Wednesday, February 22, 2006

Go Eric Go!

I had a nice weekend this past weekend.  On Friday, I met up with the group of friends I hung out with in high school.  I still keep in pretty good contact with 3 of them, but one of them I hadn't seen in at least 10 years.  It was neat to get together & reminisce.  The next day I went to watch my oldest nephew play baseball. He's 18 now & a senior in high school.  I remember the days (I'm sounding old, aren't I?) of watching him play t-ball & little league.  Now he's an all-star.  He already has a college scholarship & hoping to eventually make the pros.  He is so good that the other team didn't even want to pitch to him.  They would automatically walk unfair.  For some reason they felt it was safe to finally pitch to him...and he hit a home run.  Woo hoo!  Go Eric Go!  I'm so proud of him.  He has grown up & is such a gentleman.  My brother & sister-in-law raised him well.  The rest of my family was also parents, my other brother, nieces & nephew.  I had a good time even though it was 82 degrees & overly sunny.  I got sunburnt!  I won't complain though.  Compared to up north...I'll take these 80 degree days.  I'm looking forward to going to more of Eric's baseball games.  Hard to believe this is his last year playing locally.  Where has the time gone? 

I spent the rest of the weekend with my youngest niece Elizabeth.  She's 9, going on 21.  We shopped, watched movies, played computer games & she confided in me that I'm her best friend...sweet.  She is my little buddy.

I watched the Daytona 500 on Sunday....yay...Nascar is back.  I would have been happier had Tony Stewart or Dale Jr. won, but I like Jimmie Johnson it was alright. 

I worked last night - it was a good night.  My first patient is sort of a sad situation.  I had been warned that she is full of drama...which worried me.  The last time I was warned about a drama queen, she ended up coding & dying the night I had her.  This patient was admitted with a pulmonary embolism, congestive heart failure, chronic obstructive pulmonary disease and chest pain - now that's a handful of diagnoses!  Turns out (according to the doctors), that she is basically a drug seeker.  I was warned that she will be asking for drug meds...the doctor had discontinued all of them except for 1 mg of Morphine every 4 hours for chest pain only.  I go in to assess her & she immediately tells me she's feeling nauseous.  I look at her medications & she has nothing for nausea.  So I place a call to her admitting doctor.  He calls back & I tell him she's feeling nauseous.  He begins to tell me her background...she has been admitted to local hospitals 29 times in the past year...whoa!  I looked her up on our computer....14 times since September for misc things.  Anyways, he starts to order Zofran & I tell him she has requested Phenergan.  I always know something is up when a patient begins recommending their own meds.  He says "Ok, but it will be by mouth, not IV."  I was fine with that.  I get her the medication & she is complaining that it's not IV.  "Sorry, this is what the doctor ordered."  She tells me she won't bother me anymore tonight.  I go check on my other patients when I get alerted that this patient is now experiencing chest pain.  I go back in & reassess her....vital signs are normal, nothing has changed on the monitor...but she's laying in bed clutching her chest & moaning. 

How am I to determine whether it's real or not?  Do I get the, because her normal BP already runs in the mid-90's.  If I give her nitro, it will drop her.  Do I do a stat EKG?  Do I alert the doctor?  I ask the patient whether she's experienced this before.  She says "yes, all the time."  Ummm, ok.  I ask "What helps to relieve it."  She replies "Dilaudid or Demerol."  Hmmm, ok.  I informed her that the doctor was already asked during the day shift to order one of those for pain & he refused.  Her mood changes.  She says "Ok, I'll just lay on my left side & the pain will go away."  I leave & come back about 10 minutes later...she's sleeping.  That didn't last for long though.  About a 1/2 hr later, she was complaining of chest pain again.  I went ahead & gave her the 1 mg of Morphine.  Who am I to decide exactly what she's experiencing?  She had Morphine ordered for chest pain & she was complaining of chest pain.  As soon as I administered it, she was fine.  It's sad to see someone going to such extremes for pain medication.  Her pulmonologist came in early the next morning & asked "What is going on with this patient other than her wanting pain drugs?"  Apparently they are very familiar with her. 

My second patient was an elderly female that simply wanted to be left alone to sleep.  The night before they woke her up to give her a bed bath & change her linen.  They told me she was combative & mean.  Well....I would be combative & mean if you were waking me up at 4:30 in the morning for a bed bath.  I promised her that wouldn't happen during my shift.  The pulmonologist went in to evaluate her around 6:15 am & she wasn't happy.  I had to laugh...just let the lady sleep! 

My third patient was a male in his mid-40's with a huge medical history.  I don't expect people that young to have MI's, 4 stents, strokes, valve replacement, surgeries, thrombocytopenia, hep C....the list goes on & on.  He was awaiting having a heart cath done.  His platelet count was too low for the cardiologist to do it....68,000.  So I transfused 1 unit of Platelets.  The magic number we were looking for was 75,000 in order to have the heart cath done.  Wouldn't you know it....the next morning his platelet level was 74,000.  So I put a call out to his doctor, got an order for another unit of platelets & hopefully, his level was high enough by noon time when the heart cath was scheduled.

My fourth patient was a "medical misadventure."  Otherwise known as a drug overdose.  She took a large amount of Cardizem, added alcohol to the mix & then called 911.  She had been placed under the "Baker Act" - here in Florida, anytime you are a threat to yourself or others, they enact the Baker Act.  Which basically means for 72 hours, you are under constant surveillance & cannot leave until a psychologist has evaluated you & given the ok for release.  Lucky for her, the psych doctor was in the same day & for some reason did not feel she needed to be a Baker Act.  I'll have to remember her name & go back & read the psych doctor's report on her...because I don't understand how a person with suicidal tendencies is not a threat to herself.  Perhaps he felt because she was in the hospital & under surveillance anyways, that at the present time she wasn't a threat.  I don't know.  She was a little on the strange side.  She was in her late 40's & had a flat affect.  I don't know what her history was...she wasn't cooperative with giving a medical history.  Hopefully she'll get the help she needs so this doesn't happen again. 

So it was a decent night.  There was a code blue called on the Med/Surg floor.  Apparently it wasn't much of a code because the patient was already dead by the time they discoved he wasn't breathing.  That's one reason why I wouldn't want to work on Med/ truly don't know what's going on with your patients.  Sure they are supposed to be lower risk than those on PCU....but still, they are capable of coding & the only way you know that is if you are physically in the room with them.  I like PCU with the telemetry.  You know when something isn't right as well as vital signs are taken 3 times a shift rather than 1 time a shift.  Oh well, I'm sure Med/Surg has it's advantages also...but I think I'd be constantly checking on my patients to make sure they were still breathing.  That's all for now!

Thursday, February 16, 2006

A Good Week

As anyone in healthcare knows...we have our good weeks & our bad weeks.  I had a good week at work this week.  I put in 3 days in a row.  I prefer to do that because for the most part - you end up with the same patients.  Some of them get discharged, some of them you have to give up to another nurse to even out the assignments...but mostly, you usually get them back.  I think that works out for both myself & the patients....because really....would you rather have a nurse you are familiar with or a new one every night?  I managed to develop a good rapport with a few of mine.  The others were either totally non-verbal or just plain out of their mind...but that's another story.

My first patient was a gentleman in his late 50's that was awaiting a surgical procedure.  Well, actually his foot needed to be debrided & with that came the possibility that he may have to have a couple of toes amputated.  The morning of his upcoming debridement...he developed chest pain.  That postponed the surgery because now he needed cardiac clearance.  We finally received that after a day & a half...surgeon's assistant reschedules the surgery - for a day that the surgeon doesn't even come to our hospital.  So it gets delayed until Wednesday at 4 pm.  Come to find out, the surgeon is backed up from earlier surgeries so this gentleman has to wait until 6:30 pm.  Poor unfair.  I have to say, he maintained a positive attitude through it all (thankfully).  I would have totally understood if he was complaining, but he smiled & joked about it along the way.  I did my best to meet his needs & I am pretty sure I succeeded.  He ended up only needing his the debriding & not the amputation. 

My next patient was a woman in her early 60's in with COPD exacerbation.  She also was a smoker & an alcoholic.  Have you ever seen how people behave when you take away their cigarettes & alcohol?  It's not pretty.  Soon enough she was downgraded to Med/Surg status because she refused to wear her heart monitor.  As soon as a bed opened up on Med/Surg....I moved her quickly.  I just have little patience for people that cometo the hospital & immediately start complaining about how they want to go home.  You want to straight up ask "Why did you come here then?"  I understand addiction...we had gotten her a nicotine patch...but she still wanted to leave.  You're at the point of wanting to say "Just go then."  Of course you can't say I did the best I could while she was in my care & transferred her to another floor since that's what her doctor ordered. 

My third patient was a man in his mid-80's that was totally non-verbal. At night he slept most of the time....even when I tried to arouse him.  He had really terrible looking decubs on his heels which required dressing changes twice a day.  His family was as sweet as can be.  It's refreshing to see a family so involved & so caring about their family member.  So often these type of patients end up in a nursing home left to pretty much die without a family member around.  This family wanted to take him home.

I got a new admit after that...a 97 yr old woman with a diagnosis of rectal bleed & electrolyte imbalance.  Her potassium level was 2.9 on arrival to the ER & 3.1 when she got to my floor.  Neither I nor the ER doctor found any evidence of rectal bleeding though.  Her H&H was within normal limits - which is amazing for a woman, much less a 97 yr old woman.  She was a sweet lady...the kind you wanted to hold her hand & tell her she'd be ok.  I hung some potassium replacement & left her to get some sleep. 

My fifth patient on Monday night was also another new admit.  A male in his mid-70's that came in with a diagnosis of CVA (stroke).  By the time he got to my floor, it had pretty much resolved itself without any neuro deficits noted.  He was a lucky man. I really liked this gentleman.  I don't say that about most of my patients, but this guy was so easy to communicate with.  He was another one that you truly just wanted to take care of & see that he would be ok. 

That was Monday night.  Tuesday night comes along...I have 4 patients instead of 5.  Gina had been down to 2 patients, so I gave her my assignment for the 97 yr old woman that was admitted the night before.  I also managed to move my cigarette/alcohol addict down to med-surg, so that left me open for a new admit.  My other 3 patients were doing fine.

My new admit came along at about 4:30 in the morning.  A woman in her 80's that was simply very confused.  I can't even remember what her diagnosis was....UTI maybe.  I don't remember.  What I do remember is feeling sorry for the lady that was in the other bed...because she went from dealing with the cigarette/alcohol addict driving her crazy to this little old confused lady that I found out later was constantly screaming throughout the day.  Anyways, she was ok when I got her....definitely I was concerned that she was a risk for falls.  At the time though, she simply wanted to get some sleep.  When I came back that night, she had already been downgraded to med/surg.  The day nurse said the patient had pretty much attacked her.  She went in to find out why she was screaming continuously & the patient latched onto her arm & scratched her.  Ouch!  Needless to say, I was glad she had been transferred to a different floor.  It's not that I mind taking care of confused people, because I don't mind it.  However, when they are sharing a room with another patient & it is the nightshift - where most patients want to sleep during the night, it can be frustrating having to deal with one that is confused & disruptive. 

I think all hospitals should be made to have private rooms only.  It is not fair for patients that are totally alert & oriented to have to share a room with those who are not or those who have 930482049 family members or phone calls constantly throughout the day & evening.  I know if I were to stay in a hospital - I would demand a private room.  They are on our case with pt rights & privacy....yet when they are sharing a room with another patient, that other patient hears everything that should be confidential.  Or case in point...they called a code last night in a room where there was 2 patients.  It turned out not to be a true code, but the other patient should not have to deal with 15 people running into his room in the middle of the night.  I know it's costly, but I still say all hospital rooms should be private rooms in this day & age.  I worked at a hospital that was just built a few years ago & that's what they did....all private rooms.  It was very nice & I'm sure the patients appreciate it. 

Ok, back to story.  I came back into work Wednesday night...fully expecting my CVA patient to have been discharged.  Nope, he's still here.  My patient with the possible toe amputation is in surgery & I have a new patient assignment.  I also had to give up my non-verbal patient to evenly distribute the nurse to patient ratio on my floor.  So since one of my patient's was in surgery, that left me with only 2 patients.  That was nice.  I got to actually spend time talking with my patients.  I think that's important.  There are many times where I don't have the time to really talk to them...mostly I only have the time to do an assessment, pass their meds & make sure they aren't in any pain or discomfort.  Usually at change of shift, there are too many things that need to be done...orders left undone by the dayshift, new admits arriving on the floor & other chaos.  So this was nice...having time to actually talk to my patients.

I went to see my CVA patient first.  He was smiling & saying "Can you believe I'm still here?"  Both of us were pretty sure he would have been discharged during the day.  He told me the cardiologist wanted to keep him one more night...his Coumadin level wasn't therapeutic yet.  A few hours later, the neurologist came in & said "You don't need to be here, you can take care of the Coumadin stuff on an outpatient basis."  So now the patient was confused & wanted my input.  He said he had been looking forward to discussing this with me (awww).  I basically told him "Do you really want to take a neurologist's opinion on something that is cardiac related?  Or would you rather follow the cardiologist's recommendations?"  He said "That's all I needed to hear."  I reassured him that the cardiologist on his case was a good doctor & that he doesn't keep people in the hospital for the fun of it.  That if he advised it was better to spend another night here, then it's good advice.  He thanked me for reassuring him.  I swear, he is like one of the nicest patients I've ever had. 

I went in to see my new patient assignment.  A lady in her mid-80's in with UTI & mild CHF.  This is the patient that was having to share the room with my other confused patients.  I really wanted her to finally get one night of good sleep, since the last 2 nights were interupted continuously by the other patient's that had been sharing the room with her.  I talked to my clinical leader & we came up with the idea to move another patient that was already on the floor into her room so in the event that I got a new admit...we wouldn't have to disturb this patient throughout the night.  It was a good move...she was able to get a lot of sleep. 

My patient from surgery came back around 8:30 pm.  He ended up not needing the amputation.  Yay!  I'm reading over the post-op orders & the surgeon writes "Resume pre-op medications."  Ugh!  Our hospital has started this new thing back in January called Medication Reconciliation.  I know other hospitals do this, but I've never had to deal with it before & it seems that the majority of doctors haven't either - so they don't cooperate.  We were told in our unit meeting earlier that night that it is against JCAHO law (or whatever) to write "Resume pre-op meds" or "Continue home meds."  That each med has to be addressed by the doctor.  The PACU nurse apologized to me, told me the surgeon flat out refused to fill out the medication reconciliation form.  That annoys the time that it took him to write "Resume pre-op meds"...he could have had that other form filled out.  All it consists of is checking the boxes on the paper of what meds to resume.  He doesn't even have to write the meds out...they are already there.  He just needs to check a box next to the med & sign his name at the bottom of the form.  I end up calling the admitting doctor who also happens to be very resistant to this new change.  I tell him I just received this patient back from surgery.  He replies "Continue all meds" & then wants to hang up.  I inform him that I need to review each med with him.  He yells at me "Start now!!"  So I basically read each med without him saying a word.  Then when I'm done he says "Ok" & hangs up.  Why do they have to be such jerks about it? 

I never did get another patient last night.  So it left me with only 3 patients the entire night - which is nice.  That's how the patient ratio should be in PCU...or at the most 4 to 1.  I'm off tonight...actually I'm not scheduled again until a week from Monday...but I'll call over the weekend & pick up some days next week.  I got a raise...well actually 2 raises.  One was my yearly review raise.  I think it was something like .54 cents/hr.  Then there was a hospital wide .60 cents/hr raise.  So basically it's over a $1 more than what I was making last year.  Not great...but not bad either.  Better than nothing, right?

I've put off any decisions about traveling or agency nursing or even switching to another hospital for now.  It got to be too much to think about & right now things are going ok at my current hospital.  I'm sure in the future something about this hospital will annoy me again...maybe then I'll make the transition...but for now, I'll just focus on learning more in PCU, enjoy working with my co-workers & making money. 

Sunday, February 12, 2006

Would You Want to Know?

I was reading the newspaper this morning & in the obituaries I saw the name of one of my patients.  Although I knew her diagnosis was terminal, I was still surprised to see that she passed away.  I reflected for a few minutes on the last time I cared for her.  It was very brief as she was downgraded from PCU status to Med/Surg.  Her sons were in the room with her...doting on her.  It was nice to see the sensitive side of two men that looked more rough than tender.  She was in the hospital for a blood hopes that it would give her a little more energy. 

The thing is...she knew her days were numbered.  Hospice was being brought in the next day.  She'd known for awhile that she wouldn't be able to defeat the cancer that was taking over her body...yet thru it all...her attitude was positive.  She was in her late 70's...lived a good life, had a great family & now the end was near.  She was still smiling, still joking, still making it the best that she could. 

It got me thinking today - would you want to know you were dying sooner than later?  For me...I don't know.  I'll have to think about it.

Wednesday, February 8, 2006

How do things work?

As I sit here throwing out my cassette music tapes from the 80's & 90's, it leaves me exactly do they work?  Oprah had an episode where this guy explained how the tv & phones work...which is amazing.  But how do video & audio tapes work?  And who invented them?  As you can see, I have way too much time on my hands this week.  :)  And you're probably wondering why does this chick still have cassette music tapes from the 80's?  I have noooooooooo idea!

I took this week off from work.  I needed a little R&R, plus I wanted to get all of my continuing education stuff taken care of.  I'm all set for nursing, but I also have a building contractors license & a real estate license. I'm so dynamic, aren't I?  Haha!  Renewal is every 2 years, but it seems like I was just doing all of this continuing education stuff.  Oh well...just have to get it done.  Luckily it can all be done online (yet another thing that I don't understand how it works...the internet). 

I also got hooked on the tv show "24."  I kept hearing about how great it was.  I'm not much of a Kiefer Sutherland fan, so I skipped it when the show first started.  After constantly hearing about how great it was...I decided I must see for myself.  Needless to say, I'm hooked & I like Kiefer now.  If you haven't seen it sometime. 

I still haven't made a decision as far as what my next step in nursing is.  I talked with an old classmate about agency nursing.  She says she got called off/cancelled a lot & usually at the last minute.  I don't want that.  Do I stay in my comfort zone for another year or take a chance & venture out?  I suppose I could do both - I'm just waiting for clarity to arrive.  I've had agencies calling & the latest is some dialysis company wanting to know if I want to do travel dialysis.  Ummm, no. 

Did I mention that a couple of weeks ago I was messing around with the radio at work - moving it around to try to get better reception & I accidentally set off the code blue alarm?  Ooops!  My bad!  That won't happen

I had a JCAHO meeting type thing yesterday.  It seems like such a waste of time.  The information is good, but we get so tired of it being thrown at us repeatedly.  And if I hear one more time "Wash your hands", I'll scream.  My hands are so dry from the constant handwashing.  I've got it so drilled in my head, that I find myself washing my hands even when I haven't touched anything or anyone!  Ahhhhhhhhhhhhhhhhhhhhhhhhhhh!!! 

Thursday, February 2, 2006

What Do I Do???

I'm still undecided about the mother/baby thing - mostly because I still want to gain more experience in the PCU/tele type of nursing - that is where the major demand will be in the years to come (thanks to the babyboomers).  I like taking care of patients, but I want to make good money's all about supply & demand.

I went into work on Monday night...still awaiting a call from my manager regarding my pending per diem status.  I had a very, very busy discharge, one transfer to med/surg, another patient where I just got report that there was a probability of a pulmonary embolism & the day nurse never notified the physician, another patient with chest pain and two admits.  I didn't stress out, just tried to prioritize & get things done.  What more can I do?  We were short-staffed (big surprise!), so the other nurses were busy also.  I don't think I took a break the entire night & I was still finishing up the paperwork at 6:30 am.  Oh well, it made the night go by quickly. 

Turns out the patient with the pulmonary embolism also had a DVT in her left calf.  I think I scared her when I told her she's on strict bedrest...that she is not to get out of the bed for any reason.  She was afraid to even move in bed.  I explained to her the reasons for the bed rest & that she was allowed to move in bed.  Educate, educate, educate.

Anyways, even with as busy as I was that night...I was coming to a conclusion that I like it there (other than the administration) & that at a per diem rate, I could see myself continuing at this hospital.  How quickly things can change...

Along came Tuesday evening - I had only 2 hours of sleep during the day (grrr) & I see my manager in the hallway.  I truly felt like a stalker tracking down my prey.  It's ridiculous that she doesn't return phone calls.  So I stop her & ask the status of going per diem.  She says she already has enough per diem nurses, so basically NO, I cannot go per diem.  She needs to hang onto her "staff" nurses.  Ummm....I thought per diem still was considered staff.  Whatever!  Like Gina says...she's basically giving me that push that I need to jump into travel/agency nursing.  There are no other options unless I want my payrate at the bottom of the "nursing" barrel.

In the meantime, I have the staffing person calling me multiple times - begging me to work Sunday night - Superbowl night.  They are very shortstaffed (big surprise!) & desperate.  She says they'll do whatever it takes - yet another lie.  They are offering to bring in food.  Big deal!  Absolutely no $$ incentive to volunteer to work that night.  They are trying to teach the staff a lesson not to be greedy, so they no longer offer us bonus incentives to pick up extra shifts.  Instead they rather pay an agency something like $60-70/hr to send over a nurse to cover.  Makes no sense to me from a financial viewpoint, but then again - I never want to go into administration.  Basically they are pissing off their own staff nurses by taking away incentives, yet paying more than twice as much for an agency nurse...all while complaining that they need more staff nurses.  The other night, they started out with only 3 nightshift nurses for 26 PCU patients - they were begging dayshift nurses to stay later (but offered no incentive).  They also had 17 patients waiting in the ER to come to the floor!!!  Common sense isn't so common & it's definitely being displayed right now with the changes they are making.  Needless to say, I won't be working there Sunday night or any other night except for the 2 nights a month that I'm scheduled...not unless things change.

I am currently checking into travel/agency nursing.  It is a little scary to go into a new facility not knowing how well received you will be as an agency nurse....but at $35-45 per hour, I can overcome those fears  I know Florida pays the worst when it comes to nursing wages, but I'm not ready to venture very far at this point.  I still have my dog & unless I can bring him with me...I'm not going very far & I'm not leaving him behind.  I do want to see the US, but (hopefully) there is plenty of time for that in the future. 

As far as the mother/baby unit goes...I haven't made a decision - haven't told them yes or no.  It's still an option at this point. The fact that it's a great opportunity still keeps it in the back of my mind.

I had a patient say to me last night that it must be a calling to be able to take care of patients...that she knows it's hard work.  I told her taking care of patients is actually one of the's all the paperwork & doctors & administration that drains us.  I really do wish I had more time to spend with my patients as opposed to the paperwork.  I can't even imagine what the future holds as the babyboomers are aging & it looks as though there will be a huge nursing shortage.  Something's got to change or nurses will leave the industry.  I don't want to discourage any nursing students out there - it's a great career, the money is pretty good....I have no regrets about choosing this field. 

I'll keep ya updated!