I've been keeping busy this week to keep my mind off of the big test on Monday. I can't believe it's the end of February already! I have thankfully gotten back to a day schedule by going to sleep very early & waking up very early. I worked Wednesday night, had an EKG med class on Friday, went to dinner last night with Julie & Shawn (love the Olive Garden!) and then met up with Kelly to see a movie (The Wedding Date - it was ok). Today I'm meeting up with Gina to go shopping & to check out where the testing center is that we have to go to on Monday as well as find a hotel in the area to stay at tomorrow night.
We keep hearing the same thing from anyone that has taken the exam: "I think I failed." They can't even give us any idea as to what to study. I feel so very unprepared - it's not a good feeling, but then I keep hearing that no matter how much you prepare, you still feel unprepared. I won't find out the results until Wednesday - it's gonna be a long 2 days next week waiting to find out.
I worked this past Wednesday night & it was frustrating. Between having very unstable patients & a preceptor that would ask me to do something & then change her mind when I started doing it was wearing on my nerves. She gave me one patient that had a heart rate in the high 130's, low 140's & then tells me we need to get this person to the ICU as soon as possible. The day nurse pretty much did not do her job - she had the unstable patient for an hour & never addressed her serious problems. Instead she was orienting her to the room & how to use the call bell. Hello......the woman is practically having a heart attack & the top priority is to show her how the room works??? Dumb, dumb, dumb. The nurse didn't want to call the doctor, didn't want to give the lady her meds - I sat there thinking this woman could die simply because of a nurse that is not too bright or is more focused on going home than taking care of a patient in serious condition. I understand wanting to pass off a difficult patient, but not when the patient's life is on the line. We finally do all we need to do to get her a bed in ICU. I ask my preceptor "Don't we need to get the heart monitor off the code cart to put on her during the transport?" Shesaid no. No???? I thought it was something we always did while transporting someone to the ICU. She replied "Only if the patient is unstable." Ummm....heart rate in the 130's, showing signs & symptoms of an impending MI, being transferred to the ICU & she's not considered unstable?" What does it take to be considered unstable in my preceptor's eyes??? Next the patient care tech & I were transporting her to the ICU when the tech says "Hang on a minute, I have to get this new admit (different patient) into bed." So we stop outside the door of this new admit so she can run in there really quick & get the patient into bed. Well, what was supposed to be really quick ended up being not quick. So I'm standing there in the hallway with our unstable patient who is telling me she feels lousy, that it's like nothing she's ever felt before & my transport partner is taking her time doing not so important stuff. Another nurse was walking by & yelled at the tech "This woman is going to ICU - that is your priority right now." The tech got a little pissed off, but come on - the patient is going to ICU for a reason!!!!!! Needless to say, I was less than happy with how the night was going so far. Later that night I got a new admit - a woman that was practically in the same boat as the one I had just transferred to ICU only add on top of her heart attack, a really bad infection of unknown origin (WBC 39.6). And the doctor did not prescribe any antibiotics. Because this woman was a DNR (do not resuscitate), she ended up on our floor rather than the ICU. She already had a heart attack sometime within the last 48 hours of arriving to the hospital. She was doing ok when she got to my floor - suffers from dementia also so she was somewhat confused. Got her admitted, she's resting quietly, everything is good. A couple of hours later, her heart rate is in the high 130's - go assess her & she is shaking, breathing is labored, she's disoriented. She had not gotten any of her meds in the ER (starting to see just how incompetent they are, but that's another story). My preceptor used her critical thinking skills & decided that since this woman hadn't urinated at all in the 3 hours we had her - that she would insert a foley catheter (without a doctor's order). It was a good thing she did because this woman was unable to urinate on her own because she has a RAGING urinary tract infection - we're talking thick nasty looking pus-like urine - I've never seen anything like that ever before. It was gross what was coming out of her bladder. Again - why was this not addressed in the ER??? Especially with a white blood cell count of 39.3!!!!!! My preceptor put in a call to the doctor, told him what she had done & that we need an order for a urinalysis. Meanwhile her heart rate came down, she was doing better.
I had another patient that had a heart cath done earlier in the day & it showed 99% blockage in one of the main arteries. The doctor then scheduled the guy for surgery at another hospital for Friday (we don't do major heart surgery at our hospital). I don't understand why it had to wait until Friday unless the doctor was busy. 99% blockage is not a good thing. Maybe it's because we aren't a trauma hospital that things are not taken so seriously - I don't know. Or maybe cause I'm new, anything that raises a red flag I do take very seriously. It was just a frustrating night.
Ok, time to go shopping!!!!!