Short-staffed

I woke up this morning to 2 phone calls from my hospital asking if I could work tonight, Sat &/or Sunday night.  They are offering callback pay.  It's no incentive for me unless they are offering it on Sunday too because I already put in my 3 days this week...anything more is automatically overtime which is the same as callback pay.  I'm wondering why they are so short-staffed.  They are in a process of trying to eliminate travelers & agency nurses...but it's not going to work.  Our census is still really high even though it's nearly May.  I should put in some overtime.

No way am I working tonight...I have a baseball game to go to...a District Championship!  It was a close game yesterday...0-0 for 5 innings & then suddenly in the 6th, it got a little crazy.  Our guys were down 2-0 because of their own errors on the field, but pulled it together to score 4 runs in one inning & advance to the championship.  Whew!  They automatically move on to the Regionals next week.  Yay!  I still want them to win tonight though.  Perhaps if the game is over at a decent time, I could go into work at 11.  I'll just have to wait & see. 

I'm still debating about Saturday or Sunday.  I know I should work...but should & will are two different things...lol.  I need some time off to myself, ya know? 

I was thinking back about one of my patient's this week.  A gentleman in his mid-80's (looked much younger) that was diagnosed with a possible PE (pulmonary embolism).  Two tests were indicating that he may have one...so when I took over after shift report, I went in to assess him.  I told him that he is on bedrest & should remain in bed as opposed to ambulating.  He verbalized that he understood.  I got a call from his wife about a 1/2 hour later saying she just talked to him on the phone & that he is scared to even move.  Awww, poor guy!  I didn't mean to scare him!!  I went back in & reassured him that he could move in bed, that he didn't need to lay completely still...he could turn on his side if he wanted.  It turns out he did not have a PE, it was more of a bruising on the chest wall from a fall he had earlier in the month in which he fractured some ribs & his body was simply healing. 

Have a good weekend everyone!

An order is an order, isn't it?

I had another good week!  We did have a code blue, but it wasn't my patient & her heart never stopped beating...she just was unresponsive.  They ended up intubating her & sending her to ICU.  What was strange about that is earlier in the night, the patient kept saying "I don't want to be intubated."  She was stressing out over it....it's like she had a premonition about what the morning would bring.  Weird!

I won't go into details about my patients this week because there really isn't much to say.  They were all alert & oriented, no drama queens or kings...it was a peaceful week for me....until this morning.

I received a woman in her mid-80's from ER with a diagnosis of dyspnea (in layman's terms...she was having difficulty breathing).  The orders were short & simple... basically said "Patient on bipap, ABG's in the morning."  ABG's are a lab test "Arterial Blood Gas."  She had already had 2 sets of ABG's done in the ER...one on 5 liters & one a couple hours later on bipap.  Her results were much, much better on bipap.  Anyways...the patient comes up from ER...not on bipap, rather on a 50% venti mask at 15 liters.  Hmmmm...ok, maybe for some reason they couldn't transport her with the bipap, even though they managed to bring the machine up with her at the same time.  I ask the ER nurse why she is on a venti mask instead of the bipap & she said "I don't know, respiratory set it up."  Hmmm...ok, so I ask for the respiratory therapist to be paged to come set up this patient's bipap.  He calls back & basically says the patient is fine, she doesn't need it.  Ummm, helloooo, the doctor wrote that he wants the patient on bipap.  It doesn't say "do whatever the respiratory therapist says to do."  I page him again, this time instead of calling back...he shows up & we assess the patient together.  I am saying to him "Don't her lips look kind of bluish?"  He replies "It's kind of hard to tell in this lighting."  What?????  Open your eyes.  So he asks if I have an 02 sat monitor.  Ummm...YOU'RE the respiratory therapist, where is yours?  He knows we don't have them laying around the units as much as I would love to have one readily available...we don't.  Only respiratory has them.  He gets one & returns, her 02 sat is 96%...which is good.  So he says she's fine, if she has trouble breathing, then call him & he leaves.  I ask a couple of other nurses what they think of this & how do I cover myself for not following what the doctor specifically ordered.  They were all agreeing that it is not up to the resp therapist to make the decisions without the doctor being aware of it.  I discussed it with my clinical leader...she also said it was wrong for him to refuse to put the patient on it...but advised me to document, keep a close eye on the patient & notifty the doctor in the morning. 

Hmmm, decisions, decisions.  The patient was a DNR, however, that doesn't mean we purposely assist her to have difficulty breathing.  Plus she has a history of COPD...which I always thought that when they have COPD...they aren't supposed to receive more than 4 or 5 L of oxygen.  I discuss it again with my fellow nurses & they encouraged me to either call the doctor & let him know what's up or to call the respiratory therapist & tell him the bipap has to be put on the patient.  I much prefer calling someone who is already awake & at work...so I opt to call the respiratory therapist.  I tell him that I reviewed the orders with my clinical leader & that since the doctor has specific orders for this patient to be on bipap, that I need him to come up & put it on her.  He replies "She's fineeeee!!!!!!  She doesn't need it."  I told him I understood that, but that I have to cover myself & follow the written orders.  He begins to say "It's my call", but he stops just in the middle of saying call & then tells me I'm making too big of a deal about this.  I was being as nice as possible because I really don't like conflict.  I tell him "Ok, I'm just going to run it by the Dr. so he's aware of the situation."  I had no problem if the patient was fine on a venti mask, but I wanted the Dr. to be aware of it & not throw a fit because his written orders weren't followed.  Respiratory replies "You'd wake a Dr. up at 2:30 am over this?"  Ummm, yeahhhhh.  Then he says in a smart aleck tone "Don't you need your charge nurse's permission to call the Dr.?"  I tell him I would have no problem getting that for this situation.  So he finally says "Fineeeeee, if you're going to make this big of a deal, I'll come up & put it on."  It took him like less than 60 seconds to do this.  He came stomping up the hallway like a little baby, goes in my patient's room & says to her "Your nurse wants me to put this on you", puts it on & then stomps back down the hallway.  The other nurses were saying "I think he's mad at you!"  Oh well!

I mean seriously...I pictured myself trying to explain if anything happened to this patient through the night...and I'd be the one taking responsibility for it.  I don't know why he was giving me such a hard time about it.  I remember back to last year when I was brand new at nursing & I had a patient telling me she was having difficulty breathing, that it felt like an asthma attack.  I page respiratory for a breathing treatment.  This same respiratory therapist calls back & says "I just saw the patient an hour ago, she's fine."  Ummm...noooooo she's not.  He finally shows up & then jumps into action because she was truly in distress.  I remember the nurse that helped me out that night told me that for some reason, our respiratory department has an attitude...that they can't stand a nurse telling them what to do or something to that effect.  I don't understand why some of them give us a hard time.  All we're asking is for patient care to help the patient breathe better. I'm not asking them to do my job or to assist me with anything...just follow what the doctor ordered.  Am I wrong?

I'm sure he'll get over it.  I'm off until Monday, although I mighttttt work Saturday &/or Sunday.  We'll see.  My nephew's team starts districts tomorrow.  Did I mention that according to Sports Illustrated his team is ranked #4 in the nation overall???  WOW!  They are ranked #1 in the state for their division.  I sure hope they do well these next few weeks.  Wish them luck!  I'll keep ya updated!

Oh, one other thing...I found out this week that I was chosen as one of the guest editor's favorite journals.  Thanks Donna!  I hope y'all find my journal interesting.  Feel free to leave comments or to email me!  :)

 

 

 

3 patients each night

Another week of work completed, although I just "might" work Saturday night for some overtime.  It's been an interesting week to say the least.

First off...updates:

That code from last week in the bathroom...he passed away on Friday.  :(  He had a lot of health problems prior to the code & his family decide to make his code status DNR. 

My patient with the colon mass & perforated colon that was in ICU.  He was transferred to med/surg & will be going home soon.  His prognosis is not good, but at least he'll be able to leave the hospital. 

I worked Mon, Wed & Thurs this week.  I'm trying to remember back to Monday....hmmmm.  I recall that I only had 3 patients, which actually...my entire week was only 3 patients each night.  I really lucked out.  Anyways, let's see...Monday night...I had an ICU transfer.  A gentleman that had come in with respiratory distress.  He was slowly improving.  Not much to really say about him.  My next patient was diagnosed with obstructive jaundice.  I never heard of that before.  I believe they thought he had a gallstone stuck in the pancreatic duct & they tried to surgically remove it.  He had an NG tube set to low-intermittent suction that had plenty of output as well as an Abrams drain from the incision that also had plenty of output.  He was a quiet guy...not much to really say aobut him.  My third patient I can't even remember!  Talk about short-term memory loss!  Hmmm...perhaps it will come to me later. 

My night went smooth. I did eventually get another patient & this sort of annoyed me...not the patient, but the ER staff.  They received orders to transfer this patient to PCU at 5:10 am.  Guess what time they called report...6:25.  I wasn't even off the phone 60 seconds & they already had the patient coming down the hall on the stretcher.  How is this possible?  Anyways, they really screwed up as they had mixed up my patient's paperwork with another patient on a different wing...not good.  So half the orders were correct, half weren't.  I eventually wrote up an incident report because they were being careless.  The ER nurse tells me during phone report "The patient's blood pressure has been in the 180's since she got here."  Sooooooo...you're sending me an unstable patient?  Have you even addressed with the doctor the blood pressure?  It just seemed really careless with the way this patient & her paperwork were handled.  You don't send up an unstable patient...especially during shift change!  That's my gripe for the week.  :)

Tuesday night I went to my nephew's baseball game.  They won, but OMG...the fans of the other team were just awful.  They would not stop yelling insults at our players....they were especially attacking our catcher...yelling at him that he's on steroids & a lot of other stuff I won't even post here.  It's just wrong.  These are still kids...high school kids....but still kids.  You don't bash them during a sporting event.  I'm all for cheering for your own team, but why verbally attack the players on the other team?  I don't get it.  The principal of that school was there & he allowed it to continue.  It's just wrong.  However, we won.......yet even after we won, they were chanting "Overrated, overrated."  Ummm, helloooo...we just BEAT you, why are you yelling at us?  Very strange! 

Wednesday I returned back to work & got all new patients even though I was on the same floor as I was Monday night.  This time I had my patient that was diagnosed last week with a brain tumor...he was back in the hospital for nausea & vomiting.  It turns out that last week when he had the low heart rate...it didn't have anything to do with his heart...rather the brain tumor is growing & causing pressure in the brain that is resulting in a vagal response which causes the heart to slow down & also causing the nausea/vomiting.  It's also causing something with prolactin...I don't remember if it was causing him to produce too much or not enough as well as affecting his short-term memory.  He's the nicest guy...I really hope they are able to do something for him.  We don't do neurosurgery at our hospital & the soonest he could get an appt with a neurosurgeon was the middle of May.  Hopefully he'll be ok.

My next patient had a chest tube...the small compact one that just sits on the chest.  It's pretty neat.  I got a call from the surgeon placing orders to consult a pulmonologist & see what his opinion is on a thoracolesis &/or pleuradesis.  I was like "Ummm, excuse me?"  I had never heard of those words, much less know how to spell them!!!

My third patient was an older woman that was a direct admit from her doctor's office.  She was diagnosed with COPD exacerbation.  She made me laugh...not necessarily on purpose though.  I had woken her up at midnight to give her some medications.  She seemed confused (who isn't when you wake them up?) so I began asking her if she knew where she was.  She replied "Yes, I'm at the Vatican."  Ummm, ok.  Do you know who I am?  "Yes, you're father Jennifer."  I chuckled & asked her if I looked like a father.  She said no, but that we were there for a meeting.  I attempted to reorient her & then let her get back to sleep.  Turns out I woke her up in the middle of a dream.  :) 

We had a unit meeting earlier that night.  Those meetings are boring.  They are expecting JCAHO to be checking out our hospital this coming week..we shall see as JCAHO no longer announces when they'll be there. 

That was my night.  They tried to give me a 4th patient around 5:30 am.  A man that needed a PICC line placement.  That sounded way too good to be true, so I looked up his history & it turns out he had C-diff 4 days earlier.  I called the charge nurse & said "Do you really want to put someone with C-diff in a semi-private room?"  Nope....so no admit for me since we didn't have any private rooms open on our wing. 

Thursday was much of the same.  The patient with the brain tumor had gone home & in his place I got a patient diagnosed with "near syncope."  For some reason, he lost the ability to stand for a split second & fell at home.  So he was in to figure out what made him lose the ability to stand. 

My other 2 patients were the same & not much to really report on either of them.  Last night was a very slow night...I actually made the comment that it felt like we were in detention like in The Breakfast Club movie & just watching the clock slowly tick by.  We were overstaffed...we had 4 nurses on our wing & we each had 3 patients.  The other wing had 3 nurses & only 7 patients.  I'm not complaining, but slow nights are not necessarily fun nights.

That patient with obstructive jaundice....turns out it's a pancreatic mass = cancer.  Cancer that has metastized all over....again, terminal cancer.  I still think about what it must be like to be told you have a limited amount of time left to live.  I know we all have a limited time because eventually we all die, but to be told an exact number of something less than a year......just scares me.  It's weird...one of my friends works on an oncology floor at a different hospital.  She, for some reason, always knew she wanted to work in oncology.  I remember thinking that seems like such a sad place to work...where everyone has cancer.  But now I'm seeing that pretty much everywhere you work, you will have patients diagnosed with cancer as sometimes the signs & symptoms are kind of hard to diagnose at first. 

Tonight was my nephew's last regular season game & of course it was raining...figures.  They managed to play 4 innings & were winning 4-1 by the time the game was called.  They finished the regular season with 24 wins & 1 loss.  Not too shabby.  I got an invitation today to his high school graduation party in May.  I can't believe he's all grown up!!!!

I still can't recall who my 3rd patient was on Monday night & now it's driving me crazy.  :)  Byeeeeee!

Up & Down week

I had a good week at work overall (I love how it's only Wednesday & I can call it a week...lol, but it is nearly 40 hours of work when you do 3 nights in a row!).  I worked Sun, Mon & Tuesday nights. 

On Sunday I started out with 4 patients & knew I'd be getting a new admit sometime in the night.  I don't mind having 5 patients IF there is also a patient care tech on the floor.  Yet there was not...big shock...NOT.  We are not very well staffed at night when it comes to PCT's & unit secretaries...which I think is unfair.  It's not that we can't get people to work, they simply aren't hiring or at least making no effort to hire people...not fair.  We are expected to be nurses, PCT's & secretaries...you'd think we'd get some type of bonus when we have to do these other job roles, but nope.  Nothing.  Not fair!  Luckily, I had a good group of guys as patients that night.  Other than medications & snacks, they really didn't need me for anything.

My first patient was an older man who came in with a dx of DVT (blood clot) in his left leg.  While he was at the hosp, they decided he needed a cholecystectomy also.  When they took him to the OR, he went from sinus rhythm to A-fib with RVR.  Needless to say, surgery was postponed.  He was a sweet man...the type you want to go above & beyond to take care of because he's unable to do it for himself & grateful that you are willing to help him out.

My second patient was in with "near syncope"...he felt dizzy but didn't pass out.  Cardiology did a work up on him & the primary doctor wanted him discharged on Saturday.  He didn't get discharged though because his cardiologist wasn't on call over the weekend & the on call dr. didn't feel comfortable discharging him until his cardiac meds had been addressed...so the discharge was to be postponed until Monday.  This guy was a walkie talkie...another sweet man.

My third patient had back surgery & while he was on the med/surg floor, physical therapy got him up to start ambulating him & he passed out cold.  So they transferred him to PCU for a cardiology work-up...but that was postponed because they were thinking that perhaps the Morphine PCA was the culprit.  They discontinued that, started him on Lortab PO instead (as if that is any comparison to IV Morphine).  It was enough to take the edge off the pain though, so he wasn't complaining.  Very, very nice man....one of those that you just kind of instantly connect with, can joke around & you both know that you're on the same wavelength. 

My fourth patient was/is probably the first patient since I've actually been a nurse that I could get teary-eyed about.  I haven't actually cried because I can tell I am blocking some feelings out related to his condition, but he's been on my mind a lot. 

The only time I've ever cried related to a patient is when I was in nursing school & during clinicals I had a woman in her late 30's/early 40's & she came in with nausea & vomiting & right sided pain.  They were thinking that maybe she had gallstones.  She asked me numerous questions regarding gallbladder surgery.  I'm pretty familiar with it as I have had my gallbladder removed about 10 yrs ago.  Anyways, the nurse told me in confidence that this patient's test results came back & it wasn't her gallbladder.....it was a tumor on her liver...cancer...terminal cancer.  The nurse told me the doctor would be in around 6:30 pm to tell her, so don't say a word to the patient regarding this.  Ok, no problem.  I went back into the room later & her family was there & now they were asking me questions related to the gallbladder & such.  It was so hard answering those questions fully knowing that this wasn't the patient's problem.  I felt like I was misleading them by answering their questions.  I would have rather not known the real problem.  What brought me to tears was later that night...around 6:30 or 7 when I was at home, it dawned on me that my patient was probably getting the devastating news right about now.  I can't even imagine what it's like to know you have a limited amount of time left to live. 

Since then I've beenable to distance myself emotionally from stuff like that. It's not that I distance myself from the patients...because I really do take care of them the best I can & try to make an emotional connection in those first 30 seconds of introducing myself.  I just don't dwell on how impacting their diagnoses are...if that makes sense. 

Anyways, my fourth patient was a man in his late 50's that came in because he was feeling tightness in the chest.  He had no health problems in the past, yet the news he got is pretty much the worst you can get.  It turns out he has lung & liver cancer.  I was told that even the doctors that broke this news to him got tears in their eyes.  They wanted to do a colonoscopy to try to find the source of the cancer. 

I got my fifth patient around 3 am.....a woman in with chest pain.  I don't mind getting patients after midnight...because they usually just want to finally get some sleep after being in the ER for hours. 

On Monday I got my four guys back.  My fifth patient was being discharged & we had enough nurses that I wouldn't be getting anymore than four.  I like, like, like having patients that I had the night before...because you're already familiar with their history & they already know who you are when you walk in the room.  I did my rounds, eventually transferred the patient with back surgery down to med/surg as it turns out it was the morphine that caused him to pass out (so they think).  I was expecting to get a new admit to fill the bed of the patient I transferred, but I lucked out.  The housekeeper was so busy that night, she didn't have time to clean the room until 5:30 am.  It didn't bother me one bit...lol.

My patient with near syncope who was supposed to be discharged on Saturday......well, the primary doctor came in & was yelling about why wasn't this patient discharged...I wrote orders...blah, blah, blah.  The nurse explained to him about the cardiac meds needing adjustment before the patient went home (the current ones he was on were dropping his heart rate to the low 40's).  Turns out the results for his CT of the brain were back & he has a brain tumor.  Needless to say, he wasn't about to be discharged anywhere.  More tests needed to be run.  So it was a blessing that this discharge never took place on Saturday.

 

There was a code blue called that night on the other wing.  While going to the bathroom, a male patient had an acute MI (heart attack). 

Gina & I were in the cafeteria when they called it, so we went up & they were saying he was on the bathroom floor & needed help getting him to bed to fully perform the code.  Well, this guy was over 300 lbs.  There was no way I'd be able to lift him without killing my back, plus my shoulder is already really sore from pulling a muscle while working out.  So I knew I wasn't going to be much help.  It was a mess.......all these people trying to run the code & get him into bed.  They did manage to save him & off to ICU he went.  Hopefully he'll recover...time will tell.

Tuesday night I had my 3 guys back plus an ICU transfer.  When I arrived at work, my older patient was in PACU...he had his gallbladder removed in the afternoon & was in recovery.  My patient with lung & liver cancer had his colonoscopy that afternoon...they found a large mass & the doctor accidentally perforated his bowel during the procedure...so he was in emergency surgery.  The poor guy...all he wanted was to go home.  He was looking soooo forward to going home after being in the hospital for the last week.  Instead, he ends up in ICU.  :(

My patient with the brain tumor was now med-surg status as his cardiac meds were adjusted & no longer needed cardiac monitoring.  We transferred him pretty quickly as our ER was overfilled (as usual - why don't the majority of these people go see their primary doctors instead of going to the ER???).  Anyways...it was overfilled & I knew there were patients waiting to come to our floor.  That left me with one patient...my ICU transfer.  The guy was a little quirky, but mostly slept.

I got news that my patient with the colonoscopy was officially being transferred to ICU, so we had to pack up his stuff & move it over there so that another patient could take his place in PCU.

I got my older man back from surgery....he was doing quite well.  It still amazes me that they can make incisions in your abdomen & the only dressing you need is a simple band-aid.  Needless to say, he was sleepy from the anesthesia & he also slept most of the night. 

That left me open for two new admits.  I lucked out...both were walkie talkies in with chest pain.  Labs looked really good, no complaints of chest pain since they got to the hospital...both arrived after midnight & wanted to get some sleep.  Just the way I like them! 

So my week at work was overall good for me, but sad for my patients who got bad news regarding cancer & a brain tumor.  It made me stop & think about how many other people around the world are getting such devastating news.  So, so sad.

I would have gone back for a fourth night, but my nephew was playing baseball against a team that is "supposed" to be one of the best in the state.  Well, by the fourth inning, my nephew's team had scored 10 runs, the other team had zeroooooooo.  So after 5 innings the game was over....something called "a mercy rule."  If you're winning by 10 or more after 5 innings, they call the game.  So yay....they win again.  Two games left in the regular season...then it's playoff time...woo hoo.

Time for me to catch up on some tv...take it easy y'all!!!

 

Soul2Soul II

Wishes do come true!  For those of you that don't know who or what Soul2Soul II is....it's Tim McGraw & Faith Hill in concert.  For weeks I've been checking out tickets on Ebay for their concert in Jacksonville & St. Pete all the while hoping they would come to Orlando.  Well......guess what...they added on another show & they'll be here Saturday June 3rd & guess who has great seats?  Me!  Thank you TicketMaster!!!!  I cannot wait to go.  Tim McGraw is my favorite singer & I like Faith a lot too.  This is going to be great.  Yes, I did see his special on tv last night & I also have his latest cd.  The man is just incredible!  I can't wait for his movie to come out...My Friend Flicka.

I worked Tues & Wed this week.  I've been debating about whether to work tonight, but I think I'll just take it easy (as usual).  It was a decent week...no real emergencies.  The only thing that really stands out is the first night I got an older gentleman that as soon as night came, he sort of lost it.  I was told by the day nurse that he was perfectly fine all day long...I walk into him wanting to get out of bed to get a hamburger & to go see his broker.  We manage to get a posey vest on him although that makes matters even worse.  He's yelling & swearing & threatening the staff.  Luckily he was med/surg status & a bed opened up.  I called report & we moved him down to med/surg.  The med/surg nurses were not happy...they tried to send him back, but that didn't work. I told my tech that we had to get out of there quickly & we did.  I already had two other confused patients, I did not want this one back.  Luckily, my other two patients were pleasantly confused & not yelling out or trying to get out of bed like this one. 

I also attended an "I-connect" meeting...it's the new computer system that we are going to be changing over to.  I'm happy about it.....I'm all for less handwriting & more typing as well as more time to spend with the patients.  Anyone out there have any experience with it?  What do you think of it? 

I have a somewhat busy week next week.  I work Sunday & will probably pick up Tues & Thurs.  I have my nephew's baseball games on Mon & Wed.  On Saturday I'm taking my niece to Libby Lu's (makeovers for girls...http://www.clublibbylu.com/) with her best friend to reward her for doing well in school.  She got 5 A's & 2 B's on her latest report card. 

I've been working out with my friend Kelly at the YMCA.  We've been at it about a month now...I keep losing & gaining the same 6 lbs.  Not fair!  We do weights & then a cardio class on Mon, Wed & Fri.  It's entertaining to say the least.  Much more fun when you have someone to joke around with.  I saw an infomercial about "Turbo Jam" last night...it looked like an interesting work out.  I have a bunch of Tae Bo cd's, but I'm looking for something different.  Any opinions? 

Now that I got up to get my concert tickets...I'm going back to bed for a nap.  Hope everyone is having a good weekend!

Victory

Ahhh...it's been a good week.  This post is pretty much non-nursing related because I haven't been back to work since my last post.  I am scheduled for Tuesday.  Did I mention I love the flexibility of my job? 

It's been a good week because my nephew's baseball team won 3 games this week.  Their record is 18 wins & 1 loss.  There are 6 games left in the regular season.  The pro scouts are everywhere.  It's pretty neat seeing them around.  My nephew is hoping he gets drafted.  I believe the draft is June 6th...so we'll see if he gets an offer.  The catcher on his team is definitely going to be drafted in the first round.  I'm interested in seeing what type of signing bonus he'll be offered.  I should start getting his autograph now, huh?  :)

On top of all those victories....Tony Stewart won the Nascar race today.  Yay!  And Jr. came in 4th...pretty darn good.

I'll write more later in the week.  Take care all!