Sunday, January 29, 2006

Opportunity is Knocking

There is so much going through my mind right now - so this will probably be a long entry as I try to sort it all out.

First off, I got a job offer for the mother/baby unit.  I still have a few questions to ask, but essentially, the job is mine if I want it.  And I do want it.  However, a part of me is afraid to leave my comfort zone - which I know is a totally natural feeling.  This is an incredible opportunity & I won't pass it up.  This hospital is one of the best in Florida & it's actually expanding as they will move into a brand new building in May.  Compared to the three hospitals I've been employed by...this is a "real" hospital.  Real in the fact that it is a huge hospital with many, many different units.  It is also a Level I Trauma Center as well as a teaching hospital.  So it is seems as though it is a true hospital as opposed to these small town hospitals that I'm used to.  Heck, the NICU at this hospital opening in May will have more beds than my entire hospital has right now.  So it definitely is the place to be to learn what you want about nursing.

I'm not crazy about the's about 30 minutes which is fine...but there can be a lot of traffic & who knows how long it would take to get to work if there's an accident on the way.  I'm also questioning being on the mother/baby unit.  What do I know about any of that?  Nothing really...which is ok.  I learn quickly.  It will just be an adjustment & hopefully the nursing staff is nicer than the last hospital I was at.  The pay is decent, the benefits are good & the differentials are excellent.  So I am pretty sure I will at least sign on part-time to start.  I have to make sure I like it before I commit to full-time.  If I do end up really liking it, then I'll also think about moving closer.  There would be no reason for me to remain in this town that I'm in now - I have no ties here. 

I plan to keep the job I currently have in PCU also.  I am attempting to go per diem, but you have to literally become a stalker in order to get the manager's attention.  She won't return emails or phone calls.  At the same time though, I don't mind staying at the commitment level I'm at right now.  I only have to work 2 days a month to remain on staff.  It allows me the flexibility to try other things out while still having something secure to fall back on.  Plus they are shortstaffed, so it's quite easy to pick up shifts if I want to.  In fact, they already called on Friday asking if I'd work tomorrow night.  The drawback is that they are no longer offering bonuses/incentives to pick up shifts.  They say the staff is getting too greedy.  What a joke.  They are the ones that need our help desperately or else they end up paying an agency nurse twice as much as what they would pay a staff nurse...but we're the greedy ones.  Whatever! 

On top of all that, I also got a call from a nursing agency I am interested in.  The only thing I don't like is the numerous amount of paperwork that they want copies of.  I am not a fan of paperwork!  The incentive though is that they pay nearly $500 per shift.  Who could pass that up?  The only drawback I see is having to go to hospitals you've never been to before & not knowing anyone & pretty much having to wing it - because there is no guarantee that anyone else will show you the ropes.  At the hospital I'm at now, I don't think anyone treats the agency nurses any differently.  We really do have a very friendly nursing staff...which makes it hard to leave my comfort zone. 

I worked 4 nights last week & I think I've been sleeping the majority of the last 40 hours that I've had off.  It was a decent week...I have no complaints regarding the patients.  The doctors are another story.  Two of them were quite rude to me over the phone.  All I was trying to do was review a patient's medications before sending her home.  They both refused to review the medications with me.  One of them yelled "Send her home on whatever she came in on."  Nice order, huh?  He said he had too many patients to remember what each of them took - even though I was willing to go over the medications listed, he refused.  I wish patients could see how some of these doctors behave.  Luckily, not all doctors are jerks.  I have met a few that know how to act like normal human beings.  Right now the staff psychologist is my favorite - if only they could be more like him. 

My hospital has been filled this the point of holding patients in the ER until a bed would open up on a floor.  They were holding 20 patients one night.  I don't know if it's the weather or what...just a lot of people have been in the ER.  It has been feeling more like a nursing home than a hospital lately.  I think it will be refreshing in the mother/baby unit - younger healthy patients & new life as opposed to taking care of sick elderly people in their 80's & 90's who take a zillion different medications.

So that is what is going through my mind this weekend. I'll let ya know what I decide.


Friday, January 20, 2006

A New Direction?

I went to the Job Fair/interview yesterday afternoon.  It was interesting to say the least.  It was a room set up with something like 100 managers from practically each & every nursing department in all of their hospital locations.  It tended to be a little distracting with so many people talking all around me.  It was more like a semi-interview as opposed to a real interview.  I spoke with people from the flex pool as well as someone from the mother/baby unit.  She seemed to really like me.  Gotta love the interview questions, right?  "Tell me about a time when you participated in teamwork."  Or "Tell me when you went above & beyond for a patient."  Anyways, it ended with the lady from mother/baby telling me she'd speak with her manager & that she would see me soon.  She asked how soon I could start, etc. 

Of course I came home last night & reflected on the possible direction change of my career.  What do I know about taking care of mothers & babies?  Absolutely nothing!  It's a good opportunity though.  So if they are offering, I will accept.  Time will tell.


Wednesday, January 18, 2006

Official Anniversary

Today marks my official one year anniversary of working at my current hospital.  I'm no longer considered a "rookie" or a "new" nurse...although I know I still have plentyyyy to learn.  I received a .60 cent raise.  I don't know, call it disappointed, but I think it should have been more than that.  Oh well...just more of a sign to spread my wings & fly.  We're still getting the run around about going per diem & we're hearing this is typical.  That until you actually put in notice of quitting do they actually listen to what you are requesting.  I'm not at that point yet, but I have been looking around.  Tomorrow both Gina & I are going on job interviews at one of the big hospitals in Orlando.  Soon they are opening a brand new mother/baby hospital & they are trying to recruit staff now.  I've always wanted to learn more about the mother/baby/labor/delivery aspect of nursing & I'm thinking if this isn't a great opportunity, what is?  I still plan to remain at my current hospital for a very limited capacity = 2 days a month.  If this other hospital wants me, I'm willing to give it a go & step into a different specialty of nursing.  The more I learn, the better, right?

So that is my current plan.  I need to find my resume for tomorrow & get organized with my nursing paperwork.  I have no idea where my CEU certificates are or even my nursing license.  I believe it's in my safe, at least that's where it should be.  Now if only I could find the key to my  One day I'll get organized!

This week at work wasn't bad...nothing much really going on.  I had a few patients that were unable to sleep at night....I found it odd that they were able to stay awake all night, but then again...look at me, that's what I do...well, when I'm working anyways.  Then the day nurse would complain that they were lethargic through the day.  What can I do?  I can't make someone go to sleep...well, I can given the right medication, but that's a different story. 

Our ER was super busy last the point that it felt like a drive thru - we had to go down there to get a bedside report & then take our patient back with us & eventually return the stretcher to the ER.  The nurses down there were too busy to leave.  That's a first & a major reason why I wouldn't want to be an ER nurse...they seem too busy.  Not that any other nurse isn't busy, but I like organization & planning my times events change my plans, but for the most part it flows pretty well.  In the ER, you never know what's going to happen & it seems like the nurses are overwhelmed & can't even really give you a good report on your patient because their mind is racing in other directions.  At this point in my life, I do not thrive off of you won't be seeing me venturing into ER nursing anytime soon. 

I'll write more tomorrow after the interview.  Wish me luck!

Saturday, January 14, 2006

Mudslides anyone???

I went out tonight with Kelly.....a friend/classmate from nursing school.  We went to the movies & then to Red Lobster where we had a couple of mudslides & toasted to completing our first year as nurses.  Kelly is an oncology nurse, which is perfect for her - she's always good at making people feel better mentally.  I wish she'd switch over to PCU so we could work together, but she won't.  Her home is in oncology.  We traded multiple "work" stories over dinner.  Nothing too gory this time.  It was a nice time. 

I had a short week at work this week...just two days.  I was sick all of last weekend & not back to feeling all that much better, so I made it an easy week.  On top of being sick, I also broke my toe...yet another reason to make it an easy week.

It was an interesting week as usual...I've reflected so much on the events that took place last week with my patient that died.  I even looked up her obituary online.  Of course I've secondguessed myself & wonder if perhaps I missed something that could have made the outcome different...but ultimately I think when it's our turn to go...there are no interventions that are going to prevent our departure.  So I am at ease with all that went on. 

I've had patients this week that were in the same room she was in last week.  I definitely was reminded each time I went in the room - I think that room # will always stick with me.  Luckily these patients were ok though.  Monday night was a busy night...lots of admissions.  I had a patient that required a sitter - she had a "medical misadventure"....fancy wording for medication overdose. 

My other patients are just a blur...they were all stable...sick, but stable.  I did receive a very interesting patient towards the end of my shift on Wednesday morning.  A woman with psychogenic polydipsia, which basically means she drinks way too much water - like so much that it could kill her...but she can't help it...she craves water.  In her case, she drank so much that her sodium count was 121 (135-145 is normal) & she was having seizures. 

On a different note...going back to last week...Wednesday night there was a Code Gray called on my floor.  Gina & I were both there so we go check it out only to find it's this little old man that was determined to leave his room.  He was so NOT intimated by women & he had this crazy look in his eyes - enough for me to stay away from him.  Within seconds our manpower showed up...about 5-10 people came flying around the corner.  That definitely changed his attitude....a smile broke across his face & he was like "All of you don't need to be here."  Within a few minutes, we had him back in his room & we found out from his nurse that it was his birthday.  Since there was a crowd gathered, we decided to sing "Happy Birthday" to him.  It was cute.  Nice to see a potentially difficult situation turn out so well. 

There was a shooting today at a middle school I went to back when I was in 6th grade.  I turned on the tv & saw the news coverage....then went on to read about the officer that shot the kid & it is someone I went to high school with.  Wow!  Anyways, it's a sad situation - the kid is on life support.  Hopefully he'll make it & get some help for whatever caused him to bring a gun (ended up being a pellet gun) to school & holding his classmate hostage. 

I'm off until Monday night & plan to relax playing with my new, playstation, well as shop for a few other things I am wanting/needing.  :)  Gotta have time for R&R.

Wednesday, January 4, 2006

Things Can Change in the Blink of an Eye

Last night at work, I was playing through my mind what I would be writing about in my journal this week.  I thought it would go something like this....I had 4 patients, didn't get a good report from the dayshift nurse, but had hopes that the night would get better.  I assessed all of my patients, passed meds & took care of their needs.  One of my patients was a rather large woman...over 500 lbs.  She was 40 yrs old & quite demanding & somewhat needy.  I was told she can be a bit of a drama queen & I was noticing between her actions & comments, that it seemed she was.  She was admitted last week with respiratory failure.  The doctors were wanting to do a CT scan to rule out a pulmonary embolism, but at her weight, it couldn't be done at our hospital or any hospital in the area.  We were trying to contact a hospital in South Florida that had the proper equipment for someone of that size.  One of the doctors came in to see her...a psych doctor.  He asked me why he was consulted & I truly did not know.  She was alert & oriented, actions were appropriate, nothing really out of character other than being needy & believing that the nursing staff should cater to her every desire.  He went in & spoke to her, I observed some of the interaction.  Then out of the blue I heard her say to him "Am I going to die?"  Both he & I were shocked by the question & he replied back something like "Why would you say that?"  She didn't really have an answer.  Little did I know at that point, that she was having a premonition of what would happen later in the shift. 

It was about 11:30 pm, all of my patients were stable...some were already sleeping, some were preparing for sleep.  My patient above wears a bipap machine at night (to help her breathe).  For some reason, she kept taking it off.  I'd put it back on her & she'd take it off.  She then said to me "Stay with me, hold my hand."  I thought she was being a little dramatic.  She grabbed my hand & begged me not to leave.  

This patient was having very poor urine less than 150 for the entire day.  I thought maybe it was the foley catheter, so we took the old one out & put a new one in...still nothing...not a drop.  Meanwhile her heart rate was between 120 & 130.  I don't like heart rates above 110 so I was keeping an eye on it.  My clinical leader was in the room to help with the foley & she also could sense something in the room.  She asked if there was an ambu bag nearby.  We looked around & there wasn't.  She went & got one, put it near bedside while saying "Just in case...". 

My patient was continuing to refuse to wear her bipap, so I put the nasal cannula back on & called respiratory to come do an 02 sat.  She was looking a little dusky, but still responding appropriately.  At this time, I called the doctor...I was concerned about her lack of urine output & her heart rate.  He gave me orders to start some IV fluids & told me not to worry about the heart rate, she was ok with that heart rate.  At the same time, I am told we are unable to get an 02 sat, see if the doctor will order ABG's while the respiratory therapist is in the room.  He says ok.  I get the fluids from the supply room, go into the room at about the same time the resp therapist is drawing ABG's & now the patient is not responding.  Eyes are open, chest is moving, normal sinus rhythm on the monitor...but no verbal response.  Try a sternal rub...nothing.  We're we call a code?  She has respirations & a heart rhythm...but not responding.  The decision is made...."Jen, call a code."  My first code blue.  I run to the nurses station, pull the "code blue" switch & watch as my staff begins running to the room.  I grab the code cart & get it to the room...still in shock that this is really happening.  I didn't know what to do - so much for ACLS, huh?  Luckily we have a great code team who were all there in less than 60 seconds.  I get on the phone with the doctors while watching them work the code.  I put a call out to the family...not sure of what to say.  I've never done any of this before.  They worked the code for 40 minutes, but she didn't make it. 

My focus turned from what to do during a code to what to do afterwards.  Again, I was clueless because I've never been in a situation such as this.  I knew the parents & family were on their way - what do I say to them?  What paperwork needs to be done?  Who do I need to call?  I love the staff I work with....they helped me so much.  I know I probably would have fallen apart if I didn't have their support & guidance.  They were telling me what to say to the family & who to call...what to say.  How to fill out the paperwork properly. 

The hardest part in all of this for me was telling her mother the bad news.  She came walking down the hallway & I looked at her.  She walked right up to me & wanted to know what was going on...what happened?  I did not know the words to say.  She was looking into my eyes...wanting a response & I was speechless.  I looked towards a more experienced nurse for guidance - in hopes that she would take over or assist in the situation...but at this point I was on my own.  I looked back at the mother who was looking in my eyes & she could tell from my expression that it was bad news.  I think she then said "No, she's ok, isn't she?"  I shook my head & told her I was sorry.  She began to break down.  I can't even begin to imagine what she was feeling at that moment.  The news traveled quickly through the family & I watched as each family member reacted in their own way. 

I'm going to leave it at that for right now.  I don't have much more to say at the moment.