Thursday, July 21, 2005

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.", 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!


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