Drinks & a movie

Tonight I met Kelly up at Chili's for drinks & then we saw the movie The Wedding Crashers - great movie!  I went to nursing school with Kelly.  She works at a different hospital now, but we get together now & then to catch up on how things are going.  We had read about it in the past, but now it's a reality.  I'm talking about exchanging all of the gross details, facts, stories, situations about what we've encountered at work.  Stuff that non-medical people would freak out over hearing about, much less being able to eat at the same time.  Gotta have a good sense humor to survive!!!!!  Otherwise the stress will eat you alive.

Update on my house situation - both the house I live in & the house I rent are up for sale.  A builder has touched base with my dad & wants to buy all the land we have to sell (about 20 acres).  He is sending a "letter of intent" with his offer.  Hopefully it will be a good offer so we can sell.  I want out of this town.  As much as it's comfortable & I hate the idea of packing up all my stuff...the thought buying another home & starting new sounds wonderful to me.  My only requirement - it must have a swimming pool.  I can't go another summer without close access to a pool. 

Lots of change seems to be looming - a new hospital & a new house - I'm ready for both opportunities.  Bring it on!  Have a good weekend, y'all!!!

Finally some time off

Ahhh, in the past week, I have worked over 80 hours (what's wrong with me???  lol).  Now I have 7 days off to relax & recuperate.  There was a staff meeting at work yesterday.  They went over the new policy of being in the staff breakroom at 6:45 prior to shift change - no later.  Which is fine with me.  I get there around 6:05 anyways.  Rather be early than late.  They reviewed the unit's gallup scores again & showed us what type of remodeling they are doing on the second floor.  All in all...it was boring.  And there's always one person that asks an off the wall question that has nothing to do with the topic at hand.  This time it was chest pain from cocaine & how he thinks we should send everyone to rehab.  Yeah, ok.....discuss it on your own time.

My night went pretty well though.  I had one patient whose blood sugars had been in the 300's & 400's all day...so the doctor ordered "no bedtime snack."  Well, his blood sugar at 2200 was 60.  So much for the "no bedtime snack."  I gave him some graham crackers, peanut butter & low-fat milk.  That got him up to 67.  Gave him a turkey sandwich & more milk & he made it up to 138.  Perfect as far as I'm concerned.  By the time morning labs were drawn, he was up to 255 & counting. 

I had 5 patients last night...all pretty much easy to care for.  My new admit was this undernourished older woman.  She came in with pneumonia, hip fx, diarrhea & dehydration R/O c-diff.  She was confused when she got to the room, was saying mean things to the ER nurse that brought her up.  I got her situated, assessed, talked to her for a little while, made her comfortable & she was praising me.  :)  I had another patient the night before that kept telling me that I was a good girl & she wished she could take me home with her.  Awwwww!  I think some of these patients just really need someone to sit down & give them a few minutes of their time & show them that they care. 

Anyways, my pt above only weighed 85 lbs, was pretty much justskin & bones.  She had multiple skin tears all over her body & all the nursing home was doing for her was covering them with tegaderm.  Who knows how long those had been on.  I informed my clinical leader that we needed to take pictures because she was in real bad shape.  The x-rays also showed that her left hip was broken - but it's not a new fracture - it's old.  So who knows when or even how she actually broke that hip.  Sad!!!  It's weird how some patients can be so confused, yet as I was walking by her room - I heard her reciting prayers & she knew them word for word.  I ended up giving her some Ativan because she was rather anxious & kept pulling off her gown & the leads to the heart monitor.  That calmed her down & allowed her to rest a little bit.

We had another patient on the floor that wasn't mine, but he was confused also.  So confused that not only did he repeatedly try to get out of bed, but he began to be combative.  They put him in wrist restraints & called his wife in to help reorient him.  Instead of reorienting, he began to tell his wife how he was going to kill her & was yelling at her to leave.  This poor little old lady was so shook up & saying "He's gone crazy!"  I felt for her - I couldn't imagine what it's like to hear your husband of many, many years speaking like that.  Hopefully they'll figure out what's going on with him because he was not like this 2 days ago.

It was a much calmer week compared to last week.  I'm thankful.  The administrative staff irritated me though.  I requested to work on the second floor & they wouldn't let me.  They gave me a b.s. excuse.  I would have rather them just straight out say no than lie to me with a dumb excuse.  It's like they simply don't care about their staff.  The hospital morale is so low - I couldn't imagine why!

On a brighter note, I have an interview with the other hospital on Tuesday morning.  Gina has one also.  They are a better hospital - one of the best in the area as far as cardiac care & that's what I want - to learn more about the critical care of a patient as well as be able tocompare hospitals & the way things are run.  Should be interesting!

P.U.

Just when I made the comment of c-diff being a really awful smell, I am presented with a patient this week that has a GI bleed.  Talk about a terrible odor, that makes c-diff seem like a perfume!  To top it off, our GI doctor is trying to say nothing is wrong with her.  Umm, she has blood pouring out of her whenever she goes to the bathroom.  I'm not a doctor, but I do believe that is abnormal.  She came in with a Hemoglobin level of 7.7.  It took 3 units of RBC's to get her to a level of 10.2.  However, with as much blood that was coming out of her...I think it's only a matter of time before that hemoglobin drops again.  The hematologist was consulted to examine her today.  Sweet lady, but at one point during the night, she had gotten out of bed to try to use the bedside commode - accidentally pulled out her IV which was transfusing blood & also missed the bedside commode.  There was blood everywhere - bright red blood from the blood transfusion & dark awful smelling blood coming out of her & all over the bed & the floor.  It looked like a murder scene.  Thankfully I had a great PCT to help me out.  The cleaning lady was not happy about having to mop up all that blood off the floor.  Although it wasn't the blood she had a problem with - it was the smell.  I can't even describe it, but trust me on this one...it's awful.  Even spraying some industrial smelling spray didn't make it any better.  If anything, it made it worse.  I needed some Febreeze...lol.  I couldn't believe her roommate wasn't complaining.

My night was pretty uneventful - most of the patients slept quietly through the night.  Another nurse had a patient who it seemed had a pulmonary embolism travel to his lungs.  Needless to say, he was transferred to the ICU rather quickly & put on a ventilator.  Scary stuff.  I also found out that a patient I had about a month ago - the one that "accidentally" pulled out 3 IV's in one night - had died last week in the ICU.  Seems that when he & the family had finally made the decision to go with Hospice, he died about an hour later.  Weird how some people hang on like that until the decision to let go is made with the family. 

We have a mandatory staff meeting tomorrow night - I guess they are making some more changes & they don't sound like good ones.  Such as the amount of time we'll be at work.....rather than a 12 hour shift, it sounds like it's going to be no less than a 13 hour shift.  They want to have 15 minute staff meetings every day/night before the shift begins.  Which means that will delay the oncoming shift nurses from getting report - thereby delaying the offgoing shift nurses from leaving on time.  What is next? 

I need to go get ready for work.  I'm gonna request tonight that if they need to call people off tomorrow night - put me at the top of that list.  They have 13 scheduled & only need 8 to 10 nurses for my unit now that the north wing is closed.  I want to start my mini-vacation early!

 

Crazy, but fun

It's been a crazy, but fun week at work.  I've already described my first night back...so I'll start on what happened Thursday.  Gina & I got to work anticipating that we'd have the same patients & for the most part we did, only they had given Gina one of my patients so now I had 4 instead of 5, which was fine.  However, as the PCT was taking vitals, I find that my first patient's BP is too high, my second patient is complaining of chest pain, my third patient's BP is too low & my fourth patient is bleeding excessively in the abdominal area & the dressings are saturated & did I mention he's on a Heparin drip?  Time to prioritize - who needs my help the most?  Decisions, decisions.  I talk to my clinical leader...let her know what is going on.  As much as I really like this clinical leader, she is very laid back & doesn't really help a whole lot.  So I focus on my chest pain woman first, turns out it's more of an anxiety reaction than actual chest pain & it passes.  For my low BP patient, retake her BP manually & it's a little higher than what the dynamap was reading.  Ok, she's alright & she's non-symptomatic.  My high BP patient was my stroke patient so I wasn't too worried about it at that time.  My bleeding patient was my next priority.  I'll describe that a little later.

My hospital has decided to remodel the 2nd floor...which is split into 2 wings - north & south.  On each wing there are PCU beds & also on the other side of the hall way are ICU beds.  The nurses stations are tiny, there is barely any room to walk around if 2 people need to walk by one another - it's just a lousy layout.  So they've decided to remodel starting on the north side..which is where Gina & I and a couple of other nurses were working.  So at 11:30 pm, the charge nurse decides that now is the time our patients should be moved to the south wing.  Ughhhhhh....why now?  We had about 18 patients to move & it took about an hour & a half.  As soon as we were done moving the patients, the charge nurse sent our patient care tech to a different floor - so now, not only were we behind on our paperwork, we now had to take on the role of PCT (again) & get our vitals.  Fine, whatever.  I've now been on my feet for 6 hours straight...thinking I can finally sit down & get some paperwork done when my stroke patient's heartrate went from 110-120 up to 170-180 & her BP was 192/107.  I call the doctor - had to page him twice to get a call back.  He orders Lopressor 10 mg IV q15 min x 3 until HR is <120.  I said back to him & if this doesn't work do I call you back?  His reply "No."  Ummm, then what do I do?  So he also orders Digoxin 0.25 mg IV q45 min x 3.....so this buys him time to sleep I guess.  I felt like I had no real support as far as what to do with this patient.  My clinical leader & an also this other nurse...an ICU nurse was saying 10 mg is too strong of a dose - that they don't even push that much in cardiac patients in the ICU.  They advise me to push 5 mg & see what happens.  So I do that & now the patient's heart rate is jumping back & forth...from 110 up to 150, back & forth.  So I push another 5 mg & nothing changes but her blood pressure increases.  Sigh!  So I ask the experienced nurses for advice, they tell me to give the Dig inbetween the Lopressor doses.  Nothing changes with the Dig even after 45 min.  So I am advised to go ahead & push the 10 mg if I want.  If I want?  I want to know what is best in this situation.  It's like no one really wanted to help or take responsibility in assisting me.  So I went ahead & pushed the 10 mg.  Her bp went down to 159/84, but the heart rate was still erratic.  I decided to give it a little time, went to get something to eat really quick.  It was now about 4 am, I have yet to sit down & do any paperwork.  I take my vitals on my stroke patient....her heart rate continues to be in the 140's & now her bp is 170/110.  How?  With all that Lopressor...why is the BP still up?  The ICU nurse told me that with stroke patients, often they don't respond to medications because there is brain damage or a brain bleed & the brain simply isn't getting the message to react the way the meds are supposed to make the body react.  That made sense to me.  She had a scheduled dose of Captopril due so I went ahead & gave it.  That seemed to do the trick...an hour later her bp was 180/84 & her heart rate was in the 110's & she was sustaining it.

Meanwhile my bleeding patient- he was a transfer at the beginning of my shift from ICU.  He had some kind of strange rash so earlier in the day the surgeon had done a biopsy on his abdominal area & his left wrist.  We are talking about a tiny incision...but it was bleeding through gauze & abd pads - even with a pressure dressing applied.  I called the surgeon, he told me to change the dressing & reapply a pressure dressing.  So, with Gina's assistance (thanks Gina), we changed his dressing at least twice, applied as much pressure as possible with nylon tape - only to find that once again, it was leaking through.  So now it's about 5:30 am & I have yet to do any paperwork...grrrrr.  I somehow got through it, called the surgeon to update him on the bleeding patient.  Finished up giving report....I think I stayed about 20 min later than usual, but still pretty good considering how my night went.  My feet were so sore!!!

Returning to work last night, Gina & I saw that it was just her, I & another nurse on this floor.  3 nurses & the other nurse went on breaks a lot....leaving Gina & I responsibility of all these patients.  Even Gina made a comment like "We're 7 months out of school & they leave us with this responsibility."  No tech, no huc, no support, nothing. 

When I got to work, I saw my name on the board with 5 patients while Gina & the other nurse only had 3 patients.  What?  Not fair!  It turned out that one of my patients was being discharged, so I was down to 4.  I didn't get the bleeding patient back, they had given him to Gina.  I started to ask for him back when one of the day nurses said "You don't want him back, he's not acting right."  Ok, then I don't want him back, plus he's at the end of the hall & my patients are all in rooms in the middle of the hall. 

I ended up with my stroke patient again - her heart rate remained in the 110's during the day, as soon as I started getting report, it jumps up to the 160's...ugh.  Why me???  It went back down on it's own.  They discovered she did now have a bleed in the brain, so her time is very limited.  The admitting doctor & the family wants to turn to Hospice.  The neuro doctor seems to think rehab is still possible.  Come on, doctor!  She is non-responsive, what is rehab going to do for her?  The family refused a feeding tube & refused any feedings via the NG tube.  So it's only a matter of time.  The doctors decided to make her med-surg status.  So I removed the heart monitor - more for my sake than hers.  I mean it's supposed to come off when they are med-surg status, but I knew if I left it on & saw her heart rate climbing again, I'd want to do something for her.  I couldn't just sit back & watch it climb, you know?  They got her a room on the med-surg floor & the transfer was made.

My second patient spoke spanish only - I speak very, very little spanish.  We had no one on the floor that spoke spanish.  I ended up resorting to getting the cleaning lady to help me because my patient was in distress.  She had been pulling on her foley catheter & caused her urine to get a little bloody.  She thought she was dying & wanted to write a note to her family saying good-bye.  Thanks to the cleaning lady, I was able to reassure her that the blood in her urine did not mean she was dying. 

My third patient was med-surg status too.  Very pleasant man - I wish all of my patients were like him.  He was admitted with a suspected gluteal mass.

My fourth patient was med-surg status also & I ended up transferring him down to the med-surg floor.  He was an 81 yr old male with alzheimer's & dementia.  I felt for him....just watching him made me a little sad. 

When I got back from transferring my two patients, I was told I had an ICU transfer who was also of med-surg status.  Somehow he accidentally got transferred to ICU after his cardiac cath rather than med-surg even though the orders specifically said med-surg.  The thing was though...if I transferred my remaining two med-surg patients to the med-surg floor, I would have to go home.  I didn't want to go home since it was now 1 am.  My charge nurse & clinical leader were ok with keeping those 2 patients on the PCU floor. 

I ended up getting anotherpatient around 5:30 am...a c-diff patient.  Those are not my favorites - if anyone has been around a c-diff patient, you know exactly why I say that.  For those that don't...a c-diff patient has a lot of really stinky diarrhea.  It is not a good situation especially when the patient is immobile. 

Inbetween all of that, I was also helping Gina out with her 3 patients.  One was slowly dying, heart rate in the 40's.  Another was going into hospice care today...a really sweet gentleman that kept yelling out over & over "Please just let me go"....meaning let him die.  Heartbreaking!  I kept going in there to hold his hand & try to say a few comforting words.  You could tell his time was getting close to the end. 

And her last patient was the bleeding patient I had the night before.  He woke up around 2:30 am, confused & disoriented.  Turns out he's an alcoholic & was having dt's.  He was getting rude & aggressive.  He wouldn't listen to Gina telling him to get back in bed.  Finally we were able to get him to at least sit down - we didn't want him pulling out his IV that had Heparin going.  He was just out there with what he was saying - talking to himself, telling us this wasn't a real hospital.  He kept asking "Where are the techs?"  Gina & I were thinking "that's what we'd like to know!!!!!"  He wanted to know where the on-call doctor was, why were we keeping him prisoner, was picking/biting at his IV line.  This was a 62 yr old man that was not like that at all the night before when I had him.  Of course I jokingly blamed Gina for doing something to him as well as Jack the ICU nurse who had transferred him to me.  Gina called the patient's wife to have her come in, hoping it would reorient him a little bit.  He was mad that Gina called his wife.  He started yelling.  There we were again with no real assistance.  The other nurse was telling Gina to call security if we needed help - which is a joke if you saw our security guards.  They are usually little old men that couldn't do much to help anyways.  His wife came in & sat with him, he went back to sleep & wasn't too much of a problem - thanks to his wife being there. 

Around 5:30-6 am, Gina's patient with the heart rate in the 40's had to be transferred to ICU.....that was our night.  I had fun through it all though.  I admire the ICU nurses - they are so full of knowledge & quite helpful whenever we have any questions.  That's one reason I like being on the second floor - right next to ICU.  I want to be knowledgeable like that one day too - where I have the answers rather than all the questions.  I know it takes time & experience...but that's what I want to be like one day.

Ahh - the families

Last night was my first night back to work after being off for a week.  Oh how I dread the first night back - mostly because of how long it takes to get report from the day nurse.  I had 5 patients & only needed to get report from one nurse - which is usually nice as opposed to getting report from 3 or 4 different nurses.  However, this day nurse was so unorganized & so behind on everything that it took about an hour & a half to get report from her.  She was asking me to go give patients meds that she forgot to give, to call doctors that she forgot to call, wanted me to redline on new orders when she didn't even have the paperwork to show that the orders were placed properly.  It was ridiculous.  I was a little distracted yesterday as my dog had been pretty sick during the day.  I didn't get much sleep & my mind was on him - he just turned 12 & I know the end is getting close.  So I wasn't really at my best as she was giving me this half-assed report.  I would ask her why the patient was here - what is the admitting diagnosis?  Half the time she did not even know what they were here for...lovely!  How can you assess & treat someone when you don't know why they are at the hospital? 

One of my patients had come in because she had a stroke.  She was pretty non-responsive, would open her eyes & look at you, but didn't say a word.  Her blood pressure was 181/87 & heart rate 115-120.  That seemed a bit high to me, so I was attempting to call the doctor when the day nurse says to me "Can you call this other doctor first about a patient that refused to have a test done today?"  I just looked at her...umm, hello - what is the priority here?  A stroke patient with a high BP & HR or a patient that refused to have a test done earlier today?  She says to me "Can't you just give her a PRN medication?"  Huh?  What do you want me to give her...Tylenol?  Milk of magnesia?  Jeez!  Anybody home in there?  I got some orders for Captopril & Cardizem.  It didn't do much to improve the situation, but at least it helped it from getting worse.  I know you don't want the blood pressure low, but 180's was too high for me to be comfortable with.  Not to mention her heart rate would jump up to the 130's-140's now & then.  I didn't like it.

That was the patient with family visiting.  I felt bad for them.  Two days earlier this woman had been cooking them dinner & it was a fun family night.  Now she was unresponsive & couldn't move her right side at all.  She's 93 years old, so I would think in the back of your mind, you have to be preparing yourself that anyone that age is getting close to the end...but it's still tough.  They were crying, asking questions, you could see & feel the sadness they were feeling.  I'm sure it didn't help when my other patient in the same room starts saying to me "It sure is hard when you lose family members..." - yet another reason I think all hospital rooms should be private rooms.  No one wants to hear that kind of talk when they are dealing with the reality of losing a family member.  I am not used to having to deal with these type of situations.  Usually, for the most part, the patients do get better & go home.  With this lady, I'm not sure that is going to happen.  Her daughter asked me last night if I could make her mother better.  What am I supposed to say to that?  I told her I'd keep a close eye on her & take care of whatever she needs.  Part of me wants to avoid the emotional stuff - because deep down, one of my biggest fears is losing a parent.  I don't want to have to deal with the emotional aspect of that any sooner than I have to - so I put it out of my mind.  But now with a situation like this where you are watching a family slowly lose a loved one, it is a reminder of just how tough it is. 

Stroke patients are a challenge.  It always reminds me of the episode of ER where Cynthia Nixon had a stroke & she was able to think coherently, she just couldn't express it.  I look at my patient & wonder - can she understand everything we are saying but simply isn't able to respond?  Or is she truly not there anymore?  No one knows for sure, but it makes me wonder if or what she is thinking. 

My second patient was in with chest pain.  Her stress test was negative, the cardiologist wants to sign off but she is still having chest pain & pain radiating down her left arm.  How can he sign off when she is still in pain? 

My third patient was also admitted with chest pain.  She is a 23 hour observation.  She was having a stress test done today.  I'm pretty sure if it's negative, they'll probably discharge her today.  The only pain she was experiencing on my shift was the headache from the nitro paste. 

My fourth patient was a lady that had a syncopal episode - fell & broke her wrist.  She's having surgery on Friday.  This woman cracks me up.  She's an older lady & she has all her make-up on the bedside tray.  I walked in & she was wearing the brightest red lipstick, as if she was going out to a party or something.  She was fixated on getting up to walk.  Kept asking when are they going to let her get up & walk.  I asked "Are you able to walk on your own?"  Her reply "No, you'll have to hold me up & walk me around."  Ummm...no, I don't think so.  A physical therapist I am not.  The doctor had written an order for orthostatic blood pressures on her.  Only his order said "laying down, standing, then again after standing for 3 minutes - NO sitting."  I have to laugh....the woman cannot stand on her own.  Am I supposed to hold her up for 3 minutes & then take her BP?  These doctors are a little loopy.  There is no way this woman (nor I) would tolerate me holding her up for 3 minutes just so I can get her blood pressure.  She would complain when I'd take her blood pressure while she was lying down.  It's one of those orders that I would love to see the doctor attempt to do himself.

My fifth patient had been in the hospital for 10 days.  When I asked the day nurse why this patient was here, she had absolutely no clue.  She kept asking me to look at the chart & figure it out.  What?  You've been caring for her for the last 12 hours & you can't tell me anything about her?  She says "Oh, she's on contact precautions too now."  Why I ask?  She doesn't know.  No cart at the door, no sign saying contact precautions, charge nurse isn't even aware that the patient is on contact precautions either - people are going in & out of that room having no clue about anything.  Turns out she has E. Coli in her urine.  I was actually happy about that - much better than hearing "C-diff."  This lady also has end stage renal disease & is on dialysis Mon, Wed & Friday.  So it's not like she's urinating a whole lot on her own to begin with. 

My night was spent running around catching up, tying up loose ends, calling doctors (which now - believe it or not - I don't mind calling doctors anymore) & tons & tons of redundant paperwork.  As if they don't have us doing enough writing already, we are now told we can't put a line through a space on the flow sheet, we need to write N/A in each & every blank that we don't use.  Ridiculous!!!!  My hand has calluses from all the writing.  I cannot wait to get to a hospital that uses computer charting.  Plus they sent our patient care tech to a different floor, so I had even more work to do, as if having 5 patients wasn't enough.  Then the day tech was a little pissed that I wasn't able to give any baths.  I literally had no time - not to mention that my patients had already been woken up numerous times between taking vital signs, giving meds, lab drawing blood, EKG's - the last thing I'm going to do is wake up a sleeping person at 5 am to bathe them.  I didn't like doing that when I was a tech & I don't like doing it now - don't get me wrong, I don't mind setting people up for baths or giving them a bath IF they are AWAKE.  But to wake someone up to bathe when they finally fell asleep is simply insane.  I think it was 6:35 am by the time I was finally caught up & I didn't even take any breaks last night except a 20 min dinner break. 

This hospital needs a lot of work.  It's like they look for ways to make their employees unhappy & it's working.  Employee morale is very low - not just the nurses, but the pct's, huc's, respiratory therapists - even some of the doctors don't really like this hospital either.  I can only hope that there are better hospitals out there & that they aren't all like this.  We were always told in school "Start where you don't want to stay" - that's one of the main reasons I started here.  It won't be a difficult decision to leave to go elsewhere.  Change will be good & the sooner the better.  I'm still waiting to hear from the other hospital that I applied to last week.  I'm leaning towards travel nursing in the future, but for now - I want to get a little more experience under my belt.  Hopefully tonight will be a better night than last night was!

 

I did it!

I applied for a position in the ICU at another hospital.  Gina did also.  We work with a woman that is already working in that unit & she is encouraging us to challenge ourselves & to learn more.  Which I have to agree - after only 6 months, it seems like the same old routine with most of our patient care in PCU.  We'll see what happens with that.  I also applied with a couple of nursing travel agencies.  I'm not ready to travel just yet, but wanted to see what opportunities are out there. The benefits are amazing.

I'm a little tired today.  I took my niece & went with some friends to Orlando yesterday.  Went swimming at the Nickelodeon pool & then to Sea World.  Saw way more of the dolphins than I wanted to ever see.  I'm taking my niece to Libby Lu's in a few hours - she has no idea, I wanted to surprise her. 

Not much else really going on...just relaxing in the hot Florida weather.  Hurricane Dennis passed my area by - we really didn't even get all that much rain, no difference really than the usual thunderstorms.  I'm thankful - hurricanes stay away!

Hurricane Dennis

Hurricane Dennis is on his way - the first hurricane ever in the month of July.  So far it looks like we'll just get a little bit of wind & lots of rain, but Alabama & Pensacola will get the impact.  Hopefully it won't be too devastating.  I'd be lying if I didn't say I'm glad it's not coming this way.  After having 3 hurricanes in this area last year, we definitely don't need to go through that again.  It's hard to believe it was nearly a year ago that Hurricane Charley hit - doesn't seem like that much time has gone by. 

Last night at work was alright.  I had a "sneaky" patient that was anxious to go home.  She had a stress test done at noon that day & was waiting for her cardiologist to come in & give the order to discharge her.  Time ticked by, it's 9:30 pm, he's still not around.  She asked me to call him & tell him she wants to go home.  I couldn't call & say that nor can I call & tell him to come in like she was requesting.  So her & her daughter took matters into their own hands, called his answering service - pretended they were ME & told the answering service to have the doctor call me back.  When the lady at the answering service asked for a name & a phone number - they didn't have one to give so instead they gave the name of the hospital & the patient's name & said "Call the nurse."  I get a phone call from the answering service asking what is going on.  I wouldn't have cared if the patient called for the doctor herself & explain to him she was anxious to go home, but to pretend like she was me?  Grrrr.  I said to go ahead & page him since he was on call.  Luckily a few minutes later, he happened to stroll onto the floor & discharged her like he had originally planned.  It had nothing to do with her phone call, but I'm sure she thought it did.  I've never seen someone get dressed & out of the room so quickly. Luckily the day nurse had filled out the discharge papers & all I really needed was to fill in a few blanks & get the patient's signature.  A word to the wise - if you come into the ER complaining of chest pain - plan to spend a few days at the hospital while the doctors run their tests.  They can't let you go simply cause you say you feel better without being liable for "if" something happens without running the tests.

My other patient that had a stress test that day also was very anxious to go home....only he still had to complete the resting portion of the stress test the next morning.  He was telling me he'll just come back another day for that.  Uh huh, sure you will.  Then he tried to say he had to be at work this morning & he had to be discharged.  I told him he was welcome to leave, but he'd be taking the bill with him because when you leave without a doctor's order to be discharged, your insurance company will not pay the bill.  That seemed to get him thinking straight again.  He wasn't happy, but hey, it wasn't my fault.  Then he wanted to take a shower & I told him we need a doctor's order for that too...because technically everyone on PCU is considered to be in "guarded" condition & are supposed to be in bed getting bedrest.  I'm beginning to wonder why they even put showers in the bathrooms on this floor.  Luckily this guy went to sleep & didn't really have much else to complain about through the night.

I'm not going to even go into details about my other 3 patients because they were all pretty stable & nothing really happened with them.  At about 6:30 am, I did get a transfer from our other PCU unit.  The name sounded familiar, but it wasn't until I saw her that I put it all together.  About a month ago, she had been in a different room & was soooooo demanding, always yelling, always needing something - rather than using her callbell, she'd just scream out for help.  I didn't have her as a patient, but obviously I heard her yelling out all the time.  Well, now she had gone into cardiac arrest after receiving outpatient dialysis back on July 1st.  She is like a zombie now.  Her eyes are open, but there is no response.  I don't know if she's actually with it, but simply can't express it (like in that one ER episode where the lady has a TIA) or if she simply isn't there anymore.  It was weird to see someone that was so demanding to being unable to even move really.  I don't think she has much time left.  She is now a DNR & the family is refusing the doctors to run any tests.  She has multiple DVT's & the surgeon was wanting to put in the IVC filter, but it was unlikely that the family was going to sign the consents.  I totally understand where they are coming from & can see why they are apprehensive about continuing to put her through all of that when her quality of life is simply not there.  It must be difficult though.  I worry about the day that I might have to make decisions like those. 

I am learning that veteran nurses like to complain...A LOT!  I don't know if it's because they are simply unhappy at my hospital or if this is seen universally.  They complain about everything!!!!!!  Maybe I'm still too new & not burnt out.  As much as I wish I had millions in the bank & didn't have to work, I do enjoy my job right now.  Don't get me wrong, I dread having difficult patients or encountering situations that are not pleasant, but I do enjoy meeting different people, making them feel a little better & making them smile.  I like talking to them, finding out a little about who they are & making sure they are comfortable while in my care.  I hope I never get to the point where I don't care who they are & simply want to get in & out of the room as quickly as possible.  I was listening to a few of the nurses this morning complaining about a certain doctor.  She happens to be my doctor - I've been going to her for the last 15 yrs.  She is really nice to me - but she intimidates the nurses & is rather rude on the phone or she simply doesn't return their calls.  I haven't had to deal with her on a professional basis (yet) although I am curious to see how she would treat me considering the relationship we have.  Listening to those nurses complaining just made me laugh to myself.  Oh well, if it's not one thing, it's another thing...they love to complain.

On a brighter note & off topic - my rental house is getting repaired, fixed up, improved - whatever you want to call it.  Then I hope to sell it & also sell the house I'm living in & probably move to a condo.  I like the idea of moving, but I don't like the idea of moving into something smaller.  It's the best option though since I am planning on going into travel nursing next year &won't be home a lot of the time.  Oh well, we'll see what happens - as I've learned many times in the past, anything is possible.

Say a prayer for those that are in Hurricane Dennis' path - they'll need it.

I just have to laugh!

What a night it was last night.  I got to work early (as I usually do) in hopes of getting a quick report about my patients that I had the night before.  Things never seem to go as planned though.  It is so frustrating getting a not so great report from a (let's face it)...not so great nurse.  It throws everything off. 

Anyways, I am in the middle of report regarding a new admit from earlier in the day.  The day nurse is telling me about how this patient's brother is a lawyer & also power of attorney & he is already threatening to sue if things don't go right.  I don't like those kind of family members!  During report, the cardiologist shows up to make rounds & he goes in to see this patient.  While he's assessing this patient, the patient starts to vomit in a bath basin.  Next all we hear is yelling.  I don't know if it's the patient yelling at the doctor or what.  Turns out the patient was demanding that the doctor clean out the bath basin & the doctor was yelling at him saying "I don't do that, I don't touch that stuff."  Then he comes out of the room, calls the admitting doctor to inform him that he will not take this patient.  I just have to laugh at his reaction to a little bit of vomit & the patient's request for this highly-paid cardiologist to clean up his mess.  I go in there to see what's going on, the patient in the other bed (mine also) is already dressed & pretty much fleeing from the room as fast as he can.  I said "Where are you going?"  He replied "Home."  I said "Wait, I have to get the approval from your admitting doctor."  The cardiologist had already cleared him for discharge, but I still had to get an order from the primary doctor.  He said "I cannot be in a room with that guy any longer!!!!!!"  I totally understood.  If you ask me, ALL hospital rooms should be private rooms.  So I let this patient wait in the waiting room while I worked quickly on getting him discharged.

Meanwhile, the admitting doctor of the first patient calls in an order to the day nurse to consult with the patient's original cardiologist knowing full well that this cardiologist not only "doesn't" come to our hospital, he has no priviledges here - so even if he wanted to, he can't do anything.  I call back to inform him of this - fully expecting orders to consult another cardiologist, but instead I get an order to send the patient to ICU.  Ummm, ok!  I don't mind one bit - between his nausea & vomiting and a threatening brother/lawyer, I'll be happy to move this patient elsewhere. 

So I prioritized - get my discharge wrapped up so he can  go home.  (I hadn't received the ICU order until after this patient had been discharged.)  So next on the list was getting this patient off of PCU & into ICU.  He was continuing to vomit, even after giving him Phenergan.  His heart rate was jumping up from 95 to the high 130's.  I delivered him safely to ICU.  The nurse was not happy about getting this patient, but sorry - I'm just following doctor's orders. 

I get back to my floor at about 10 pm & I am told to call ER - that I have a new admit.  I take report & they have him delivered to the room about 5 minutes later - nothing like giving me a little bit of time to get situated.  Luckily he was an easy to care for patient.  I'm not even sure why he was admitted.  He came into the ER complaining of chest pain & rated it as a "1" on a scale of 1-10 with 10 being the worst pain you've ever felt.  By the time he got a bed in the ER, his pain was gone.  All of his labs were normal, tests were all normal, no further chest pain, vital signs stable.  Yet they admit him.  Like I said, he was easy to care for.  After I assessed him, he went right to sleep & slept through the night without any further complaints.

Luckily my other 3 patients were all doing pretty well while I was running all around.  I had one patient who came in with what they thought was bacterial meningitis.  I remember the night he was admitted back in June & wondering if he was going to survive. Turns out he had viral encephalitis.  I read multiple times that he was aphasic, but he was able to follow commands.  He definitely isn't a man of many words, plus he speaks primarly spanish - but last night he says to me out of the blue "You are a very nice nurse."  I was shocked that he said a full sentence.  So perhaps he is able to talk but only talks when he feels like it.  Who knows?  It's nice to be appreciated.

I somehow managed to only have 4 patients.  Everyone else had 5.  They were pushing to give me an admit, but the only beds open were in semi-private rooms & the patient they were trying to give me had a WBC of 2.1 due to chemotherapy.  He definitely should not be sharing a room.  Luckily my clinical leader was on top of it & delayed the admission until we could get a private room - therefore bypassing me for a new admit.  Gina says to her "Do you pity Jennifer?  Is that why she only had 4 patients?"  My clinical leader replied "No, she worked her butt off tonight, she deserved a break & that's why I kept her at 4."  Yep, yep - worked my butt off & still had all of my paperwork done over an hour before the change of shift.  I must say I handled it all pretty well.(So much for my med-surg nursing instructor emphasizing while I was in school that I needed to work on time management!!!!!!!!)  It just makes me laugh to think about how crazy the night began & how smoothly it ended. 

Ok, time for me to get some sleep.  One more night of work - then two days off - then three days on.  Sweet dreams!

Focus

It's been so nice having the last week off.  I'm dreading having to go to work tomorrow night.  I'll be working the next 6 out of 8 days.  At least when it's over, I get another week off - I'll just have to focus on that.  I'm planning to go to Sea World & also spend a few days at a hotel for some sun & fun.  I promised my 8 yr old niece I'd take her with - so hopefully the weather will cooperate.  We've had rain every single day throughout the month of June & so far in July also.  It hasn't rained here yet today - but it's looking a little cloudy.  Hopefully it will pass so it won't ruin the July 4th celebrations.  The hurricanes have been staying away also - thankfully. 

I got to spend some time with my family, went shopping, watched the Busch race & the Pepsi 400 (woo hoo Tony Stewart).  I was happy to see Dale Jr. finally have a decent finish.  It's been a long time & hopefully his focus is back. 

I also took my niece to see Herbie - Fully Loaded.  Cute movie!  I saw Mr. & Mrs. Smith last week - good movie.  Next on my list is War of the Worlds - just need to find the time to see it. 

I haven't really thought much about work during my time off.  I have been thinking about the timing of setting up an interview with the other local hospital.  Optimally, I would like to remain on staff (per diem) where I'm at now & work there at least 2 days a month (at per diem rates) and work full time at the other hospital - but I am not relying on that to happen.  I am not even sure how to go about talking to my manager regarding this.  Before anything though, I need to set up an interview & get a job offer.  Do I set it up now & tell them I cannot begin until August or do I wait until it's closer to August?  I'll figure it out eventually.  My only hope this week is that Gina & I are working on the same floor.  It just makes it so much easier & fun.  So we shall see.

Happy July 4th y'all!!!