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. 

1 comment:

compuruss89 said...

Glad you had a good week!  I am greatly enjoying reading your journal.