consult came in and ordered a dig load and an increase in her beta-blockers. I was looking at her heartrate (53 at the time) and thinking NO WAY am I giving a digoxin LOAD and a beta-blocker! I clarified this with them, they wanted it given. I discussed it with the charge nurse. I ended up giving the dig load first, and having her stand/walk for about an hour after. Her heartrate stayed over 60. I gave the beta-blocker several hours later, and she again brady'd down to the upper 40s, but was asymptomatic. I had her get up, she was in the upper 60s. Craziness!

So that was my first experience with Afib (and with hesitating to follow a medication order). But another issue arose when it turned out that the patient and I got along very well. We chatted a lot and found out that we knew a lot of the same people. But I felt the eyes of the other nurses on me every time I was sitting down and talking with her. I did not neglect my other patients nor did I reveal any information about anyone else to her. But I felt the pressure of carrying on as a professional at the same time I was becoming someone's friend. Where is that ambiguous line drawn? She wanted to give me her email and I did feel ambivelant about that, too. When is it ok, if ever, to develop a friendship with a patient? Is it ever ok to continue a friendship after the professional relationship ends? I suppose this is left somewhat up to individual judgment. I just did the best I could.

I had to re-evaluate my loan payments. There is no way I could make the monthly payment they were requesting... I am going down to 4% of my monthly income. Tough break! Maybe I should go back to school so I can defer...

debt and trouble, trouble and debt

2008-12-15T23:49:00.002-05:00

I was a float nurse during our nursing check-offs for LVADs. I covered the other nurses and worked my ASS off for the hour or so that I had their patients. I walked them, cleaned them, passed meds, tried to make them feel like things were finished when they came back. And I got recognition for it which rocked. Also got in trouble twice, once for no gown in a contact precautions room (I wasn't touching the patient!), and once for a chest tube becoming disconnected from suction. Actually, the charge nurse and I had a good laugh about all of the really ridiculous things people were throwing fits about that day!

I went to an EKG class that rocked my socks. It was 12-lead interpretation, and it lasted all day. But I feel about 10x smarter!

Then I felt about 100x dumber when I made a stupid, potentially dangerous calculation error at work. It scared the hell out of me. I guess that's what will make me a better nurse, in the end, making mistakes... you just have to hope you catch them before it hurts someone.

michigan's economy coming down on nurses

2008-11-29T14:20:00.003-05:00

I guess I never dreamed that the economy was going to affect my job. I'm a nurse, right? Everyone told me that no matter what happened, I'd always have job security. Maybe they were right, but maybe they're wrong.

This month the hospital's census has decreased dramatically. Michigan families don't have health insurance because of lost jobs, and Michigan families aren't going to the doctor or the hospital. So many nurses have been called off of work at the children's hospital that they are scrambling to find them temporary positions at the main hospital. They have promised that nurses will be the last employees laid off.

Last week, out of 36 hours, I was cancelled 20. This week, I've only worked 24. As much as I love to sleep in, I love paying the bills more. I have used up a lot of PTO time and been mandated off. The union is trying to figure out how to give nurses all the hours in their appointments.

Let's hope the Big 3 pull through. Let's hope people are scared to go to the hospital and they soon feel better enough about finances to come in. Let's hope the Obama administration can pull of something in the way of health insurance for the unemployed.

Or the nursing shortage is already a thing of the past, at least in this area.

into the frying pan

2008-11-11T15:59:00.004-05:00

Today I overheard another nurse talking about a seminar on Advanced EKG interpretation. I mentioned that I would love to go to it, and she said "you want to go advanced EKG? Shouldn't you do a regular one first?" Hells no, she did not just say I'm not knowledgeable enough on interpreting EKGs to attend the seminar! I registered for it an hour later. See you there, biotch.

The LVAD guy came to our conference room for an inservice. He told the whole roomful of nurses that if they had any questions, this young lady (pointing to me) was excellent. Same nurse said "oh really? She knew that much?" So there.

A patient of mine today was put on comfort care only. The family flew in, and everyone was standing around with tears and lots of questions. I felt very inadequate but tried to show my compassion. What else could I do?

blind leading the blind

2008-10-23T09:44:00.003-05:00

Yesterday I was given a student again. The instructor told me that the students really like me. She said they identify with me, but also, I'm good. I was flattered. I think having a student is a big help, and it's fun to show them new things.

A few days ago I had a elderly patient whose 60-year-old daughter was at outside in the hall, looking teary-eyed. When I asked if she was alright, she told me that her partner of 31 years, who recently passed away, spent some of her last days on this floor and it was terribly difficult for her to be there. She didn't know I was gay, but I decided to let her know by the end of my day. When she prepared to leave, I pulled her aside and said "I think you are incredibly lucky to have spent 31 years with a woman you love. I hope I find a woman to spend so many years with like that." She gave me the biggest hug and thank you.

I also experienced things from a patient's point-of-view when I went into the ER one morning with a terrible migraine. The gown, the IV, the wristband... it felt like a bad dream. Next thing you know, a nurse is going to come in and say "hey hey, time to get you washed up!" Yikes! They gave me compazine and toradol, my headache got better but I slept for 24 hours but fitfully. I don't think I'll go in for a headache again. My BP bottomed out and I had to be bolused with 2 liters. Man I peed constantly for days!

My grandma was recently in a nearby hospital, smaller of course. The nursing care was horrendous, or should I say, nonexistent. The nurse-to-patient ratio there is 1:8, for starters, and neither my grandma or her roommate, who needed a lot more help, were offered washcloths, walks, or even a drink of water. The food was late or the tray was wrong or nothing came at all. Meds were either skipped or given only at my existence. Before she went in, she had heartburn. After coming in, she had a BP in the 70s, she was over-anticoagulated, had restless legs because they didn't give her her medication, and because no one helped her to the bathroom, she was terribly embarrassed that she'd had an accident. What a crock of shite! In my hospital, where a lot real shit is flying around, that shit would never fly!

feeling exposed

2008-10-11T16:23:00.003-05:00

Things have gotten a little hairy at work. I was made two mistakes- Y-ing two incompatible meds, and not watching someone swallow their narcs. I also got a call yesterday at 7:20 asking where I was. They said I was written in for overtime- I think not. I didn't sign up for no stinkin' overtime! Wednesday at work I got blood in my eye while discontinuing an IV, and had to go through the whole shibang of reporting a body substance exposure. Luckily, the guy is clean.

I hope the coming month is better. I hope to make less mistakes, and I hope I can try harder not to be so hard on myself when I do.

see it, do it, teach it

2008-09-26T16:15:00.001-05:00

I forgot to mention that I had a nursing student put with me last week. Talk about the blind leading the blind. But I told her she could see what it's like to be a new nurse. She really ended up helping me out because one of my 'easier' patients started going down the tube and while I was trying to figure out why suction wasn't working for his brand new NG tube, she and her instructor took care of my other patients.

I figured out yesterday that I make up to $37 per hour for overtime, which definitely is an incentive for me to stay over another 4 hours after an 8 hour shift. I did that yesterday, but had an ill-timed visit from Aunt Flo right at the end, and needed the help of a couple co-workers to fetch me new pants and give my last meds. I love my co-workers!

old nurses speak out, new nurse speaks up

2008-09-20T15:37:00.002-05:00

I attended my grandmother's nursing reunion today. I discovered a sort of animosity for new nurses hidden under all of those flowered shirts and trifocal glasses. One by one they stood up and bemoaned the current state of the nursing profession, with the fact that we no longer wear white uniforms topping the list of reasons that we, as a profession, have trotted too far off the beaten path for professional redemption. Nursing is not respected. And certainly won't be as long as you aren't traipsing around with white uniforms and huge, wing-ed hats.

I had to disagree. I may be new, but I'm also a lot closer to remembering the pride I felt the first time I held my license in my hand, the first time I introduced myself as a nurse, the first time I scribbled RN after my name. I was proud, not just because I passed a test, but because I was a nurse, and my whole life I, along with everyone else I knew, held nurses up with great esteem. I was one of the them. Nursing is very respected to day, which is why I chose to go in this direction. I've never met a patient or their family who didn't think our jobs were important and hard. I've never met a person who didn't say 'wow' when I state what my profession is. I've never heard (yet) a physician or PA say 'what do you know'. In fact, they consistently ask me for my opinion, for my knowledge, for my take on everything.

I'm sorry that older nurses can't see that. I'm sorry that they have been made bitter by their experiences as nurses and as patients. I'm sorry that they feel good nursing care cannot be given without a white uniform and hat. I'm sorry that they feel like nurses only like to sit around and gossip, rather than bathe their patients or turn them or whatever. I was like, no... we do all of these things, still. Oh you should've heard the groans around the room when I said we don't lift our own patients! What is nursing coming to, after all? Well, I don't have time to find 4 other nurses to strain and huff and puff with me, nor do I want to injure myself. I make sure it gets done and I oversee the process. That's the beautiful thing about nursing today, I'm not just a grunt worker. I'm a professional, with decisions to make. I'm not there to haul patients up by their draw sheets every two hours. But I will make sure it happens.

In other news, I had a patient for four days with trisomy 9-q, a 33 year old with the mental capacity of an 18-month-old. I had some long, trying days, let me tell you. The parents came in the first day and ripped me up and down for everything under the sun. I listened, calmly. Let them vent. Then I addressed every single concern they had and followed up with it the next day. I felt the importance of that next day weigh down upon me walking into the building that morning. I had made some promises, and I had to deliver. When I was able to locate a speech therapist, arrange a swallow study, and bring in PT all in the same morning, completely bypassing the medical service, I was thrilled with myself. This is nursing!

high times

2008-09-13T12:55:00.002-05:00

I've had several good days at work, after my return from a long weekend off. My first day back was only four hours, and amazingly, they didn't need me to stay another four. That day was also an "ice cream social" for employees. Another nurse and I went down in the middle of our shift to check it out. They had a ton of ice cream, good ice cream, with all the toppings. It was delicious. They had a lot of other booths and fun stuff, like a booth where money flies around and you have 30 seconds to catch it. The news was there, filming.

Yesterday most of the nurses tried out my brand new electronic stethescope. It's an ADC, cost about $150, and miracle of miracles: I can hear! It amplifies the sound and zooms in on it, it's a million times better than regular stethoscopes. I think it went on everyone's christmas list.

what you get for being BORED

2008-09-03T14:50:00.003-05:00

Monday night I was bored. I had two patients who didn't need much of anything. I took it for granted. I thought in my head 'this SUCKS. I'm not learning, I'm not challenged.'

So we all know what's going to happen, as soon as you start thinking that way. Tuesday I came in, and my admit came rolling through the door before I was done with report. Not a good way to start. I had to untangle two chest tubes, the oxygen, the SCDs, the IV lines, the PCA and epidural and get them all on a pole, which got me behind to start out with.

Then another patient, an adult failure to thrive post-gastrectomy, needed albumin. He was supposed to have a PICC line placed in radiology while his dophoff tube was being placed, but they sent him back up without putting it in. Now guess what, he has no IV access because his peripheral had stopped working. He was supposed to go back down at 2:30. At 3:30, he still hadn't gone. At 4:30, I started trying to figure it out. I got on the phone with the vascular access team, who said they had nothing to do with it and don't put in STAT PICCs. I talked to his SGI service (his docs), who told me to call radiology. Radiology said he wasn't on their list. I told them, I'm staring at the order right now, how is it that you don't see it? Sorry, was all they said, we can't do it. Re-submit the order. So I resubmit the order. Still nothing, they say they don't have time.

By this time I'd given up on the PICC. I decided to just go with a STAT peripheral for the time being. I page the STAT vascular team. They don't show up. I page out to the floor and get two people on our unit to try. They have a hard time because both of the guys arms are so swollen, they are third-spacing and weeping and he's dry as a bone. Finally, vascular access shows up. The first guy has no luck. The second woman who comes brings an ultrasound, and she can't get it with that. By this time, it's 10pm. I tell service, sorry, no go. What do you want to do? Charge nurse is saying that an MD has to do it. I can see that the MDs aren't going for that. We're basically just SOL until morning when they do the PICC.

While all of this is happening, I'm frantically trying to do my vitals, because my tech? She apparently didn't feel the need to do anything last night. I try to get meds out at least an hour after they're due. I have to restart this guy's tube feeds, and there is no order to use the dophoff. Finally I say, fuck it, he's got no IV access and he needs pain meds, so I use the dophoff, which luckily didn't become an issue later. Now he's got to get this aluminum gunk down the dophoff and it keeps clogging it, but luckily I get it all in and flushed.

My first patient, the new admit, keeps calling for little things and is being whiny. I simply don't have time to be a waitress that day. I have a tech page lift team to boost her up in bed. My friend K, a new nurse, went to help me and oversee lift team. The guy from lift team is a total jerk and says he won't boost her because she's going to slide right down. K tells the tech she'll take care of, to leave me alone because I'm busy. The tech runs right into the med room, with the lift team guy behind her, and both of them stand there telling me they aren't going to boost the patient. All of the other nurses in the med room are just staring at them, and looking at me in disbelief. We've never had issues like this with lift team. Yeah, she's going to slide down again, eventually, just do your fucking job and BOOST her UP! But the guy continues to give me attitude, and we all tell him to get out then and forget it.

Meanwhile, a million other things are flying at me and I feel tears come to my eyes. I'm hungry, tired, and way behind. I don't want to cry though. By the way, I have a third patient who has an LVAD that's not working properly and I haven't given her any attention. Her docs are also trying to find me, so is pain service who wants me to order toradol for my first patient. I have call backs waiting for me and docs who are pissed that I'm not standing by the phone. It all gets very overwhelming and I'm still pissed about lift team.

The end of the night does not let up. My LVAD patient needs two units of fresh frozen plasma. I ruin the first bag they send because I don't clamp the saline, and the whole thing has to be re-done. The other nurses are so nice to me about it though, they tell me they also ruined their first bag. The patient is nice too, luckily. She has been teary all day because she wasn't expecting to need her LVAD replaced, and I feel bad that I have no time to give her any emotional support. My no-IV-access patient has been nauseous, and I basically have to tell him, nicely, to deal with it because we can't give him nausea meds. We asked service about something IM, but they said no.

My last 45 minutes I do all of the stuff no one else would probably bother to do on this kind of day. I post my strips (which I usually do first on my shift), I do my SOAP notes, my care plans, the admit's paperwork. I review my charting. The only thing I didn't do that day was read my patients' histories and labs. I hate that I couldn't do that. I have a headache, my feet ache, and I want to go home.

I guess I did as well as anyone could have, under the circumstances, but if every day was like this one, I'd quit.

day in, day out

2008-09-01T09:54:00.000-05:00

I wake up at 6am. It's my fifth day in a row, out of seven. Second twelve hour shift. My work clothes are in the dryer but I still tear the dresser apart looking for another shirt. Sometimes I eat cereal before I go, sometimes I use the milk at work and eat it after report. Once, I tripped on the bottom step on the way to my car, and tore a hole in my pants. At 7, I'm trying to figure out if my assignment is ok, and usually I just say "ok whatever, I'll take it". Now I'm thinking about a cup of coffee, if I can get one off the patient cart, or if I'll try to make some myself. Sometimes it's ok, sometimes I burn it. I don't know how I do that, because I do it the same way every time. I just push "start brew" and sometimes it burns. What a mystery.

I post my strips, I do my assessments, I dole out pills, I fill out care plans, I get walks and baths finished. It's usually nine or ten when I sit down to chart. But no one else is there. Am I just fast? Or am I forgetting something? I answer my lights. I read my patients' histories and labs. I think about more coffee. The rest of the day is meds, walks, and damage control.

Report is when it all comes clear. Did I really tke care of everything? Make things easier on the next nurse? When I get home my feet are achy, despite the ted hose and extra support in my expensive walking shoes. I sometimes still smell c-diff stool. I take off my clothes first thing, but I'm too tired to shower. I feel too tired to eat, but I usually do. I try to stay awake for a while, for Saba's sake. But sleep comes easy, after days like this. I don't need to take anything, or stay up reading long.

I got to sleep in today, ahhh the joy.

work was never so easy (dot dot dot)

2008-09-01T08:58:00.003-05:00

A few of my coworkers had some stressful days, but mine were pretty easy. I tried to help by answering lights, walking their patients, getting vitals, buying them bagels, etc. Still, I felt like I wasn't really sharing an equal workload.

I have worked far too many days in a row, and it's starting to feel like home there, a home I don't exactly want to live in but don't really mind, either. There's coffee, afterall, and $1 cookies from downstairs. That's something.

Someone from work just called and said 'can you bring your camera? We are all wearing pigtails today and want to take a picture!'

battling headaches, battle on!

2008-08-27T16:56:00.002-05:00

I continue to try to find my niche on my unit and among my peers. I also continue to learn and grow with every patient I take. Today I had two Trans-hiatal esophagectomy (THE) patients. They are a specialty on our floor as well as in our hospital. They kept me hopping today, along with a post-op CABG admit from the ICU.

I battled a migraine all day, and I was happy to be only 8 hours.

sooner or later

2008-08-21T16:08:00.002-05:00

I had had too many good days, and my confidence was too high. Last night, with not much reason for it, I felt incompetent. I guess it might have had something to do with the code.

An older man recovering from an aortic dissection repair suddenly became bradycardic, and then went into asystole. The code was called. It lasted a half hour before they called it. Then the nurse came out, looked right at one of us who was standing there, burst into tears and said "it's all my fault". Then she ran off.

I felt like crying, too. That could've been me. That can be me anytime. I wanted to go check on my patients, assure myself that they were alive.

My report to the night shift was disorganized and incomplete. It made me feel like a failure, incompetent, a poser. And deep down, it was the code and the tears, and the knowledge that when or if it is me, I would have nothing to offer, and no way to help.

training the residents

2008-08-20T13:06:00.002-05:00

It's been pretty calm at work the last few days- with the exception of some chest pain from a rule out MI patient, which resolved itself with one nitro. I had this nightmare the night before, about a patient who went into v-tach, I pressed the code button, and only a few students came to help me and they had no idea what to do. That was the dream. At work, my R/O MI patient says he's having chest pressure and left arm pain, and suddenly throwing PVCs every which way. I got a bit panicky, but soon I was focused and fine.

Yesterday I had a patient who choked on some chicken, went sky-high tachy, desatted, and who was on an off service who came and said if his BP drops, we're going to shock him. We're going to what??? Sure, his tachy rhythm might be mistaken for Afib, from a distance, but after showing the strip to a few more experienced nurses, the concensus was just tachy. Not to mention, the patient already has a pacemaker and AICD! I was like, uh, excuse me boys? Let's not shock the patient, ok? He's going to be just fine. They looked up at me and said 'ok... well, we're still going to do an EKG and troponins'. Cool, go for it. Then the real physician came over later, and cancelled all that crap. What a day!

The balance beam final came on RIGHT at 11, when I had to give report. I beelined it back to the break room and everyone said "You missed Shawn Johnson!" Shit. But when she won, I was jumping up and down, and everyone was laughing and saying 'get her an ativan!'

Another fun fact- there are blue pads all the way across my couch at home now, just in case my cat pees on it again.

psych nursing 101

2008-08-17T12:01:00.002-05:00

I had three mentally ill patients yesterday. One of them had a trach, which she managed to pull out, and kept biting me and the sitter. That was a scary moment, when I came in the room and that trach was sitting in her lap. I couldn't figure out the obturator, so I put it back in without it. Luckily, it went back in easily. I spent the majority of the day giving the patient lectures about biting and trying not to threaten her with restraints.

My other crazy patient escaped from the hospital in the morning. She had a sitter, who was let go right after, and took off. She was located later outside of the ER.

My third patient I have had for a while. He refuses to move. Refuses to get out of bed, turn, reposition himself, etc. So I enlisted the help of PT for that particular lecture, and it worked. He sat up in a chair for about 45 minutes out of the 12 hours.

I never felt overwhelmed though, I always felt I was on top of things. And we had NO techs. I feel pretty good about it all, although I'm hoping for a better lineup next time.

a gold medal day

2008-08-15T14:58:00.003-05:00

If nursing was an olympic sport, I think I would've given one of my best performances yesterday. I took four patients, something we rarely do on our unit. With my eye on the clock (I didn't want to miss women's gymnastics), I had everything done by 10. Everything being- meds, patient walks, insulin, care plans, SOAP notes, charting, dressing changes, etc.

It felt like I just stuck a difficult landing.

learning on the spot

2008-08-14T10:53:00.002-05:00

Yesterday was another good learning day. I got to hang blood by myself, for the first time. I was busy, busy, busy. No one can say that nurses don't earn every penny we get, it just kept coming and coming. I had a discharge and an admit. Admits are way easier with the MAR online, though.

Tonight is the women's all-around final on the olympics, and I will have to find an empty room to sneak into to watch.

I have to admit that I feel a little lonely at work now. I don't really have any friends, just a couple but our schedules are hard to match up. I hope it changes but I'll just be as friendly as possible to everyone until then.

my many skills

2008-08-13T10:50:00.002-05:00

Yesterday was my first day back after four days off. Actually, I was supposed to go in Monday, but when I got there, I wasn't on the schedule. Their mistake. But they sent me home, they were all set. Then, 45 minutes later, when I was already back in my pajamas, they called me back and said 'uh, can you come back?' Uh, no.

Anyway, I took on the hardest patient there was. I figured, what the hey, no better way to get back into things than to jump in head first. But she wasn't bad at all. I got trach experience, so that was good.

The highlight of my night came when one of the techs came to me and asked me to come translate for a patient down the hall who doesn't speak English. She speaks Hindi. I said no way, my Hindi is nowhere near that good! But he convinced me, and I managed it, and I was sooooo freakin' high! That rocked.

growing up and out

2008-08-08T11:10:00.002-05:00

My first day off of orientation was Sunday. It was a strange feeling, but also such a feeling of pride in myself. My first two days on my own were uneventful. I felt as if my head was held high, as if something inside of me was standing taller every day. I have never felt such a sense of accomplishment, such satisfaction with myself.

My third day brought all the learning experiences I could ask for, including a plugged J-tube, a THE leak, and a patient returning fresh from cath lab. I learned to use hot water, coke, and above all, muscle for the J-tube. I learned to wash it off and jam it back into the hole when it falls out. I learned how to do dressing changes for the leak, by having the patient swallow water while I use a Yaunker to suction it out. I learned how to hold the leak closed while the patient eats. I learned the standard orders for a patient post-cath lab, to take vitals every 30 minutes x2, then every hour x4, checking the pedal and tibial pulses, ambulating the patient 4 hours after sheath removal, and checking the groin site. I overheard a patient's wife saying, as if just realizing, 'Edith is a good nurse!' and felt my heart swell.

The next day, I was called at 11:30 and asked to come in and be assistant charge. What a sense of self-importance I had as I changed out of my pajamas and into my compression stockings! How I walked into that building, as if I alone could do the job, as if I had not just happened to be the only RN they could find to do it!

I was given the A/B side pager (it alerts us to dysrhthmias from the monitors) and instructed to take our brand new Dura Heart patient down to X-ray. This is the first patient to receive a Dura Heart, the fourth and newest LVAD, implanted for the first time by our very own cardiac surgeon. It's magnetic pump reduces damage to red blood cells, reducing the need for anti-coagulation. It has the potential to replace heart transplants, it lasts so long. Our first patient is doing fine, and we're all feeling a sense of pride at having him on our floor.

I took patients at 3. I had two aortic dissection patients, one pre-op, one post-op, and in my spare time I educated myself on the diagnosis and the surgical repairs. I also went up to 5 to visit my friend D, on her first day off of orientation on the ortho-trauma unit. We talk excitedly about our successes and our 'learning experiences', the ups and downs of our floors, our co-workers, our hours. We have been together through nursing school, through every step of our new careers.

The other orientees that started with me did not get off of orientation early. Last night was supposed to be their last night, but one orientee has not done so well. I feel bad for him, but the secret smugness I feel inside at having done better than someone else shames me. I feel like he has not had all of the learning opportunities that I had during my orientation, either, and this has only hurt him more. I wish him every success.

welcome to 4BC

2008-07-30T07:41:00.003-05:00

I got a taste of a nurse's life on 4BC for real yesterday. 12 hours of nothing but running. My new preceptor let me take care of everything on my own, which was good, but daaaamn. My patients were coming and going all day, pharmacy was screwing everything up, service was complaining, I was giving amio boluses and mag boluses... stat orders coming out of my ears. I managed two have time for two small cups of coffee and a frozen lunch. Otherwise, I was running all over the damn place.

Oh but it's good.

on shaky legs

2008-07-26T12:33:00.003-05:00

I got new preceptors... again. But it turned out to be kind of a good thing, because the one who I was dreading working with most, she let me go pretty much on my own and had some really good ideas for me. I had a meeting with the educator, who had only good things to say about me. I will be off of orientation on August 4th. Hoo-rah!

I have overheard some of the night preceptors complaining about their orientees. I am surprsised that none of the people I started with are doing anything on their own yet! I mean, seriously? I guess I don't know everything about them, though. I'm just surprised.

ready to be on my own... or not

2008-07-19T15:32:00.002-05:00

My preceptors say I'm doing great and I'll be ready to be on my own soon. Thursday evening really put that to the test. My preceptor needed to run downstairs for 15 minutes, and I was alone with my 3 patients for a while. In that time, I gave Morphine IV push, I talked to service on my own, and I sent a patient down to X-Ray with the SWAT team. I was sweating, and nervous, and suddenly I really felt my newness, even though I tried to cover up for it.

I think I did ok, though, and it was good experience. I've never been so nervous about giving Morphine in my life, though!

I've also done a driveline dressing on my own twice, now, and I'm feeling good about that.

dreams come true

2008-07-14T10:55:00.002-05:00

I passed. My results went up yesterday afternoon. It was an amazing feeling, to see that tiny little word: 'pass'. Tears nearly came to my eyes. Everyone was saying 'congratulations! But we knew it already'. The pressure was enormous, thank god I lived up to it.

I started signing my name with 'RN' right away. Then I stood there, grinning stupidly at it. It looks awesome. Someday soon I'll take it for granted, but I just want to sign 'RN' all over the place right now.

I just have to wait for them to post my license number on the website so that my nurse educators can give me a password to take out meds. I feel like I'll finally be a trusted and equal member of the team. I have been so lucky to find my unit, where all of the nurses are so close and comfortable with each other, where there is so much respect and teamwork amongst everyone. I never expected to have this much fun at work.

so that was that

2008-07-11T16:00:00.002-05:00

I did it. I took the NCLEX-RN. I got the minimum number of questions, which means I either did super well or really bad. I wasn't nervous until a half hour before. Then I sat down at the desk and finished all of the introduction stuff, and it hit me. My hands started to shake and I had to take deep breaths to calm myself down. I kept thinking, these are the answers that really count, and freaking out.

Now I think waiting will be the hardest part. There is no peace until I know that I passed.

full of crap

2008-07-10T13:02:00.003-05:00

Yesterday my nursing friend popped open a colace and put the liquid in my ear. One of the MA's told us it would help break up an impaction I had, which she saw with her otoscope. A few hours later, my hear was throbbing and I left for urgent care to get it irrigated out. This big scab thing came out in the basin, ew, very gross.

I had a good day with lots of laughing with my new nursing friends. I never imagined it would feel this good to be "one of them". I never imagined I would get along with so many people so well.

Tomorrow is THE BIG DAY.

not what I signed up for

2008-07-03T16:33:00.003-05:00

I wanted an insulin drip. What happened was the insulin drip was continued and I was left with a raging penile yeast infection. So I dealt with it. The coolest part of the day was when we went to take out a patient's sutures, and they were so healed over that we had to dig into the skin and wrip them out, with blunt tweezers no less! Blood was running, we kept pouring saline over it and blotting it up. I felt so bad for the guy who was a total trooper.

Sometimes I feel so far away from my other friends now. All I want to do is talk about blood and gross infections and cool rhythm strips, and they are SO not interested. When I'm a real nurse, will I ever be able to connect with them like I used to?

when the night shift snows you

2008-06-27T21:48:00.012-05:00

We got report today, and went to check on our patients. We found Mr. N with resps of 40, heart rate 110, fever of 102.7, sats 70% on room air, A&O x 1. We came close to calling rapid response, but we got his sats up and his resps down, notified the service, and gave a tylenol suppository for the fever. Then we felt the "rice krispies" over his anterior lung fields... that was the first time I ever felt crepitus. Cool... I mean for me, not for him.

By the time we got all that worked out, we were way behind on morning meds. We asked for some help, but we still didn't get lunch until 1:30. I got to watch a driveline dressing (next time I'll do it) and dress a stage 4. So a good learning day. I got a headache at the end though.

My nursing school friend, C, started on the floor today. She was nervous, but I gave her one of my "brain" sheets for organization and told her she'd be great. It feels strange to be ahead of her.

I took my EKG test yesterday, and passed with only two points missed. I feel pretty good about EKGs now. Two of the new nurses who are orienting in my group failed. It sucks for them, but I hate to admit that I felt even more proud of myself because they didn't pass.

Wednesday I made up for my absence on Tuesday. When I got there, I saw that I was orienting with none other than the nurse educator, the one who is strict and who I've never felt liked me (or many other people). All the other nurses kept telling me "good luck" sarcastically, with doom in their voice. I was nervous as hell, but I told myself "maybe I can impress her and win her over". And I did my damndest to do just that. By the end of the day I felt like I'd been a success. She didn't criticize me and even told me 'good job' a few times. I felt like I'd passed my NCLEX... awesome!!! I think I made a good impression on my hardest sell!

sometimes it's all I've got

2008-06-24T18:34:00.000-05:00

I went to my third EKG class today with the chills and a sore throat. Later on, I was warm, according to nursing friends, and I debated in my mind whether to go to the floor afterwards or not. I almost went, because I wasn't feeling SO bad. But then I thought about all of the transplant patients and surgery patients, and I ended up calling and asking if I could come in tomorrow instead, if I'm afebrile. It sucks.

This whole thing takes its toll more than people think. I've given up a lot of things, temporarily, to make my career begin successfully. I sometimes wonder if it will cost me friendships that I worked hard for in the past. I hope to get back to my usual activities later in the summer, when my NCLEX is behind me and I successfully transition off of orientation. I just have to remember that I'm fighting for this like anyone else who wants to win something. I'm putting in hours of work, determination, and dedication. But I worry that in the meantime, I'm disappointing the other people in my life.

where's my valium drip?

2008-06-20T11:56:00.002-05:00

I survived my first three-day-in-a-row stint at work. And I had lots of fun discharging my patients yesterday. I totally remembered how to do it from my externship, and my preceptor was surprised when I took the reigns and did it without even asking her. In reality, I can feel myself sort of kicking against all the supervision. I just want to do my job, and ask questions when I need to ask questions.

I'm learning a lot about how to deal with pain, and how to get pain dealt with. It's not a joke when people are in pain, and it's important to get it taken care of immediately. I feel like I'm growing a lot more, a lot faster, during my orientation than I ever did in nursing school. This is fun!

my lunch smells like tube feed

2008-06-18T19:56:00.003-05:00

I have experienced the joys of gunky empyema tubes, the smell of leaking tube feed, spilled j-tube meds, and stomach contents all over my bare hand. Oh let me count the ways I love being a nurse!

I finally got my test date- July 11th! I'm going to be the happiest NCLEX taker they've ever seen!

they're turning me into a nurse

2008-06-12T10:17:00.002-05:00

My days on the floor have been good, but I get impatient with having a preceptor. I especially hate having to wait for her to get meds. I only have one preceptor who won't even let me give oral meds. This is bad news for me, because the state STILL hasn't received the correction from my school and I'm still waiting for my authorization to test. I'm dying of jealousy of the other new grads who are testing next week. I want my damn license already.

I have taken a lot of classes as part of my orientation, too. Mostly med surg, but now I have started my EKG series, and there will be a big test at the end on reading strips.

I hope that I can do this job well, that I can become someone who is respected on my unit, someone who can make a difference not just with patients, but with my co-workers. I do want to be involved with the unit, I want to be a leader (eventually) and someone people think of as hard-working and contributing. I really care about our floor and our patients, and I don't think of it as 'just a job'. I feel like someone who really contributes to society. Maybe it's a puffed-up image of nurses that I have, but when people stand up and take off their hats when I enter the room and say 'I'm your nurse', I don't know... it's a good feeling.

My world has been infiltrated by chest tubes, wound drainage, monitor strips, and multiple choice questions.

news from the front

2008-06-05T12:35:00.000-05:00

I survived my second and third day on the floor with minimal damage to my fragile self-esteem as a new nurse. I was finally with one of my regular preceptors, a nurse about my age, and we had a couple of very laid-back days together. I took a CHF patient waiting for an LVAD work-up, a THE patient suffering from complications of her surgery, and even squeezed in a final admit with a lobectomy right before the end of the shift. I felt like I had more of a routine going on, and I'm getting a little bit more comfortable with the documentation systems and my assessments.

I heard some crazy adventitious lung sounds, and a heart murmur, and I was really proud of myself for *finally* hearing something out of the norm!

This week was my med-surg series. More lectures and demonstrations on IV therapy, drains, ostomies, chest tubes, and trachs. Friday I have an all-day class just on using our brand spankin' new online MAR.

Today I received my first 'real' paycheck. WOW! I can pay all of my bills with one paycheck!

survivor mode

2008-05-29T09:18:00.002-05:00

Well, I survived the long and boring central nurse orientation and happily looked forward to this week: my first week on the unit as a nurse, not a tech. The first day was more orientation. But yesterday was my first day on the floor with patients. I was scared to death. I felt like I had no idea what I was doing, I was way, way, WAY outside of my comfort zone, and the title 'nurse'? Yeah, I felt like a poser. What do I know about being a nurse???

My regular preceptor couldn't be there, so I was handed off to another relatively new nurse. She is a great nurse, excellent at everything, except maybe... precepting. She flew threw everything so fast in the morning that I got incredibly frustrated, just trying to figure out what was going on. Later in the day I got a handle on things, though, and did better. I'm not used to working for twelve hours, and until about 5:30, when my circadian rhythm kicks in, I was exhausted. My eyes were burning, my feet were aching, all I wanted to do was go lie down somewhere. But I kept plugging on. This was no joke... now it was up to me (well, me and the other nurse) to take care of these people!

The patient I was primarily responsible for was mitral and tricuspid valve repair, post-op day 8, with a chest tube, a dophoff, an NG, glucose checks, and basically everything else you could think of. Getting her to eat was the hardest part. I helped out with the other patients as well, and I'd have to say the highlight of my day was getting to remove staples from an abdominal incision.

I definitely figured out how to organize my notes and my day a little better, and got a minimum idea of the charting systems and routines... but if nothing else, now I know that I really have a long, long way to go before I feel like a 'real nurse'.

it's under my belt

2008-05-06T08:44:00.002-05:00

So I did it, I graduated! I am now a graduate nurse with a bachelor's of science in nursing. But I'm not getting too excited yet... the NCLEX and getting through my first six months as a nurse looms on the horizon. Scary changes. I'm not sure if my education has prepared me for most of it, but I have to keep in mind that I'm as prepared as anyone else ever was.

I found out who two of my preceptors on the floor will be, and I'm pretty happy. One is a more experienced nurse, V, who has always been very friendly and helpful to me on the floor. I told her she would be precepting me and she said she was really glad, that she likes me. The other is a younger, newer nurse who is gaining experience as a preceptor. She is pretty cool and seemed happy that I'll be her preceptee.

Graduation was a good time. I felt proud of myself and glad that my parents and grandma can finally feel like all of their support has paid off. Three of my fellow nursing students will be working with me on my floor, but I'm the only one starting in May. I'm especially glad that I'll be with my nursing buddy C, we have fun together. Ok, we complain together, but it's fun!

I got an A in statistics, an A in community health clinical, and a B in lecture. I graduated cum laude.

And I start nursing orientation a week from Monday... so, welcome to a new blog, the title is changing to: "The Life and Times of a New Grad Nurse!"

falling behind

2008-04-22T15:55:00.002-05:00

I have neglected this blog pretty badly. But I haven't exactly been immersed in nursing school the way I was last semester. I never went to my community health lecture, except to take the tests, and I missed four of my clinicals due to traveling. But I did get to make that up with a two hour presentation on community health care in developing countries. It was awesome and I rocked. The instructor told me I should become a teacher, I should apply for a fullbright, I should present to all these groups... etc etc. Nice to be so complimented on my academic strengths!

Today I took my student loan exit interview. I am $35,072 in debt, and I will be making payments of about $250 per month. Doesn't sound too bad... except that it's going to take 20 years to pay it off! But I accepted that responsibility a long time ago. I'm just eager to get started. A real job, a real income, and finally able to pay all of my own bills. I mean, my dad is still paying off his college loans! I only plan to defer my loans or whatever if I'm in grad school. Because I'll have to work a little less.

Today is my very last final of my undergrad education. It's for statistics and I'm confident I'll do ok.

I graduate on the 27th and I start nursing orientation on my unit on the 19th of May. I barely work at all until then, because hours have been severely slashed for temps. But I will be studying like crazy for my boards.

In hospital work related news- nothing. I got to suction a trach for the first time with the help of M, another graduating nursing student working just down the hall from me. She has all the trach care, I have all the heart monitors. We should be able to help each other out. I'm also exciting that my friend C from nursing school is starting on my unit one month after me. It's so great that I'll be around familiar faces, especially since I was given a days/eves rotating position. Now I'll know everyone and that will make being a new nurse just a little easier. Easier to ask for help, anyway, and less shy about sounding like a moron.

And thank GOD I don't have to work nights... I'm disoriented enough during the day!

muddling through the last semester

2008-02-17T20:12:00.002-05:00

I have been very lazy about updating here, for those of you following my career. Community health is very disorganized, and for the most part a big waste of my time. Everyone is complaining about it, but I guess there's nothing we can do but slog through it. I work at headstart for the morning preschool class once a week. I basically... hang out with the kids. I measure how tall they are, how much they weigh. But it's not like I can do that every time. I guess things could be worse.

up to my elbows in sh*&#

2008-01-10T20:48:00.000-05:00

News from the teching front: I spent my day trying to keep the poop off a guy whose rectal tube was falling out because it had been in so long his anus had stretched out too much to catch the stool. Plus, he is ARP (antibiotic-resistant precautions) which means I have to glove and gown every time I go near him. Makes for a sweaty and tedious day. I've been 'sitting' with him for two days in a row, so I told the charge nurse to give me a break!

mission accomplished

2007-12-30T19:50:00.000-05:00

I got out of the semester with an A, and two B+s. Not bad! I'm satisfied, for sure, although how I got away with it I'm not sure. A lot of luck.

So I'm taking a much-needed break from the nursing world, just for a couple weeks. And then it's NCLEX study time, community health and a statistics class for grad school.

sometimes I just don't get it

2007-12-11T00:09:00.000-05:00

I got my collection of papers back from my prof. She is a really tough grader, especially when most papers are opinion-papers, and she gave me an 88. Which is all fine and dandy... but. (You heard the 'but' coming from a mile away.)

I had to write a paper about my 'my future role in nursing' which included my future career goals. I put that I want to go into nurse-midwifery, and geriatrics. She wrote 'this is incongruous'. Yes, maybe it is, but... that's what I want to do, and those are my goals! You can't take off points for that!

And I said I wanted to be a part of a team working for women's health. She said 'midwifery is not women's health'. Since when is giving birth unrelated to a woman's health? Especially if you are assisting her to do it in a manner that she finds most comfortable and suitable to her? Or if you are providing her with safe, affordable, quality care? That's not part of women's health???

What-EVER!

you might be a nurse if...

2007-12-07T15:26:00.000-05:00

...You can drink a pot of coffee and still go to sleep in the morning.

...You think it is acceptable to use "penis" and "vagina" in a normal conversation.

...You know the phone numbers of every late night food delivery place in town by heart.

...You´ve ever been telling work stories in a restaurant and had someone at another table throw-up.

...You refer to motorcyclists as organ donors.

...You believe Tylenol, Advil, or Excedrin provides a large part of your daily calorie intake requirements.

...You´ve ever had a patient with a nose ring, a brow ring and twelve earrings say, "I´m afraid of shots."

...You have to leave the patient before you begin to laugh uncontrollably.

...You believe a good tape job will fix anything.

wee update

2007-12-07T02:02:00.000-05:00

I got an A in my med-surg clinical. A 98 for final performance. After all of our differences, my instructor said I did wonderful, excellent, just where I should be... so what the heck was I so worried about this whole time?!?

Just one exam left, in two weeks' time. Time to get back to karate and making money!

my next great adventure

2007-12-04T12:00:00.000-05:00

Here I am, still a semester away from graduation, and already I've got my sights set on grad school. I would love to go directly into nurse-midwifery, but it's looking more and more like that dream will have to be put on hold for a while. I can't get in to labor and delivery until I've done a year on another floor, and I can't apply to the program until I do a year in L&D. And basically, I want to get going sooner than that. So I'm thinking of applying to U of M's nurse practitioner in gerontology program for winter '09. All I need to do is take a basic statistics course next semester, and my GPA is high enough that I don't have to take the GREs. And by the time I enroll, I'll have my first six months of 'real nursing' under my belt, at least.

I plan to take the program pretty slow, probably four years instead of two. It's intense, and I have to work and make money as well. It's amazing to think that at this time next year I'll be starting out my training as a nurse practitioner! Insane. But I guess right now I need to focus on finals, taking the NCLEX, and getting hired on the telemetry unit where I work as a new grad.

Everything is going swimmingly in nursing student world. I give a group presentation today, and then I just have one final exam and some computerized testing to do. I really did it, survived this crazy-ass semester. I knew I was nuts to do all of this in one term, but I also knew I'd be so happy to have it all over and done with. And I am!!!

I've gotta get through this

2007-12-01T00:12:00.000-05:00

I slogged through another 12 hour NICU day on Wednesday. I'm given no responsibility, and since my preceptor doesn't take any patients, I just sort of float here and there, helping people. I spent the majority of the day helping an older nurse with the 'feeders and growers'. Meaning- I fed and changed babies all day. The frustration of just 'hanging out' somewhere, coming from clinicals where I had my own group of patients and all the responsibility I could want, almost got me in tears. The sheer monotony of it. I supposedly have one day left, but whether I will actually go or not, I don't know.

The good news is, my preceptor gave me an 'A'. I guess I was a good cart stocker.

weeeee are the champions

2007-11-27T19:07:00.000-05:00

Today was the last day of clinicals for me. I will have a community health clinical next semester, but one very important thing stands out about the end of this one: I will never have to wear these green scrubs again!!! I threw them out. I'm so done with that color.

taking out my frustrations

2007-11-26T10:42:00.000-05:00

I suppose I have been sounding quite negative in my recent posts. Besides the fact that I do use this blog for my share of ranting and raving, I am just frustrated by the fact that my 100 hour preceptorship was not the learning opportunity I envisioned it to be. It has been a frustrating experience, but also eye-opening. Truth be told, I do have a firmer grasp on what it's like to be a NICU nurse, and what kind of nurse I do NOT want to be in the future.

I am so happy and excited to be finishing this semester. It's been tough, because as my confidence in my nursing abilities take hold, my patience with those above me slowly dissolves. But I know they are trying to give me the best guidance they know how, and it's impossible to meet the individual needs of every single nursing student.

When I graduate in April, and pass my NCLEX, I know it will only be a starting off point in my career. Another beginning. Because I know I am fated for grad school and big work and big ideas after that. I still cling to my desire to be a midwife, but I also hope to be a geriatric clinical nurse specialist. I know it's a lot, but hey, I've got a lifetime. And there's so much to do! I want to work in Nepal, too, improving healthcare on a global level as well.

I have really big dreams and I know that this BSN is the first step down a long road. I take the nursing profession very seriously, as it has the potential to improve healthcare and re-define quality of care in every community. I want to be a part of that. I want to live my professional life boldly, never ceasing to learn or grow, always striving to better myself and the way in which I affect those around me for the better.

My last boss, and one of my nursing mentors, gave me a quote for a gift last christmas. The last line of it says "To know even one life has breathed easier because you have lived, this is to have succeeded!"