End of the Year

It's the last day of 2005 - time sure does fly by & so much can change so quickly.  A year ago I was just graduating & nervously awaiting the start of a new career.  Now I am contemplating leaving the hospital I have become comfortable with - partly to gain more experience & partly because they make things more difficult than it has to be.  The lastest is that we have a new manager/director of our department & she is holding up my ability to go per diem (more money).  Gina is in the same boat.  We were told when we were hired that after we gained a year of experience, we could opt to go per diem.  Now she is saying she needs some time to figure it out - who knows how much time that is, but I want to be paid more now that I met my part of the bargain, you know?  So her indecision may force me to move on to other hospitals.  It's something I want to do, yet at the same time I am very comfortable with the routine & the staff at my current hospital.  That's one good thing about this career....ANYTHING is possible.  With the nursing shortage, we are in demand...makes it easier to move on if you're unhappy where you're at. 

I had a wonderful Christmas.  I love Christmas time, but I am glad it's over.  One less thing to think about & far less money to spend.  I did buy myself a couple of presents...for one - a new computer.  Yep, it was time.  I'm switching over to high speed internet (about time) & wanted a computer that could maximize my use.  I went with Dell & boy, are they fast.  I ordered it Monday night, it was built & shipped on Wednesday & delivered to my door by Friday at noon.  So glad I didn't pay $160 extra for next day delivery because their free delivery was quick.  I love it - it's soooo quiet, you cannot even tell that it's on.  My old computer, well, let's just say it definitely wasn't super quiet like this one.  My other purchase was a Play Station 2.  I used to play video games all the time & sometime in the last 10 years I stopped.  I have no idea why.  I'll grow up one day, but for now, I'm getting back into video games.

I am not scheduled to work until Tuesday.  It's been nice having the last week off.  Have I mentioned how much I like the flexibility of nursing?  That is one thing I do like about my current hospital - we can pick our schedule as opposed to other hospitals that assign you certain days.  Flexibility is key. 

Not too much else going on.  I'm trying to decide what to do tonight for celebrating the New Year.  It seems like it's the same decision each year - go out or stay in?  When I go out, I'm wishing I was at home & not on the roads with all of the drunk drivers.  Yet when I'm at home, I feel like I should be out partying in the new year.  Can't win, can I?  2006...where has the time gone???

Happy New Year everyone...be safe tonight!

 

My Instincts were Correct

In my last post, I just wrote about hearing what I would describe as a "death rattle"....well, I was correct.  I worked last night & looked up in the computer to see how my 95 yr old patient was doing only to find out she died on Wednesday.  I feel for the family....it's hard enough losing a loved one, but I think it's worse when it's very close to Christmas or any other holiday. 

I worked overtime last night & was so glad I did.  I ended up with only 2 patients.  They were pretty easy to care for although one of them seems to be quite ill.  She had hip surgery yesterday, needed blood transfusions, had very poor urine output...3000 ml in & only about 400 out.  So not sure if she was going into renal failure or what.  On top of that she has a raging UTI and her cardiac enzymes are elevated. 

My other patient was a gentleman that was in for chest pain.  It wasn't cardiac related so I imagine they'll send him home today.  I'm debating about whether to work tonight or not.  Overtime makes it so worth it, but I still have a lot of Christmas stuff to do.  I'll take a nap & decide later.  Ciao!

Wrapping

Everyone ready for Christmas?  I have spent the last few hours wrapping presents.  Next year I'm teaching my niece how to wrap so she can do it all except for the presents I buy for her.  I used to enjoy wrapping presents, but now...I just want to be done! 

I had a good week at work...busy the first 2 nights, but my third night was a piece of cake.  I've come to appreciate nights like those because they are so rare.  Actually looking back, Sunday night was a lot of work & I wasn't too happy.  My rooms were all spread out down the hallway.  I prefer them to be together...not just because it makes it a little easier, but I think the patients would appreciate it more seeing the same faces over & over rather than multiple people coming in & out of the room.  Anyways.....as soon as I reported to my floor, I was told "Oh nooooo, you have "that" patient."  Not exactly the words one wants to hear.  I was told he was yelling & screaming the night before, he was punching & kicking to the point of needing to be put in wrist & foot restraints.  He has alzheimer's & Sundowner's...meaning he doesn't really sleep at night as well as being beyond confused. 

My second patient is a 95 yr old woman in with altered mental status.  I've had her as a patient before & she has definitely gone downhill.  In fact, I had her for 3 nights straight & it seemed she was getting worse as time went on.  At 95, what is there really to expect?  There are exceptions, but most people don't make it to 95.  Add into it that she also had c-diff & a UTI....her body was having a rough time fighting the infections.

My third patient was also someone I've had in the past.  He was in with pneumonia, but also had some anxiety issues going on.  Nice gentleman, just worried way too much about things he didn't need to worry about.

My fourth patient - well, he was awaiting discharge.  Actually, we were waiting for him to urinate before we could let him leave - since he had a foley in earlier.  Any nursing student knows...can't discharge until you see some urine...fun, fun, fun.  About an hour later he was good to go. 

At the same time, I was orienting a med/surg nurse to PCU.  My unit is so short-staffed that they are requiring med/surg nurses to be flexible & to fill-in when we need them.  She was nice, a quick learner...she'll do fine.  After all, I oriented her to the unit!!!!!  :)

I got a new admit around midnight...a 52 yr old male that became disoriented at home.  His blood pressure was 214/110 upon arrival to the ER.  So I ask the ER nurse...what did you give him for his blood pressure?  Answer:  nothing.  Ummm, why not?  Reply:  We thought it would go down on it's own.  Now I have to say...our ER has been slammed the last month - every single day & night.  This week was even worse - to the point that all of our beds were practically full & they had PCU nurses in the ER taking care of patients that were awaiting admission.  Which basically means...they are too sick to send home, but we are too full & have no beds available...so they spend a night or two in the ER awaiting a bed to become available.  Not a lot of fun, I'm sure.

So I admit this gentleman, take his blood pressure & it's something like 170/105.  I'm not a happy camper.  I end up giving him the blood pressure medication the doctor ordered in the ER but the patient had never received.  Off to sleep this patient goes, can't blame him for being tired after spending 12 hours in the ER. 

I get another new admit around 5:30 am.  This time a trach patient with pneumonia.  I was dredding it.  I just am not comfortable with trachs....there are a few things that can creep me out....a hole in someone's neck is one of those things.  This gentleman worked with asbestos years ago & developed cancer of the throat as a result of that.  That's why he had a trach.  Very, very nice man...I just couldn't understand most of what he was saying.  Not to mention when he'd try to cough up phlegm through his trach opening.  That just gags me.  Don't know if I'll ever be comfortable with trachs. 

Another thing that grosses me out....fake eyeballs or even stories about how someone lost an eye.  I just instantly feel pain.  I mention this because a patient I had a couple of weeks ago had lost an eye when he was a child.  Someone acidentally poked his eye out with a stick...eww.  Definitely gives true meaning to that saying "Don't do that, you'll poke an eye out!"  On top of that, he had a fake eyeball & the day nurse was telling me about how she helped him take it out & clean it.  Eeekkk...it's turning my stomach now as I recall her talking about it.  That same night, Gina got a patient who had no eye at all....just an empty socket.  She tried to get me to go look at it...but no way......sorry, can't do it. 

Ok, back to my first patient...the one that I was told was unruly & out of control.  I go in to assess him & he's sleeping.  I'm not dumb.....I let the man sleep.  Who am I to wake him up?  Luckily the family also hired a private sitter to spend the night in his room.  I had no problems with him at all.  He's actually a very smart man...went to MIT, was an engineer...very smart cookie.  My only problem...getting him to take his pills.  He wouldn't do it.  I tried putting them in pudding so he could swallow them all in one scoop.  He told me to leave well enough alone.  I came back later when the tech was taking his temperature...after she was done, we talked him into trying some pudding & finally got his pills into him.

By the morning, I was writing out to the clinical leader which patients I didn't want back the next night.  Not because I had a problem with the patients, I just didn't want to have my rooms all spread out again.  Luckily it worked out well.......I kept 2 of my patients & got 2 new ones.  One patient I didn't have back was the 52 yr old & I am so glad I missed out on that one.  At the beginning of the shift, I heard him yelling & swearing at his wife.  He's furious that the doctors aren't telling him why he became disoriented....he wanted instant answers.  He was yelling at the nurse, he was ranting & raving.....just way overdoing it.  No wonder his blood pressure is so high.  Personally I think he was flipping out because he hadn't had a cigarette in over 24 hrs.  Smokers tend to get a little nutty when they are forced to go cold turkey. 

Anyways, that's about it in a nutshell.  My 95 yr old patient is still alive, but I swear I was hearing what would be referred to as a "death rattle."  It was just a bizarre noise she was making, not to mention she was shaking.  There was nothing I could do to improve her condition or her comfort level.  With someone like that, you're basically playing a waiting game.  The respiratory therapist is convinced she only has a few days of life left...we shall see.

I had today off, but I think I will put in a night of overtime tomorrow night.  One of the clinical leaders called me Monday morning & was basically begging me to pick up some shifts between now & Jan 1st.  I need to figure out what nights I want to work...all next week will be shifts offering bonuses.  I sorta wanted to take the week off, but it is hard to pass up the money they are offering.  I'll play it by ear.  Enough about me.........hope y'all are done Christmas shopping & enjoying time spent with family & friends.  To the nursing students that read my journal...hope you had a great semester.  Rest up & enjoy your time off.  January will be here soon enough.  :)

 

 

 

First year complete!

December 16th, 2005 = 1 yr anniversary of graduation from nursing school...aka...the pinning ceremony.  It also marks the end of my first year as a nurse because today is also the anniversay of the day that I accepted the job offer to become a PCU nurse from the hospital I currently work for.  In fact, I accepted the offer during the pinning ceremony rehearsal! 

It has gone by quickly - that's for sure.  I know I still have tons to learn & much more experience to gain...but looking back, I have come a long way.  I feel much more confident in my nursing skills & critical thinking abilities.  As most things in life, the best way to learn is hands-on rather than from a book.  It also has been very helpful working in a hospital environment as supportive as the one I am at.  There were only 3 of us from my graduating class that took jobs at this hospital - because many did not think much of the place throughout (we had the majority of our clinicals there) school  - including us.  I've got a different perspective now...for one, we are treated differently (much better) as co-workers as opposed to student nurses.  Even with all of the travel nurses & agency nurses, it still remains to be a tight-knit group that is always there to lend a hand, especially in crisis situations...not to mention the daily chit-chat to relieve stress. 

If I had not taken a job at that other hospital (earlier this year), I probably would have not realized the difference.  It showed me that they can provide you with all of the resources possible, but if you don't have a staff that is willing to back you up & help you out - you are not going to be happy.  That's one of the things that scares me when I think about becoming a travel nurse or agency nurse - will I end up in an unsupportive work environment?  Or are there hospitals that are even better than where I'm currently at?  I guess the only way to really know is through experience.  Even the word of others isn't often believed until you deal with it first hand.  We (Gina & I) had been told by others that we would hate working at that other hospital.  We thought they were insane...but in the end, they were right. 

I haven't been in touch with too many of my other classmates.  I am curious to hear their thoughts & experiences thus far.  I also like hearing from other nursing students - those who are getting ready to start the program or are in the midst of it.  My best advice to them...be confident in yourself & don't let anyone take that away from you.  If the confidence isn't there, fake it until it is.  That doesn't mean pretend like you know what you're doing & don't ask questions...by all means, seek out the information...but always be confident in who you are.  Being nervous is normal...don't let it overwhelm you. 

It has been an amazing year & I am so glad I have chosen this profession.  I think I may have finally found my niche in life...career-wise anyhow.  :)

Full Moon Confusion

It was definitely easy to tell a full moon was due this week.  Sunday night was a busy, busy night for me.  I had 5 confused patients & it seemed like they were all competing for the title of "most confused." 

In 5th place - a woman that seemed to think she was staying at the Hilton & had her own personal nurse to tend to her every need.  She was in the hospital due to pneumonia.  The noises she made were so disgusting....it was embarrassing for women-kind.  Add to that her nose picking & pressing the call light every 5 minutes....amazingly she was the least of my worries that night.  Most annoying, but not most confused. 

4th place goes to an elderly man in with a possible small bowel obstruction.  He kept taking off his heart monitor & when I'd go back in to put it back on him, he'd state "I didn't take that off, someone else did."  Ummmm, ok.  He was a sweet man....continuously made this humming sound, even when he was sleeping. 

3rd place went to my c-diff patient.  I don't know if he had a little bit of Sundowner's going on or what.  He started out pretty alert & oriented at the beginning of shift, but as the night went on, he seemed somewhat confused although he would deny it.  Anyone in nursing knows that c-diff is not a fun diagnosis...enough said.

2nd place goes to an elderly woman in with a hip fracture.  She started out sharing a room with my needy patient.  It didn't take me long to see that if I didn't separate them, a yelling match was about to ensue.  They both referred to each other as being "the crazy one."  So I move this lady to another room...she was as sweet as can be.  I fully anticipated she would go to sleep for the night......so much for anticipation!  Instead the tech found her wandering the room...how she ambulated with a fractured hip - I'll never understand.  Ok, back to bed......put on the bed alarm.  Well, she continuously tried to get out of bed.  So next up was a posey vest...didn't want her falling & hurting herself further.  She seemed ok with the vest - probably wasn't even aware it was on.  I check on her a little later.....she has pulled out her IV.  That's ok, she already has a second IV...switch the fluids to that & tell her not to mess with it.  Recheck her...I see her scratching at the other IV.  Ok, time to restrain the hand that can reach the IV.  She was still ok with that...but, she was working on getting out of the wrist restraint & Posey with the free hand.  She wasn't swift about it, but I knew it was a matter of time before she was free.  So I restrained the other wrist...that's when she flipped out.  This sweet woman sure did have a nasty mouth on her.  Needless to say, she spent the rest of the night yelling & cursing....so much for anticipating she'd sleep.

The most confused award goes to my younger patient.  It really is a bizarre story & I have thought often about it & try to wonder how it would feel to be in her condition.  She was a woman in her mid-40's...moved to Florida from Jamaica sometime in the last 2 years.  She had a really bad headache on Saturday...took some excedrin & went to bed.  Woke up with a headache on Sunday....painful to the point of crying.  Her adult children decided to bring her to the hospital...she came into the ER totally alert & oriented...answered questions appropriately.  They gave her some pain meds for the headache, she took a nap in the ER while awaiting tests to be run.  When she woke up - her short term memory was gone.  It was basically amnesia..she did not remember ever coming to America.  In fact, I couldn't even convince her that she was in Florida.  She truly believed she was in Jamaica & that I was someone she met in the Cayman Islands.  Even the neuro doc was stumped...all her tests were normal, but the memory was gone.  I'm sure having an elderly woman screaming & yelling in the bed next to her didn't help with becoming reoriented either. 

Needless to say, my night flew by Sunday night. Before I knew it.....it was time to go home...yay!  I requested not having all of the same patients again the next night - it was too heavy of a workload for one person.  So they gave 3 of my patients to another nurse.  I kept the needy one & the possible small bowel obstruction.  I'm glad I did....as the other nurse had her hands full.  I helped her out quite a bit, but was glad the responsibility was out of my hands. 

The patient with c-diff developed an itchy rash in the middle of the night, which turned out to be "Red Man's Syndrome."  I have never heard of it before...but it's a reaction to the antibiotic Vancomycin = one of the big guns when it comes to antibiotics.  The reaction can get so bad that the person stops breathing - eeekkk!  She got him some benadryl & by the time she administered it, the morning labs were in.  His H&H was dropping...something like 8 & 24.  Not good.  More calls to the doctor for her. 

The woman with the hip fracture managed to get out of her posey vest & fell getting out of bed.  She didn't have any apparent injuries, but required a call to her doctor as well as filling out an incident report.  Back into wrist restraints she went & the yelling began.

The woman with amnesia was trying to leave the hospital.  She was convinced there were 2 men in the room trying to put her in a body bag.  We had to talk her down & make her believe that wasn't happening.  So add hallucinations to the amnesia. 

I thought to myself...ok, it's been a crazy 2 days, Tuesday night definitely has to improve.  I once again made a request not to have the needy woman back.  I could only take so much of her demands.  My request was granted...I got a new patient load on Tuesday.  I still had the man with the small bowel obstruction which was fine. 

I also had a gentleman that was transferred from ICU earlier in the day.  He had internal bleeding when he came into the hospital.....had surgery & was on the road to recovery - except when he'd go into V-tach every now & then.  Since he wasn't symptomatic with it - we didn't treat it.  Still though.....I don't like seeing runs of V-tach.

I had a woman in her mid-30's in with syncope.  Seems she was under a lot of stress at home due to her teen daughter.  All of her test results were normal.  I believe they were going to discharge her & treat her with an antidepressant.  I talked to her & told her that as stressful as it is watching a teen make mistakes - that sometimes they have to learn the hard way.  Her daughter is 18....teens make dumb decisions everyday...hopefully they learn from them.  She agreed with me, but it was apparent she was stressed. 

Along with my 4th patient...a woman in her late 50's in with chest pain.  I could tell immediately there was some stress going on at home, just wasn't sure how much truth there was to her statements.  Many times through the night I had to tell her to try to stop thinking about what is going on at home & focus on taking care of her own health.  What put it over the top was this morning...right before the change of shift...she came out of her room & basically started yelling at one of the other nurses.  My patient was convinced the nurse was making fun of her & that she could hear her talking about her & laughing.  It was bizarre.  I got her back to her bed & the woman was shaking & began crying.  I wasn't sure what to do.  I didn't want to argue with her that the other nurse wasn't making fun of her when the patient was so convinced this had happened, but I also didn't want her having a mental breakdown.  She grabbed my hand to hold & sat there rambling on about things.  I could tell there was no way to talk any sense into her, so I asked "What can I do to make it better?"  I felt for her, but she was obviously overreacting & there was no way to prevent that. 

Actually...before that outburst...another nurse got a new admit.  Literally a woman that would not stop screaming.  Really nice to get an admit like that at 5 am when most of the other patients are sleeping.  She would not stop screaming.  We had to restrain her hands because she kept trying to punch & grab us.  We also had to get a foley catheter into her...it took 5 of us to hold her down. 

So any thoughts of putting in a night of overtime tonight were quickly put to rest.  Too many signs to just stay home.  I hope this isn't how the next month will be...but it seems like we've gotten quite a bit of confused patients lately. 

On a sad note, a patient that I had taken care of about a month ago passed away last week.  I saw her name in the obituaries.  It made me sad.  I don't usually remember too many patients offhand, but she was one that stuck in my memory.  I'm sure I probably wrote about her in here...she was my patient that had the nosebleed that wouldn't stop & a high heart rate that the doctor didn't want to address.  I knew she was transferred to the ICU, but I was really hoping she'd get better & go home to continue her happy life.  It gets to me that she passed away...especially around the holidays.  :(

Speaking of the holidays, I do believe the majority of my Christmas shopping is complete.  I still need to get a few things, but it's nice knowing I'm just about done.  Now it's time to buy myself something...lol.  I need to decide what it is I want.  I'm leaning towards a new computer...but no rush.

Hope y'all are getting your shopping done.  Have a good weekend!

 

I should be napping

It's been a pretty good week so far.  I worked Sun, Mon & Tues nights and will be going in tonight for some overtime - so I should be napping - but I wanted to post on here first.

My week went well...Sun & Mon nights I had the same exact patients both nights - I enjoy that.  Makes it better for both myself & the patient...as opposed to having a different nurse each & every shift.  It also makes getting report short & sweet.

I started off in report being told about my first patient...an elderly man with dementia that was angry & would yell things out continuously.  He was in for pneumonia I believe...I had no problems with him at all.  The first night he started off sitting in a chair, got him into bed & he slept the entire night with absolutely no anger or yelling out.  What can I say - I have the magic touch...lol.  The second night, he would keep asking for coffee - even if you just gave him a cup.  Sad to see how the mind sometimes works...or doesn't work properly.  By the third night, he was downgraded to med/surg status & I transferred him around 9 pm. 

My second patient was an elderly woman in with CHF.  She is probably one of the sweetest patients I've had so far this year.  She happens to be a retired RN.  She was improving greatly each day, but the smile on her face said it all.  When I showed up Tues night, she was looking for me & was so happy to see me.  I like when I can make a connection like that.....to bring a smile to a patient's face is the best reward, if you ask me.

My third patient was also in with CHF.  This gentleman just cannot catch a break....in his early 50's...he's had heart problems, got better....then found himself with back problems....had spinal reconstruction surgery - thought he was on his way to recovery only to find out he now has lung cancer.  Monday night he was feeling depressed about his life.  I took some time to chat with him...it's difficult to try to cheer someone up with all that he's been through, so I simply encouraged him to express how he was feeling.  The next night when I came in, he said hewas feeling a lot better - that he woke up with a new outlook & his spirits were lifted.  I was glad to hear it.  He also was downgraded to med/surg status & as much as I didn't want to give him up as a patient, I transferred him to med/surg around 10:30 pm. 

My fourth patient - he was amusing.  He came in with syncope - kept passing out at home.  He blamed it on taking Levaquin, but as they ran the tests, it showed that it wasn't a reaction to medication.  I had time on Sunday night to actually spend time with my patients (as opposed to tons of paperwork) & I was concerned about him because he kept stating that he just didn't feel right.  I've learned enough to know that when a patient says things don't feel right - to listen to them.  So I pulled up a chair as he sat bedside.  He was saying he felt like he was going to pass out.  However, he was able to talk & talk - I learned all about his life over the 3 nights that I had him.  We joked, we talked, we looked out for one another...by the third night, he was trying to swap his blueberry muffins with me for some cookies...lol.  His admitting doctor came in Tuesday morning & asked me "Is this patient ready to be discharged?"  I told him "No, he's having trouble with his left leg, is having difficulty standing, complaining of feeling like he's going to pass out & he's short of breath."  The doctor said "Are you looking for reasons to keep him here?"  So much for advocating for my patient.  I told him I'm just answering his question.  He turned & said "I don't care, I'm discharging him to a nursing home."  Then he went to talk to the patient, came back out & said "You're right, this patient is not ready to be discharged."  At least he was able to acknowledge when he was wrong - unlike some people I know <g>.  Anyways, this patient had a stress test on Tuesday & it was positive.  The cardiologist wanted to do a heart cath & possible heart bypass surgery.  The patient wanted a little time to think it over.  Tuesday night his neurologist wanted to do a CT of the brain.  I informed the patient & he got upset - said he had bad memories from the past & did not want to be put through that again.  I told him that was fine....he has the right to refuse any tests.  So I informed the neurologist, cancelled the test & informed the pt it was all taken care of.  He continued to tell me about his fears about CT's & MRI's.....I told him he didn't have to convince me - I'm on his side & I understand his apprehension.  Later I went in there & he told me he had been dreaming about our conversation.  I told him that surely he must have better things to dream about.  :)  I hope everything turns out ok for him.  He was a sweetheart.

On Monday night, I was given a new admit....to quote the ER... "we wanted to get him out of here before he coded."  The gentleman came in on bipap & everyone was telling me that once the pulmonologist saw him, he'd probably be transferred to ICU.  Luckily it was 6 am when I received this patient, so by the time I got done with the admission paperwork & assessment, it was time to go home.  Later I found out that rather than going to ICU, the family decided to go with hospice.  I chatted with the hospice nurse for a little while - they truly are angels here on earth.

Tuesday night I got 2 admits also.  Another one that seemed like he belonged in ICU....his pH on arrival to the ER was 7.1.  I believe they say anything under 7.0 is death...so I was concerned about receiving this patient.  Respiratory worked with him & got his pH up to 7.4 by the time he made it to my floor.  He was fine through the night, no problems to speak of.

My other new admit was in with pneumonia, recurrent falls & hyponatremia.  His sodium level was 127.....normal is 135-145.  Needless to say, he was on the confused side.  He kept calling me "boss."  As the night progressed, the more confused he became.  I should have given him some saltine crackers to help with that sodium level, but I didn't think about it at the time.  He kept removing his heart monitor.  I'd go in, put it back on, explain to him the importance of it...he'd say "Ok, boss" & 10 minutes later it would be off again.  I couldn't see restraining him over that, although the heart monitor is very important.  I left it for the day shift nurse to decide what she wanted to do. 

I ended my shift with getting a flu shot - I don't want to get sick this season.  I know many say that the flu shot doesn't do squat, but I have gotten them the last 2 years & have not been sick at all......I'm hoping to keep that going.  Although I probably just jinxed myself by writing it...lol.

Anyways....I'm going back for more tonight & maybe even Saturday night - it's hard to pass up the overtime $$$ as well as the bonuses - wish me luck!

Sara Beth

Have y'all heard that song by Rascal Flatts...Sara Beth.  It's on right now...so beautiful.  Here's the lyrics:

Sara Beth is scared to death
To hear what the doctor will say
She hasn't been well, since the day that she fell
And the bruise it just won't go away

So she sits and she waits with her mother and dad
And flips through an old magazine
Till the nurse with the smile stands at the door
And says will you please come with me

Sara Beth is scared to death
Cause the doctor just told her the news
Between the red cells and white, something's not right
But we're gonna take care of you

Six chances in ten, it won't come back again
With the therapy we're gonna try
It's just been approved, it's the strongest there is
And I think we caught it in time
And Sara Beth closes her eyes.

And she dreams she's dancing
Around and around without any cares
And her very first love is holding her close
And a soft wind is blowing her hair

Sara Beth is scared to death
As she sits holding her mom
Cause it would be a mistake for someone to take
A girl with no hair to the prom

For just this morning, right there on her pillow
Was the cruelest of any surprise
And she cried when she gathered it all in her hands
The proof that she couldn't deny
And Sara Beth closes her eyes

And she dreams she's dancing
Around and around without any cares
And her very first love was holding her close
And a soft wind is blowing her hair

It's quarter to seven, that boy's at the door
And her daddy ushers him in
And when he takes off his cap
They all start to cry
Cause this morning where his hair had been
Softly she touches just skin

And they go dancing, around and around
Without any cares
And her very first true love is holding her close
And for a moment she isn't scared

Touching, isn't it? 

I had my niece stay over last night...we watched Santa Claus is Coming to Town and then...what even today I can't believe I watched.  Not only can I not believe I watched it, I can't believe anyone even came up with the idea = the first annual Miss Dog Pageant.  Yes, that's right....51 female dogs, onefrom each state & the District of Columbia competing to win Miss Dog.  They even had an evening gown competition!  What's next???  Oh well, my niece loved it...there was even a dog that had her name...Elizabeth Marie as well a dog with her friend's name Morgan.  Morgan made it into the finals...lol, go Morgan go.  (Are you laughing yet, Julie???) 

I love spending time with my niece.  It reminds me of how simple life should be....relaxing & playing.  No stress, no worries, just fun.  I told her last night not to get any bigger...to stay little.  She just rolls her eyes at me...lol.

I don't think I mentioned it earlier, but I went to The Olive Garden on Sunday afternoon.  While there, the waitress proceeded to drop a glass of water not only on our table, but in my lap.  I was soaking wet.  On top of that...our food took about 30 minutes to make it to the table.  She followed it up with "I'm sorry."  That's it..."I'm sorry."  I could tell she was somewhat new & I really did not want to get her in any trouble. I know I've made plenty of mistakes at my job...that's all part of the learning process.  However, I did contact Olive Garden online with my comments...never thinking anything much would really happen.  I have to say though...they actually do read comments.  By Wednesday afternoon, I had the general manager calling me on my cell phone apologizing profusely.  I also received a letter from corporate as well as a $30 gift card.  So as disappointed as I was after my meal on Sunday, I am proud of their efforts after the fact. 

I start back to work tomorrow night.  I wish I could say I'm looking forward to it...but my thoughts are the same as any day that I have to work.....I hope I get decent patients.  It's like playing the lottery everytime I'm at work...you don't have any clue how your night will go.  In a way I like that....a crisis could develop at any moment.  At the same time, something touching or meaningful can be said or done also.  I love the mystery of it all.  Hopefully it will be a good week!!

"No more blood pressures..."

Yes, you read it correctly...no more blood pressures.  That was an order I received from a doctor the other night.  I had a patient whose blood pressure at 8 pm was 198/92 and her heart rate was 115.  She was sleeping & had already received pain medication, so I knew it wasn't her activity or pain level that was messing with her vital signs.  So I call her doctor...tell him the details, he orders Lopressor 25 mg.  I give her that, let her sleep for a couple of hours & recheck it around 11 pm.  Her heart rate is good...in the 70's, her blood pressure is now 202/90.  I recheck it...same reading.  I call the doctor again, he orders a Catapres patch & says "Do not take any more blood pressures tonight."  Huh???  You don't want me to recheck her blood pressure?  "No, NO MORE blood pressures on this patient tonight.  Hold them until the morning."  Nice doctor, isn't it?  He just didn't want to be bothered again.  Sorry, I didn't follow his order...I did recheck it around 4 am vitals, it was still elevated, but a little better 185/77.  I definitely made sure to document his exact words. I wasn't going to get in trouble for not reporting a high blood pressure on a patient whose normal bp doesn't run that high.  Obviously something was going on with her.  Granted she was 95 yrs old & a DNR, but that doesn't mean I want her dying on my shift.  So far I have not had any patients die on me, I would like to keep this trend going.

My other patients were ok...I felt like I was working in a psych ward in a nursing home.  I think dementia has to be one of the saddest conditions I've ever seen...simply because nothing you say or do will affect the way your patient is behaving - however, that didn't stop me from trying to reason with my patient.  :)  She would not stop yelling out...she was calling her daughter's name, then the name of the woman that takes care of her at the nursing home, then she was pleading for water - which I gave her often & finally it was "helpppppppp meeeeeeeee."  All night long.....didn't matter how much Haldol or Ativan I gave her, the results were the same.  She did not sleep for one second.  She was in restraints because she would attempt to get out of bed, pull out her foley, pull out her IV.  By the end of the shift, I also was resorting to saying "helppppppp meeeee." 

In addition to those two patients, I had two combative males that required a sitter.  Did I also mention that on this floor....it was just me & one other nurse?  That's it.  I handled these guys fine......one wanted his sleeping pill & pain medicine, once he got that, he was cooperative & the other one just wanted to be left alone so he could sleep.  Not a problem.......sweet dreams.

I got my 5th patient around midnight...a woman that had checked herself out AMA two days earlier.  Not a wise decision when you have a DVT (blood clot).  She was pleasant as can be...I had no complaints. 

I'm not feeling too good today...not sure if it's the weather or pms or if I'm fighting off some kind of cold or flu.  I just feel blahhhh.  Luckily I'm not scheduled to work until Sunday.  I go back to a full-time schedule for a few weeks.  I don't like feeling blah.  Maybe some chocolate chip cookies & milk will make things better, right????

Hope everyone had a wonderful Thanksgiving & got lots of Christmas shopping accomplished!

Tony Stewart - Champion once again

Woo hoo....what a wonderful Sunday it was watching Tony Stewart wrap up a great season & take home the championship trophy/title.  It's nice to see how much he has matured & isn't out of control off the track.  Don't get me wrong, I love when these guys get mad at each other & act out, but at the same time...it's nice to see them act like men & handle their conflict with words rather than temper tantrums.  Now they're off for 2 1/2 months....I get my Sundays back.  Which means.....back to work for me!

Yep, going back to my Sun, Mon, Tues work week...at least through December.  There is a lot of change coming up.  One good thing - they are starting to focus on computer charting.  They have formed some type of team that will practice with it first so that all the issues can be ironed out prior to all of us using it.  So it's probably at least a year before we get our hands on it.  On top of that....the manager of my unit & the director of my unit have both resigned.  That means new management which is kinda scary.  Obviously there will be changes, I'm just hoping it's good change, not bad.  There is already a rumor that they are not going to allow overtime anymore.  That doesn't bother me too much as rarely do I ever have the urge to work overtime.  It also seems as though they have hired many, many agency nurses & as a result, we don't get the offer for bonuses too much anymore. 

It's so strange though...to go into work & the majority of the people working are agency.  There was one night I went in & didn't know ANY of the day staff.  I felt like I was in the wrong hospital.  I worked Monday night & spent part of the night helping a new agency nurse.  I didn't mind that....it actually showed me just how far I've come in just a year.  I am so very comfortable at this hospital & I truly think it's because of the atmosphere.  Yeah, we have our problems...but as far as teamwork, it is #1.  Even with all of the new agency people...we all jump in & help one another when someone needs it.  That is so opposite of what I experienced at that other hospital.  I felt like I was all on my own & that wasn't a good feeling. 

I am finally off of probation for calling in over the summer.  And come January...I can go per diem = more $$$.  I am working this Friday because they are desperate & offering a $150 bonus just to come in.  I couldn't resist.  I've had the last couple of weeks off & it has been nice.  I've been working on organizing my own house & also working on fixing up my rental house.  The time flew by.  Other than Friday, I'm not scheduled until a week from Sunday.  I also took the week off between Christmas & New Years.  It is so nice having the flexibility to choose when I want to work. 

Monday night went pretty well.  I started off with just 3 patients.  One little old lady who came in with a diagnosis of CVA.  She had extreme right sided weakness & half the time I couldn't understand what she was saying to me.  I could tell she was frustrated.  It reminded me of that ER episode where the woman has the stroke & they showed you what it was like from her viewpoint.  This patient's blood pressure was high, but I expected it to be as in the past I've been told by doctors that they prefer a higher than usual blood pressure when it is stroke-related.  However, at one point her heart rate went up to the 150's & her blood pressure was 190/94.  My clinical leader & I looked through her chart and noticed in the doctor's progress notes that the cardiologist had listed his "plan of care" for her & it included Lopressor & Norvasc.  However, he never actually wrote the order for those medications.  So I called him, he said he didn't realize he forgot to write the orders...got her the medications & eventually her heart rate & blood pressure improved.  All was good.

My next patient was a 75 yr old man in with COPD exacerbation.  He seemed perfectly healthy to me.  His wife was at bedside & remained there the entire night - sleeping in a chair next to his bed.  Earlier in the night, their son came out & asked me if I knew any of the test results.  I told him the doctor would be the one to discuss test results with his parents.  He understood...did I mention he was a cutie?  Sorry, yes...even at work I do notice these things.  Later when I was talking to my patient & his wife, they expressed to me that they've been married for 50 years.  WOW!  10 children later & here they are.  They were both very sweet. 

My third patient was a mess...in with urosepsis, UTI, uncontrolled diabetes & pneumonia I believe.  His temp was 102.9 when I came onto shift.  Needless to say.....he was receiving Tylenol every 6 hours.  I managed to get his temp down to 101.3 & that's where it stayed for the rest of the night.  Kinda hard to get the temp down when he had a raging infection that needed to be controlled with antibiotics. 

Around 11 pm, I got my 4th patient.  One thing about our hospital...it seems like they are always moving the patients to different rooms.  This one was a transfer from our second floor PCU.  He came in with chest pain R/O MI...only 50 yrs old (my favorite kind of patient).  He was scheduled for a stress test the next morning & after getting him some food & Ambien...he was out for the night.  His cardiac enzymes remained negative...so I was happy.

The night was dragging by very slowly.  I was actually glad to get my 5th patient to give me something to do.  I got him around 3:15 am.  A 40 yr old with chest pain R/O MI (again, my favorite kind of patient).  His cardiac enzymes also remained negative.......some food for him & off to sleep.  That was my night in a nutshell.  Uneventful & calm. 

I'm spending Thanksgiving at my parents house...looking so forward to it.  I have my brother & his two kids at my house right now.  As much as I like having them visit, I also like having my house to myself.  I'm not sure I could ever marry & have kids.....I like my own space too much.  Oh well...never say never.  I have what I would call a blind date tonight.  I want to go, yet I don't.  We're just meeting for drinks & see what happens.  Wish me luck! 

Have a Happy Thanksgiving everyone!!!!!!!!!!!!

Happy Update

Just a quick update on my puppy dog.  He is doing much better.  I was worried he might get dehydrated so I gave him some Powerade & lots of water last night.  I don't know if that did the trick or what.  He seems like he's back to himself now.  I don't know what he had wrong with him & I realize that time with him is limited due to his age, but I'm extremely happy that I get more time with my buddy.  :)  Thanks to those of you who wrote me with well wishes - I appreciate it.

Still undecided

My puppy dog isn't any better or worse today.  I am constantly trying to decide whether this is a sign to have him put to sleep.  I've been crying on & off all day today just thinking about life without him.  He's laying at my feet now & looking at me like "What's wrong?  Why ya sad?"  Ugh, this is so hard.  :(  Needless to say, I'm glad I'm not scheduled to be at work this week.  I would be so distracted & wondering how he's doing & feel like I'm abandoning him. 

I spent part of the day with my parents & one of my brothers.  It was nice being around them.  They are being as supportive as possible, but they aren't connected to him the way I am.  They'll be back tomorrow.  I need to make a decision.

I got a call from another hospital that I applied at.  I should return the call, but I'm just not up to it right now. 

 

Sick puppy dog

After working last night, I came home to find my dog not feeling too well.  I don't know if he has some dog flu or if it's old age setting in.  He's 12 years old.  My dilemma for the past couple of years with him is...when do you know it's time to say good-bye?  He's been sleeping on my bed all day & night...not hungry at all.  His nose is really warm as well as the bottom of his paws - I know that means he is sick or running a temperature or something.   I have no idea what to do for him.  On top of that, arthritis is setting in & he's having a difficulty walking.  However, he is still very alert (while awake) & with it mentally.  So how do you know when it's the right time to make that decision to say good-bye?  I've had him since he was 5 or 6 weeks old & just thinking of losing him makes me cry.  He's been with me the majority of my adult years...my baby so to speak.  Through all the good times & the bad times, he's been the one constant in my life.  He's there day in & day out.  Ugh, I don't like thinking about this stuff.  ;(

I had a good night at work.  One patient was a 67 yr old female in with a COPD exacerbation.  She was upped to a 50% venti mask & that caused her to have numerous nose bleeds.  On top of that, her heart rate would climb to 130-140 for no real reason & then go back down again.  I ended up calling her doctor around 3 am to make him aware of her heart rate & nose bleeds.  His reply "That's fine."  I asked "You don't want to do anything about her heart rate?"  His reply "No, that's fine.  I'll see her in the morning."  Ugh, I hate replies like that.  She was a sweetheart - kept praising me (who wouldn't like that).  She wanted to speak to my supervisor to let her know how wonderful I am.  I ended up getting her some "Share" cards.  It's basically a card you fill out when you want to compliment someone.  It is nice to be appreciated. 

My other 3 patients were men.  One had a stroke & was so utterly confused.  You couldn't even talk any sense into him.  So I stood there & listened to him & each time I told him I had to get back to work, he'd start to cry.  So I'd stand there a little longer while he repeated everything going through his mind & then he'd start to cry again.  I felt for him, but there was nothing I could do.  Well, except to give him a sleeping pill.  Some people might not agree with that, but this gentleman would not have gotten any sleep without medical intervention.  His mind had been racing - kept telling me he had to get TO the hospital.  I'd tell him "Sir, you are at the hospital right now."  He couldn't comprehend that. 

My next patient had a cardiac cath done earlier in the day & they found his circumflex was 80% blocked = transfer him to a different hospital for cardiac intervention.  I had to arrange his transfer.  He was also confused.  Coming on to shift, I found him wandering in the hall.  I took him back to his room, reoriented him...he was ok.  Later in the night...like 4 am, again he was wandering in the hall & eating a banana.  Where he got it from?  I don't know.  He was saying he was on a boat & could feel the waves moving below him.  Ummm, ok.....back to bed.  This time I put on the bed alarm so we'd all be aware if he were to get out of bed again.   EVAC showed up a couple of hours later & the transfer was made.

My last patient was a 79 yr old gentleman with the diagnosis chest pain R/O MI.  I don't think it was an appropriate diagnosis as the man had no chest pain at all - not even prior to coming into the ER.  He hadn't been feeling well & felt like he was having trouble breathing so he went to his VA clinic.  They in turn gave him a prescription for nitroglycerin tablets & sent him to another clinic to get a chest x-ray.  He went to the other clinic - they couldn't get him in until the afternoon - so they sent him home.  Nice - the man is having trouble breathing & they send him home.  On his way home, he fills the prescription & takes 3 nitro tablets when he gets home.  I don't think he had any clue how nitro works.  Needless to say, his blood pressure bottomed out & he was having syncopal episodes, so he called 911.  This gentleman is 79 yrs old & still works as a barber.  Not so much because he wants to, but because he has to in order to pay his bills.  Sad....79 yr olds should not "have to" work. 

It was an easy night.  The time did fly by, I am still tired & heading to bed after watching Nip/Tuck.  That show is so bizarre, but I can't stop watching it.  I'm off now for 2 weeks.....I have a feeling it will fly by.  I have some decisions to make regarding my puppy dog.  :(  Right now I think I'll just cuddle with him & hope he's feeling better in the morning.

 

Tired yet not sleepy

I'm so tired, yet not sleepy.  I've been up now for nearly 24 hours straight - only because I woke up early this morning.  It was a good day - I totally surprised my niece with Libby Lu's.  We never made it to Build-A-Bear.  I'll have to plan that for another time.  I can't believe she's nearly 9 yrs old.  I was in the delivery room (standing next to the doctor no less...lol) when she arrived into this world.  Time flies...way too quickly.

I came home to find a message from my hospital, desperate for help.  They even offered "call-back pay"...whatever that is.  I don't know if it's the $100 bonus or time & a half or what.  Regardless, it didn't matter as I was busy celebrating my niece's birthday tonight.  They also said they need help tomorrow night.  I haven't decided yet whether I will pick up the shift or not.  I'll see how I feel after getting some sleep today. 

One thing I forgot to mention in my last post...the strangest thing I've ever encountered so far in my nursing experience.  It is regarding the 49 yr old man with sepsis.  When I came into work last Wednesday evening, two women were in the room with him.  I figured it was family members or friends...so I left them be while I went to check on my other patients.  As I was walking by his room, I noticed the lights were off & the curtain was somewhat drawn.  That got my curiosity.  I stopped & listened.  There was one woman on each side of his bed & they were waving their hands all around & chanting about cleansing his cells & nourishing his body.  It definitely seemed like some sort of odd religious ritual.  I'm all for spiritual hope & I believe in God, but this was beyond odd.  I was not about to walk in that room, however, our respiratory therapist is a brave one.  I saw her go in for a minute & come right back out.  I asked "What is going on in there?"  She was a little freaked out.  She said "They are doing a seance or some kind of weird spiritual stuff!  I had to get out of there quickly as it was quite bizarre."  Just when you think you've seen it all...lol. 

I also had an 89 yr old man two nights earlier that continuously praised me for allowing him to have the best night of sleep he's had in years.  I didn't do anything.  He was basically falling asleep from the time I started my shift & slept until about 6 am.  Other than doing an assessment & giving him meds...I simply didn't bother him.  He insisted on giving me a hug & he followed it up with a kiss on the cheek.  I had some extra time that morning, so I sat with him for about 20 minutes & listened to stories of his past while holding his hand.  He reminded me of my grandfather. 

I'm exhausted, I need to get some sleep.  Ciao!

 

"Let's Make a Deal"

There are some nights that I go into work & feel like I'm in a version of that show "Let's Make a Deal."  Do you want what is behind curtain #1 or curtain #2?  Decisions, decisions.  I worked Monday night, then went into work Tuesday night...fully expecting to get my patients back.  Instead, my name is not even on the schedule...hmmm.  I go talk to the charge nurse & she says "Well, I have a proposition for you.  Would you be willing to work in ICU tonight if we give you one stable patient or we can ask someone else & you can have your patients back?"  Huh?  ICU??  I've never worked a day in my life in the ICU & they want me to float there when they are understaffed?  It wasn't sounding like a good deal to me, plus I wasn't buying the "stable patient" dialogue because I know if the patient were truly stable, they would have been downgraded to PCU status rather than remaining in ICU.  However, the thought of having only ONE patient as opposed to FIVE was a good one.  Hmmm....what do I do?  I ended up saying no, I wasn't comfortable with being in the ICU...I have no training in there whatsoever, not familiar with their equipment nor the drips that might be going for this "stable patient."  Basically I opted for what was behind curtain #2 (my patients back).  It was a good choice as I ended up only having one patient when I took report in PCU.  We had 4 nurses instead of 3 & most of my patients had been discharged throughout the day.  

The patient I did have ended up being an ICU transfer.  His situation is a sad one.  A 49-yr old man that had hip surgery this past August.  Everything was fine, sent home, good to go.  Except....infection set in & took over his body.  He was admitted on Oct 20th with sepsis & renal failure.  He could barely move, skin breakdown on his heels & a stage 2 ulcer on his buttocks.  His heart valves are infected as well as his brain.  He is still with it mentally - to a degree.  At times he hallucinates, other times he reflects back on the life he used to know.  He would start crying & saying "I wish I could have my life back."  Ugh, so heartbreaking.  He has 3 young kids & a wife.  I can't even imagine what they are going through watching him in this condition.  He receives dialysis on Mon, Wed & Fri.  He's in constant pain throughout his body.  Other than giving him his meds & turning him every 2 hours, I found it difficult to really do anything more for him.  I did spend some time talking to him, but didn't really know what to say when he would start crying.  I knew it wasn't appropriate to tell him he would get better because I don't know if he will get any better.  What kind of words of hope do you give when the prognosis is unknown?  I managed to discover that something simple like ginger ale perked him up - so I made sure he had some anytime he wanted it.  It's not much I know.  

I got my second patient about 3 hours later.  A 59-yr old man with chest pain.  He was so cute...he obviously has a wife that is very organized or he has a bag ready to go to the hospital.  He arrived to the floor with a little suitcase type bag which had pajamas, slippers, robe & even a headset to listen to the tv & a radio.  It cracked me up - he was the sharpest dressed patient I've seen in awhile.  He was self-sufficient.  His only real complaint was a migraine headache. 

Needless to say, I had a lot of time on my hands that evening.  I didn't get my third patient until about 4:30 am.  Another chest painer.....a 64 yr old woman.  She was feeling nauseous - which I thought had been from the 6 mg of Morphine given to her in the ER.  She began to have chest pain about an hour later.  I gave her one nitro sub-lingual and 2 more mg of Morphine.  The pain went away but the nausea came back.  I called the doctor & got an order for Reglan...gave her that & it was now change of shift.  I totally expected her to be ok, but when I came back the next evening...she had a heart cath done during the day & was scheduled to be transferred to another hospital that specializes in cardiac surgery.  Three out of four vessels leading to the heart were needing repair.  Of course the hospital she was being transferred to was the hospital I quit from last week.....ahhh, so ironic.  :)  I received a call from the supervisor at that hospital who just happened to be someone I had met while working there.  He often joked around with Gina & I...he was supportive of us being there & also knew the b.s. that we were getting.  So here he is on the phone, giving me a room number for my transfer.  I say to him "Do you know who this is?"  He says "Hmmm, Jennifer, Jennifer......the Jennifer who left here last week?"  I said yep.  He told me I should have asked to be transferred to a different unit.  I told him it didn't feel like we had any options.  He was cool about it all.  Around 10:30 pm, EVAC arrived to transfer my patient. 

I'm skipping around, but basically my week went like this:  Monday night I had 5 patients - all relatively stable with no real difficulties except for one gentleman that had what we thought was a GI bleed.  He had that "GI bleed smell."  Any of you in healthcare know what I mean.  It is one of the worst odors ever.  They assigned him to another nurse on Tuesday night & I was fine with that.  Tuesday night I had a total of 3 patients.  It was a good night.  Wednesday night there were only two nurses on the floor....I started off with 4 patients, the other nurse got 5.  My chest pain lady was transferred around 10:30 pm, so I was down to three patients.  I got my fourth patient around 2:30 am. 

He was kind of strange.  Admitted with abdominal pain, CHF & COPD.  Any time I would ask him a question, he'd laugh this strange little laugh.  I'm thinking "What's so funny?"  His heart rate on the monitor had gone up to 140....good indicator that my patient is probably up to no good.  I go to check on him & he's sitting on the side of the bed attempting to get up.  I ask "What are you doing?"  He said he had to go to the bathroom.  Ummm, sir, you have a catheter - it's there so you don't have to get up.  I manage to get him back in bed & his heart rate goes down.  I tell him to stay in bed, that if he needs help - press the call button. 

I got my fifth patient around 5:30 am.  A 91-yr old man that I would not have believed was a day over 70.  He looked great.....only medical history was both hips were replaced & arthritis.  Only medication he takes at home is a daily vitamin.  He rattled off about all of his family members that were in their 90's or over 100.  His diagnosis was hemorrhagic stroke.  Hopefully he'll be ok.

Practically everyone I ran into at work was asking how it was going at the other hospital.  I told them the truth about what happened & again...they were all supportive.  It was a nice reminder that who you work with is very important.  It makes a real difference.  They put me on the 2nd floor & Gina on the 3rd floor.  That's the only thing that irritates me...how they constantly separate us.  Oh well, what can you do? 

I'm off until Monday...yay!  Actually, Monday is the only day I'm scheduled for the next two weeks.  I may pick up more shifts, but then again, it would be nice to have a break.  We'll see how it plays out.  My niece's 9th birthday is next Friday, so I'm taking her out tonight & tomorrow to celebrate.  Libby Lu's & Build-A-Bear...here we come...lol.  I need to get moving...need to get to Target & buy her some gifts. 

Have I mentioned that I love having my work week done in 3 days?  It's nice having 4 days off (or more) every single week...it really is.  :) 

Happy Halloween

Happy Halloween everyone!

Nothing exciting going on this week.  It's been very nice having nearly a week off, but the time goes by way too fast.  The job fair was a waste of time.  The hospital we wanted to talk to wasn't even there.  Plus it was more of a student convention, so we were out of place even being there in the first place.  Amazing how just one year can change things though.  Last year we were sooooooo looking forward to the student conventions & this year - no at all.  We have no interest in study guides, nclex reviews, etc.  Even the free pens & merchandise were no big deal this year.  Last year we were lucky enough to have the National Student convention in Daytona Beach.  Gina & I left there with bags & bags of stuff...all free.  One person commented that it looked as though we went shopping!  I still crack up thinking about Gina in the parking lot carrying all of her bags to the car.

Anyways...the next step in gaining experience is to apply to another hospital.  Yep, another hospital - they are starting to get farther & farther away.  We'll have to start carpooling soon.  This hospital is opening a new floor...a 23-hr observation floor.  Sounds interesting, plus the floor is closed from Friday afternoon thru Sunday afternoon = no weekend commitment.  I'll be emailing my resume sometime this week.  I'm still interested in travel & agency nursing, but want to gain a little more experience first.

I'm working Mon, Tues & Wed nights this week.  I couldn't pass up the bonus money.  Besides, no one comes to my house on Halloween anyways.  There are very few houses around me, so I would find it odd if someone did show up...lol.  May as well make some money.  I am leaning more & more towards taking 2 weeks off coming up here real soon.  I need to work on my rental house - the interior needs painting & it's not gonna happen by itself.  Plus I want some "me" time as well as Christmas shopping time. 

I managed to catch up with one of my nursing school classmates on Friday night.  We went to dinner & to see the movie "Elizabethtown."  It was fun seeing Kelly, but the movie was not really all that good.  The meaning was good - that rather than focusing on our failures, we should focus on how we respond to failing.  That true success is picking yourself up & moving forward...something like that.  I like the one line in the movie..."Do you ever feel like you're just fooling everyone else?"  Ahh, I can so understand that line.  Not that I am fake or hide the real me, but there are times when those type of thoughts come across my mind.

This post seems beyond boring...so I will end it now...lol.  I'm babbling = time for bed.

 

 

 

Grrrrrrrr

Hurricane Wilma came & went - no problems suffered here by me, but many have wind & flood damage.  We lucked out by having a cold front move in & keep most of the damaging parts of the hurricane away from my area as well as bring in some nice cool temperatures.  It finally feels like fall.  I love this weather.  I've got my windows open & breathing some fresh air.

This morning both Gina & I formally resigned with a two-week notice to the not-so-great hospital.  We worked last night.  It was a pretty good night, however, I told Gina it was probably the calm before the storm.  And as usual - I was right.  :)  Since our manager wasn't there, we put our resignation letters in an envelope & taped it to his door.  About an hour later I received a voicemail acknowledging receipt of my letter.  He also went on to say that according to my contract, I must work an additional four days.  That I must call him back & let him know what days I will work or else he'll simply schedule me & I'll be expected to show up."  Grrrrrrrr!!!!!!  I don't have a contract, we have no agreement, I'm not officially scheduled until Nov 14, which is well over 2 weeks away.  I'm wondering what happens when I don't show up because there is no way I'm going back.  I mean if they didn't treat us right when we were there as staff, how are they going to act knowing we are quitting?  Forget it.  I don't even want to know.  I'm not sure how to handle this.  Any ideas or advice? 

The only thing that worries me is that this hospital organization has a reputation of not allowing rehire at any of their hospitals (they are the largest health organization in the south) if you don't resign the correct way.  I thought I had - giving 2 weeks notice.  Obviously he doesn't agree.  Everything he has told us has been lies, so I am apt not to believe what he's saying now.  There is no contract, no obligation, no agreement...but I do think he would still be able to ban us from any rehire in the future.  Which doesn't bother me at this particular hospital - I'll never go back.  But this is a large organization & I don't want to have a black mark from ever being able to work at a sister hospital of theirs, you know?  Oh well...I guess all I can really do is see how it plays out. 

I was contemplating mailing a letter to human resources so that they have a copy of the resignation letter as well as turning in my badge.  I just don't know how to handle this.

On a brighter note, my first hospital is offering incentives to work...$100 bonus per shift.  Nice!  They are also promising to have more support staff to help.  I'll believe it when I see it.  I worked there on Sunday & I do like the people there - it's nice not feeling/knowing everyone is talking behind your back like at the not-so-great hospital.  There is a job fair tomorrow also that we are going to check out.  Ideally I'd like to go agency, but I need to investigate it all first.  Anyone with any advice?  

I only worked 2 days this week - both relatively good nights.  I am leaning more & more towards cardiac nursing.  Both Gina & I like the chest pain r/o MI patients.  It amazes me that even when someone is having a heart attack, that a lot of the time - they don't even notice it.  I guess because medical intervention has begun & they are receiving pain relief.  I just think back to that image where someone is clutching their chest in great pain, but that isn't what we see in the hospital.  Outside of the hospital I'm sure is a different scenario.  

There is another hospital with a floor specifically for 23 hour observations.  That sounds ideal to me, but I need to find out more information.  I have decided I am not yet ready for ICU.  I want to learn at a gradual pace rather than having everything thrown at me.  I don't thrive off of stress nor do I want to hate going into work.  So maybe after a few years of experience, I may venture in that direction. 

Ok, enough of the boring chit chat.  Have a good night everyone!

State of Emergency

Hurricane Wilma is on her way.  Most of Florida has already been declared a state of emergency.  The govt offices & schools are closed tomorrow.  I wish the hospitals would close...lol.  Hopefully this hurricane won't cause too much chaos.  I'll have some updates tomorrow.

This journal entry will be a short one as I have to get ready to go to work as well as finish watching Nascar.  Go Stewart Go! 

I'm very proud of my oldest nephew - he received a baseball scholarship at The Citadel.  He'll be playing first base & pitcher.  He is an awesome baseball player & may also receive an opportunity to go pro right out of high school - time will tell.  I can't believe he'll be going to college in a year.  I still have vivid memories of when he was a toddler & also just starting out by playing t-ball.  These years go by too fast.  Great job, Eric!

 

THE FINAL STRAW

One more day to go...I do believe that Monday night will be my final night working for the second hospital.  I am planning to give my 2-weeks notice after my shift is over that night & since I am not scheduled to work for 3 weeks, I believe it will be my final shift there.  The reason = incompetent staff.  I truly believe my nursing license is at stake if I remain working in such an unsafe environment.  Maybe I'm overreacting because I'm new or because I have different expectations of patient care...but I rather err on the side of caution than what I experienced during my shift last night:

When I arrived for my shift last night, I saw that I did not receive all of the patients I had the night before.  Instead, they gave me a new admit & gave one of my patients to someone else.  When I questioned this, I was told "Well, that nurse is also going to be the charge nurse tonight, so she can't take the new patient - he has too many issues going on."  Nice answer, huh?  Let's give the new nurse the toughest patient on the floor.  I looked at the telemonitor & saw that this patient's heart rate was 150.  I asked the day charge nurse "Is this being addressed?  Has he been given any meds to bring down his heart rate?"  She looked at me like I was overreacting.  She said a call was placed to the primary doctor (he had no consults) & that I shouldn't be so concerned about the heart rate.  HUH??????  Not concerned about a patient that is sustaining a heart rate of 150?  She advised me to get report from the dayshift nurse & I would understand why his heart rate was so high.  Ummm, ok.  Not the answer I wanted, but figured I'd see what's up. 

The day nurse advises me that this patient is a "frequent flyer" (shows up at the hospital often).  And that he is not only yelling & screaming at her, but he's urinating & deficating all over the floor multiple times.  Wonderful!  Add on that he has tuberculosis & aids as well as a heart rate of 150 for the last 3 to 5 hours...can it get much better?  Oh yeah...his H&H is 7.1/24.0 and his K+ is 2.8.  NONE of which has been addressed neither in the ER or when he got to the floor.  If this had been my first hospital - he would not have even been admitted to PCU, much less a surgical telemetry floor = he would have gone directly to ICU.  However, we are not talking about my first hospital...this is the second hospital.  I leave report & the day charge nurse tells me "The doctor called, I got you Ativan 1 mg & to transfuse 2 units of red blood cells & if pt's heart rate remains greater than 120 after the 2 units have been transfused, to consult a cardiologist."  What kind of orders are those?????  I'm not a doctor, but I had a pretty darn good feeling that this pt's problems would not be resolved with 1 mg of Ativan.   And I'm supposed to watch this patient's heart rate remain elevated for at least the next 4 to 8 hours & hope that the Ativan & blood brings it down?  I'm not a cardiologist, but in my limited experience, this patient would need a cardiac med to slow down the heart rate.  When I questioned it again with the day charge nurse, she replied again with a comment such as not to be so concerned about the heart rate, that the patient has issues.  Issues!

I go in to assess this patient with issues - totally expecting some out of control madman.  What I find is my patient lying in bed practically sleeping although he is awake.  I went ahead & gave the Ativan in hopes that his heart rate would come down a little.  I quickly checked on my other 4 patients to make sure they were stable, then I went back to this patient.  I wanted to get the blood transfusion started as soon as possible.  He had been typed & crossmatched before I arrived, but no blood consent form was signed - I found that odd, but went ahead & got him to sign it.  The ativan had practically knocked him out, but his heart rate was actually increasing.  It was in the 160's now!  I turned to the night charge nurse for advice - she had none.  She wasn't concerned one single bit about this patient or his condition.  She had patients of her own & that is all she wanted to focus on.  Her advice to me - give the pt some Tylenol.  TYLENOL????  He did have an temp of 101.3, so I gave him 625 mg of Tylenol & called the nursing supervisor.  I informed him of the dr's order to consult a cardiologist after the blood was transfused if the heart rate remained above 120.  I told the supervisor I was not comfortable with sitting here watching this patient tach away with a rate of 160-165 & not be doing anything to get that rate down.  He agreed & advised me to call the doctor.  Again though, the supervisor was not really concerned overall.  I called the doctor & basically told him that we needed to address this patient's heart rate as well as I needed an order from him to start the blood transfusion even though the patient had an elevated temp.  I rec'd an order to push Cardizem 10 mg IV & go ahead with the transfusion....and give Xanax 0.25 mg.  Why Xanax?  The patient couldn't be any more still in bed than he already was, but I went ahead & gave it as well as the Cardizem.  Gina was kind enough to go down & pick up the unit of blood....finally got that started at midnight.  I continue to watch the monitor & the heart rate has not changed at all = 160.  Ughhhhhh!  An hour goes by, still no change.  I call another nursing supervisor to inform her of this, she tells me to call the doctor again.  She is not overall concerned either.  Why am I the only one worried about this patient that has now gone nearly 7 hours (that I know of) with a heart rate higher than 150?  I call & wake the doctor, receive an order for 5 mg more of Cardizem and 0.5 mg of Digoxin.  I administer it & hoping it works.  Luckily after another couple of hours, his heart rate is down to 125-130.  By the time I left this morning, it was 115 - yay!  I found out a couple of hours later, he signed out AMA.  I get the feeling that no one at that hospital probably even cared or urged him to stay. 

It just amazes me the attitude at that hospital.  I know he was a lot of work, a pain in the neck & non-compliant outside of the hospital.....but aren't we supposed to give them the best care we can while they are in the hospital?  Maybe I'm still naive, not yet jaded....maybe I'm too worried about keeping my nursing license or don't know the ins & outs of covering my butt so I do things by the book...I don't know.   However, their lack of concern really opened my eyes to the danger I am placing myself in by remaining on a unit such as that one.  I have no support staff, no one to turn to when things are going bad......except Gina, who is another first-year nurse like me.  I can't imagine what takes place there when someone codes or has a heart attack.  The phrase "Give him some tylenol" plays in my mind.  As if Tylenol is some miracle cure.

Somehow Gina is more fed up with how things were last night than I was.  We both called off for tonight.  I don't want to go back, but I am scheduled for one more shift on Monday night & will fulfill my obligation as well as give a letter of resignation/two week notice.  When I called in today, my unit manager responded with "Your troubled patient signed himself out AMA if that makes a difference."  As if it was the patient that is causing these doubts I have.  It's not the patient's fault that his heart rate was tachy & no one at the hospital wanted to address it. 

Sooooo, luckily my first hospital is very short-handed & picking up extra shifts will be no problem.  At the same time, I have managed to save up some money & I may take a couple of weeks off in November or December.  I'll just play it by ear.  I am looking more & more into travel nursing.  I'd like to start out somewhere local through the holidays & perhaps actually travel elsewhere in the state or even out of state in 2006.  That's my latest plan anyways. 

I did have a situation arise on Monday night while at work.  One of my patient's was the father-in-law of one of the nursing supervisors.  Upon his return from surgery, the father-in-law told the supervisor to get out of his room, that they were not family.  So rather than asking his father-in-law how he was doing, the supervisor would ask me.  Anyone in nursing knows all about HIPPA...which is basically the patient's right to privacy.  I didn't like the situation this supervisor was putting me in - the patient obviously didn't want him to know anything & yet he was asking.  What do you do?  I managed to avoid the supervisor all of Monday night...lol...so I didn't violate any privacy issues.  By Tuesday it seemed the anesthesia had worn off of my patient & he was a little more receptive to his son-in-law being involved in his care. 

Anyways, that is the latest saga of my nursing adventures.  I am still tired & worn out from last night.  My feet are killing me, I have a headache...but at least I finally have an answer.  I have learned a valuable lesson.  If something sounds too good to be true, it usually is.  Computerized charting, admission nurses & patient care techs are wonderful to have, but it doesn't mean squat if you are working in a unit that throws you to the wolves.  That short chapter of my life is closing...by choice.

Oh, one more thing....Hurricane Wilma...make her go away!  More updates to come.

 

The drama continues

I had a 12-lead EKG class today.  I feel like I've learned nothing other than seeing a Q-wave is not a good thing.  I've got a new respect for cardiologists also.  The heart isn't a very big organ, but man does it have a lot going on in there!  Needless to say, I think I'll be taking the 12-lead EKG class at the other hospital because I feel like I definitely did not grasp any type of understanding of what I'm looking at.

Before the class started, our (Gina & I) manager showed up.  He told us he sent us an email - which of course we haven't read yet because we haven't worked there since Tuesday night.  He goes on to say something like his advice is to branch out & start socializing with the other nurses, that they are feeling slighted that we aren't spending a lot of time with them.  What????  Is this a job or is this a country club?  I am always polite to everyone (can't say the same about Gina...haha) & make small talk "Hey, how's it going?  How are you doing? etc"....but I have no desire to sit around & socialize with these nurses that have already gone out of their way to cause trouble.  I'm blonde, but not dumb.

Our friend in the ICU told us today that the manager of the ICU is considering bringing us into that unit.  I think at this point, it's the only way I would stay at this hospital long-term.  I am eager to learn, but still intimidated by all that happens in ICU.  I also saw an ad at another hospital (farther away) for pediatric ICU - no peds experience necessary.  I'm not sure I could bare to see children in such critical condition though.  I imagine it has to be very heartbreaking - not that seeing an adult in critical condition is some picnic, but children are young & innocent - they have yet to really live life yet & it isn't fair that they have to deal with pain & suffering.  That's my opinion anyways.  I'm thinking it all over.  There are so many opportunities out there that it's difficult to figure out which is the right one.  In the back of my mind is still travel nursing as well as agency nursing.  I figure the answers will come to me (in time) & that I will be led in the direction of where I'm supposed to ultimately be. 

After class was over, I decided to get my haircut.  Sounds like something simple - but for those that know me - it's not one of my favorite activities because my hair grows sooooooooooooooo slowly.  I got about 2 to 3" cut off - it was rough seeing it cut, but the funny thing is...it doesn't feel much different.  I knew the ends were damaged & had to go.  I'm thinking about getting a pedicure this weekend - time to pamper me, right?  What else am I working for?  :)

 

 

Sincere or fluff???

Well.......Gina & I were called into a meeting with our unit manager last night during shift change (nice timing, huh)?  Our manager basically apologized about 5 times to us for the treatment we received while he was out of town.  I want to believe he was sincere about it & that it wasn't just done as an effort to keep us from quitting, but I just don't know.  Seems he had a few excuses for those that were out of line, but on the upside, he had nothing but positive things to say about us.  He launched into a lecture about the saying "nurses who eat their young" & how he doesn't understand why they do it.  Then he said something like "Surely this isn't the first time you've encountered it."  Ummm...yes, it is.  Well, other than when we were students & the nurses didn't really want to give us the time of day - but even that wasn't as bad as the rude behavior we received last week.  I interrupted him during that lecture & told him rather than asking us why we think it happens, perhaps he should go to the source ("S") & ask her why she resorts to this behavior.  Basically we've been getting the same b.s. excuse - that she has a rough home life & takes her stress out at work.  Sorry, that's not acceptable & it should not be tolerated.  And it's not just us she treats rudely - she is downright rude to the patients.  We keep hearing that no one likes her, that they've all just learned to ignore her - why is she still employed there? 

We basically allowed him to say what he had to say & then we asked about our patient load & why we get such a guilt trip from the others when we won't go over our assigned patient load.  He said it was cause he was out of town & it wouldn't happen again.  We're up to 5 patients each now.  Well, last night - not more than 3 hours after this conversation took place, I got a call from the charge nurse trying to assign me a 6th patient.  Ummm...no, I will not accept a 6th patient.  Once again, I got the guilt trip - I finally had to say "CALL THE UNIT MANAGER &/OR THE NURSING SUPERVISOR - DO WHAT YOU HAVE TO DO - I AM NOT TAKING A 6TH PATIENT TONIGHT."  This is so unlike me...I'm usually easy-going, a team player...but I have my limits & it seems like this hospital continuously pushes the boundaries & somehow I end up looking like the bad guy.  Not only that, but there were regularstaff nurses who only had 5 patients - they should be the next in line to move up to 6 patients since they've been there for years.  It seems like they think they can push the "new nurses" (that's our nickname) around.  Uh, uh...it's not happening.  I'll quit before I let them take advantage of me. 

It's discouraging - to have a conversation directly with the unit manager saying one thing & the reality being something totally different.  It's not a good sign.  At least at the other hospital - there are no broken promises - they tell you exactly what to expect...even if it's not the best news.  It's the way I prefer it - straight up & to the point, no surprises........besides, I only like good surprises.  :)

Who knows if "S" will be reprimanded or not.  We told our unit manager how she is throwing out verbal warnings, threatening us with written warnings & still harassing us.  He says it will be dealt with.  We also found out that "S" is lying about us (big surprise).  She told him that we leave the floor without telling anyone & that we're gone for over an hour at a time.  Yeah...right....that would be abandonment & you can be immediately fired for that.  Besides, I would never do that to my patients.  I'm definitely not perfect, but I don't put my patients in danger. 

With that being said, my week was rather uneventful.  I worked one day at the first hospital & one day at the second hospital.  I have a 12-lead EKG class on Thursday.  I might pick up a shift or two this weekend - not sure yet.  I know it's going to be a busy Nov, Dec & Jan - so I'm leaning towards the free time I have now before dedicating most of my time to work.   It will be a lot easier to start working on Sunday nights once Nascar is over - go Tony Stewart go! 

I'm watching Martha Stewart (I am so NOT a home improvement type person), but she has pets up for adoption & they are sooooooo cute.  It's giving me the itch to get a new puppy.  I can't do it though - it's not fair to keep a puppy/dog cooped up for 14 hours a day while I'm working.  I have a 12 yr old dog who is pretty content with sleeping the entire time I am gone, but I know a puppy isn't going to tolerate that.  There is a puppy on this show who looks exactly like my dog did as a puppy - sooooo cute.   I wish there was a way to have one, but not with my work hours. :(  Maybe I'll get a kitten...but it's just not the same as having a dog.

Thanks to those of you that wrote with support of the harassment Gina & I received.  It's nice knowing we have those that understand.  Take care!