Remember me saying in my last post that I missed my old hospital. Let me retract that statement. I don't miss it one bit. I worked there Monday & Tuesday and was quickly reminded why I sought another job at a different hospital. The paperwork is beyond ridiculous not to mention the miscommunication & mismanagement going on there. I think it's sad that we literally do not have a lot of time to spend with our patients because of the numerous amount of paperwork. I think I spend maybe 20 to 30 min with each patient unless they have something more going on. I spend about 1 1/2 - 2 hours on the paperwork per patient. It doesn't make sense to me why there is so much redundant paperwork to fill out at this hospital. I don't get it.
Come to find out, the woman that handles our schedules assumed both Gina & I wanted to go to a part-time status with "no" benefits (as opposed to the other option of part-time with benefits) even though we clearly stated in our emails to her what we wanted. Once again...miscommunication running rampant. Shocking! As a result, my benefits were cancelled two weeks ago & I just found out about it this week. Nice, huh? I take it as a sign to move on from this hospital. However, I'm not totally quitting (not yet anyways). I am obligated to work there 2 days a month now. I think I can endure that. I just want to get to the month of December because that is the month I officially became a nurse = 1 year of experience = more $$$.
I'm rambling here & probably boring most of you. Sorry...just documenting the frustration I have lately with the first hospital. On top of that - they have become such control freaks to the point that they have assigned seating in the nurses station! They treat the nurses like we're 5 yr olds in kindergarten. If you are friends, they separate you. If you want to take a break or go to lunch - you have to tell your clinical leader as opposed to telling another nurse to cover for you. They make you wear "locators" so they can track where in the hospital you are. They send patient care techs home rather than have them assist the nurses in patient care. What's next? Having to ask to go to the bathroom? It wouldn't surprise me!
Ok, enough of my venting. My patients this week were wonderful. Nothing major happened, but I do feel as though I'm learning a little more day by day. I had one patient in with CHF even though his BNP was less than 5. Anyways...the second night I had him, around 2300 I noticed his breathing sounded rather distressed, lungs sounded awful, he was restless. I looked at the MAR & saw that the day nurse didn't give him his 1700 dose of Lasix. On top of that, his d-dimer that evening was positive & he had ordered a CT of the chest scheduled for the next morning because he was on PE (pulmonary embolism) protocol. His ABG's on room air were not good at all, so I was given the order to up his 02 to 3 liters. I gave him the dose of Lasix & within a couple of hours, he was doing much better. His urine output went from about 100 cc's to 1600 cc's by morning. He was breathing much easier & was more alert. I was a happy camper. I don't like seeing my patients in distress.
I had another patient that was having a heart attack. He was started on an Integrilin drip & scheduled for a cardiac cath. I came in that night to find that he had stenosis in a stent (put in last year) & was going to be transferred to my other hospital the next morning. He wasn't in any pain - he actually felt just fine which is weird considering he was having a heart attack. I had a ACLS class the next day at the other hospital & ran into his family while I was there. I think his daughter was surprised to see me - she said "I didn't know you worked at this hospital too." I'm not exactly sure what the cardiologist was planning to do for this patient, but hopefully he is doing well today.
My 3rd patient was a 90 yr old male that had been in the hospital for a couple of weeks. He was an ICU transfer & would get very short of breath with any type of movement. He was a sweetheart though, brought out my mothering instincts. I tried to spend extra time with him because he didn't have any family coming to visit him. :( Both nights he would have runs of V-tach. Being that he was a DNR, I knew we wouldn't be able to do anything for him should he code...but I really did not want to see anything bad happen to him. I checked on him when he had the v-tach & he was non-symptomatic. The cardiologist was aware of the v-tach, but did not prescribe anything.
I had another patient in with CHF. He was a little tough to warm up to, but eventually I won him over. He had a chronic cough that would cause chest pain that seemed to only be relieved with morphine. However, the doctor had told him he would not be discharged until he stopped requesting morphine. Plus he was deeply afraid of becoming addicted to the morphine because it did work instantly for pain relief & the coughing would also stop. So I'm not sure what the doctor will do for that.
My other patient was admitted with unstable angina. Tests didn't show anything & he was discharged the next day. My final patient on Tuesday was a 50 yr old woman admitted with chest pain. Before coming up from the ER, she complained of having a bad headache (most likely from the nitro). Rather than giving her tylenol...the doctor prescribed Darvocet & it was given prior to her getting to my floor. Once I got her, she complained of nausea. I had a feeling it was more connected to the Darvocet as opposed to anything cardiac. I got her some crackers & ginger ale & after a little while the nausea went away & she went to sleep. A few hours later, while I was off the floor having dinner...she complained of a bad headache once again & one of my co-workers gave her another dose of Darvocet. Ugh! I came back to find her vomiting. Not fun! Afterwards she went back to sleep & was fine the rest of my shift. Needless to say, I passed on to the day nurse the information that this patient needs something other than Darvocet for headaches.
As I said earlier, I had an ACLS prep class yesterday at my other hospital. So after working the night before & getting home at 8 am, I managed to get about an hour of sleep before having to be at class. Luckily the time went by quickly during class & we got out an hour early. We (Gina & I) went to talk to our manager to clarify some of the rumors we were hearing about nurse/patient ratios & such. He claims that the usual patient load is 6 to 1 and rarely will we ever see more than that. So all we can do is wait & see if he's telling the truth. I'll give him the benefit of the doubt for now. I still have plans to attend the job fair next month - gotta check out my other options, right?
I have ACLS prep class tomorrow morning & then I'm off until Monday night. I like having my weekends off. Somehow we pulled this off - not working weekends. That's one of the nice benefits of being part-time...you have complete control over what days to work. It also seems that we won't have to commit to working any holidays (Thanksgiving/Christmas) unless we want to. Those holidays will be here before I know it. Time seems to be flying by & I know October will be the same. Between work & plans for practically every weekend in Oct (Not-so-scary Halloween party at Disney World, Sea World's Halloween Spooktacular & hopefully Halloween Horror Nights at Universal), the month will fly by. There better not be any hurricanes in October!
Ok, I think this has been a rather boring journal entry this time. Not too much exciting stuff going on. Sorry!