Thursday, May 5, 2005


I just woke up from a 3 hour nap...that is one thing I don't like about working the nightshift - it really messes up your sleep schedule when you try to get back to waking up during the day.  I worked Sat, Sun, Mon & Tues nights - with each day I gain a little more confidence.  I love being on my own!  I still ask plenty of questions & discuss many situations with my clinical leader, but it's nice to have the independence & be able to plan my evening the way I want to.  Two of those nights Gina was on my floor - makes it more fun when you have a friend close by. 

One of my patients was the same one I had the week before.  I got to know her & her daughter a little better.  By my last shift with them, the daughter was hugging me & thanking me for taking such good care of her mother.  One cute thing that I will remember about this patient is when I went in to ask her exactly how to pronounce her last name (because the day nurse had been pronouncing it very differently than the way I was).  So I say to my patient "Mrs. so-and-so, how exactly do you pronounce your last name?"  She replied "To you, it's Naomi" (her first name).  It was just so sweet & genuine.  Taking care of her was sort of like a rollercoaster night she was out of it & lethargic, could barely speak and the next night she was alert & fiesty.  It seemed to vary between the two extremes.  She is in her late 80's & it seems her daughter realized she doesn't have a lot of time left.  It was hard to watch her struggle with that reality because the thought of my parents passing away scares the heck out of me.  She called me one night & said she was having a hard time sleeping & could I please go into the room & tell her mother that she loved her.  It was touching.

I had another patient that came in with a diagnosis of Tylenol overdose.  I don't even know why she was at our hospital because where the overdose took place was over 60 miles away.  She belonged at the hospital that has a psych facility (which was closer to her than we were).  As soon as we got her stable, she was transferred over there.  She was a handful - ripped out her IV, threatened to leave the room, got all aggressive towards the staff & in the next minute - quiet & cooperative as she could possibly be.  I tried to have patience with her, but when I saw that reason wasn't always working - I'd leave the room until I could think up another strategy.  Needless to say, I wasn't disappointed when I came into work Monday night & heard she had been transferred.  I don't have a lot of patience when it comes to people that purposely want to harm themselves.  I try to be understanding, try to see the outlook from their perspective, but it's not always easy to do - especially when they are giving you a hard time when all you're trying to do is help. 

I had a couple of other patients that were in with chest pain r/o MI.  In fact, I had two of them complaining about chest pain within 30 minutes of one another.  Those are so NOT my favorite words = "I have chest pain."  I assessed the first one, find out that it's more of a really bad headache than chest pain.  The last thing I want to do is give her nitro SL since it would cause an even worse headache.  I couldn't even give her any at the moment anyways because pharmacy messed up & forgot to add it to her MAR & the day nurse missed that also.  So as it was being refaxed to the pharmacy, I continued to assess the patient.  That's when she stated she didn't feel chest pain any longer, that it was a really bad headache.  So I gave her tylenol instead & after about 45 min, she was fine.  As I was finishing up with her, the patient in the next bed started complaining about chest pain (I'm beginning to think it's  I assess her, get the nitro & about ready to give it to her when she states "It's my head that hurts, not my chest anymore."  Ok, scratch the nitro, more tylenol instead.  Never underestimate the power of tylenol.  :)

I had another patient that was in with a diagnosis of syncope.  I was convinced he was a "decoy" that the hospital set up.  Let me tell the whole story.  We have JCAHO coming to our hospital either next week or the following week.  And in that time, we have had at least 3 hospital employees (that I know of) suddenly become symptomatic.  One of them was my patient.  I'm probably paranoid (Gina thinks I'm nuts), but I kept telling her he was a  Mostly because all of his labs were normal, all tests were normal, etc.  So who knows - that's my story & I'm sticking to it.  They have been doing mock JCAHO stuff lately, why couldn't this be it also???

My final patient of my 4-day (night) shift was a woman with a peg tube & an open abdominal wound (she had bowel surgery in the past month or so).  Those were not her problems, again...chest pain.  She was not complaining of chest pain or if she was, I didn't know about it because she only speaks spanish (put that on my list of things to learn).  Her peg tube was not able to be used because it ended up in soft tissue rather than her stomach.  But her major problem (in my eyes) was the infected abdominal wound.  You could smell it & it was not a pretty smell.  I had orders to put it to negative suction.  It's funny - we just had an inservice from wound care on how to operate the equipment & I was seriously thinking at the time "When am I ever really going to use that device???"  Well, here I am with an order to use it.  My clinical leader & Gina helped out (or should I say, did most of the work - thanks guys!).  I also had an order for a wound culture.  We took off the gauze that was there & saw what was underneath.  I had no idea what I was looking at nor did my clinical leader.  It was a large, deep abdominal wound - I was surprised we didn't see organs or that there was no blood seeping out.  There was a lot of drainage though - awful looking smelly drainage.  We packed the wound with this sterile black sponge stuff & then applied suction.  I felt like we were doing  It looked rather impressive after we were done I must say! 

After work on Wednesday morning, for some reason Gina & I decided to go to a job fair that was an hour away & it was raining out.  We were so tired.  In fact I knew Gina was tired because when we got there, she hardly even spoke & that is not like her.  Usually she's asking a zillion questions to perspective employers.  We ran into our old employer - well the human resources lady anyways - she is a strange one.  I don't think I'll ever go back to workthere if I have todeal with her.  Then we were basically pursued by another local hospital - the lady came up to us.  The time spent talking to her made the drive worth it.  The hospital sounds awesome - it's all computer charting - you have your own laptop, you are teamed with your own tech to deliver patient care rather than having one tech for 18 patients or no tech at all.  They have nurses that handle the admitting paperwork completely....the list goes on & on.  Needless to say, it sounded like heaven compared to where we are at now.  I really like the staff where I'm at, but there is no computer charting, we are lucky if we have a tech - let me rephrase...lucky if we have a tech that actually helps out rather than disappearing after vitals are done.  I'm not dissing techs in general, just some of the ones that work at the hospital I'm at.  I used to be a tech while I was a student & I did as much as I possibly could to help out the nurses.  Most of our techs give us attitude if we ask them to take a person to the lobby that has just been discharged or if we get a new admit that needs vitals, etc.  They make up excuses of why they can't do their job or they just disappear for awhile.  It's frustrating.  Anyways...this other hospital is something to look forward to in the near future.  I did have an opportunity to work there - they wanted to hire me into the post-open heart surgical floor & it intimidated me as a new grad.  I wasn't ready for that & not sure I am yet - but definitely in the future. 

On top of all that, I also got a raise at work.  Not because of my hardwork, but because the hospital is trying to be competitive with it's rates & they raised up the starting rate of new nurses & therefore I believe I will receive over a $1/hr raise.  We'll see in the upcoming weeks when I get my pay stub.

Time to go relax & watch Survivor!

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