Wednesday, August 30, 2006

Rainbows & crying wolf...

On my way home from work this morning, I saw a beautiful rainbow in the sky. Rainbows amaze me - I love looking at them. They are a good reminder that in order to see the rainbows in life, you have to endure the storms that come your way .

I am sooooooooooooooo tired of newscasters. If I hear one more thing with the word Ernesto in the story, I will scream. They have blown this tropical storm out of proportion. News coverage began on Saturday. I'm not talking just a little update here & there, I'm talking that 99% of the newscast was all about this storm. This is the problem when it comes to hurricanes - newscasters blow it out of proportion so much that people don't believe a word they say. Even with 7 hurricanes in 4 years, I still don't believe them because they don't really know anything until about an hour before the storm is about to hit. However, just like most trainwrecks in life, it also gets to the point that you can't help but watch. Then the stress sets in because you begin imagining the worst....until reality strikes again to remind you that weather forecasters are only right like maybe 1% of the time.

It is raining here...but is that uncommon? Nope. Besides, Florida needs the rain. And it allows me to see the rainbow. :)

Ok, my tough 2 days at work...yep, that's all I'm working this week - well besides the computer class I have to take tonight for 8 hours. I can't complain, my patients were relatively easy to care for. I learned a little bit...way more about tapeworms than I ever really wanted to know. I've seen one of my patients get news that is devastating - her lung cancer has spread to her bones. Once it gets there, it's all pretty much downhill. She started out a little grumpy (who can blame her), but I charmed her & took time to talk with her. I still don't really know what to say when someone gets news like that. I find it's better to try to get them to express how they're feeling, because I know nothing I say will make a difference.

I had some interesting conversations with a couple of docs. The first patient was on Heparin, her PTT (lab test) came back at 154 = extremely high. Protocol says to stop the Heparin immediately & call the doctor. So I 5 am. I could tell I woke him up...but so what...this is a critical lab value. I tell him the PTT level & he says "Well, what does the protocol say to do?" As if I had never bothered to follow it or something. So I tell him "Stop the Heparin & call the doctor & here I am...talking to you now." It's like he didn't know what to do & was hoping the protocol would give him a clue. His wise answer..."repeat the PTT in an hour & follow whatever the protocol says to do." Ummm, ok.

My second doctor incident was regarding a patient I just got report on last night. He had been there for a week, had a surgical procedure when he came in & everything was going well - until 2 days ago when it seems he had a stroke as he has the facial droop & is unable to move the right side of his body. They ran some tests & it is looking like a stroke. one has bothered to talk to the family about what is going on. All they know is that their once fully functioning family member is now unable to move the right side of his body. His speech is slurred & they want to know why. They were point blank asking me if he had a heart attack. I was able to tell them no, that his heart is ok. I can't tell them the real test results because the doctor has not talked to them regarding what's going on. So they ask me for the doctor's phone number. I give them his answering service number & tell them to call during the day because it's unlikely they would hear back from him at night (it was after 9:30 pm). About an hour later I get a call from the doctor. He says "This is Dr. so & so"...I said "hello Dr., let me find out who called you." Because 99.9999% of the time a primary doctor calls at night - it's because someone has paged him. He says "No, no one paged me." I say "Oh, ok." He says "You know, you really should take the time to find out why I'm calling." My response "Ummmm, ok." Have I mentioned that I really can't stand this doctor to begin with??? He goes on to tell me that a family member called & wants to know why. Well....wouldn't it make more sense to call the family member & ask them why??? It irritates me how some of them will avoid the family & their questions. I told him they basically want to know what is going on with the patient, that they don't understand what is going on because no one is telling them anything. He asked me how the patient was doing & that was that. Who knows if he ever called them back.

Ok, time for me to get a little sleep before computer class tonight. Peace all!

Friday, August 25, 2006

Blood glucose of 671

I had computer training on I-Connect this week. I'm not sure what I think of it overall. What I don't like though is becoming 100% reliant on a computer. Our trainer told us we no longer need kardexes, report sheets or MAR's (med sheets). I think that's insane. I plan to keep using my report sheet. I prefer to know what's going on with my patient by just glancing at the info on my report sheet rather than scrolling thru a computer trying to find the info. I caught on rather quickly, many people did not. It's gonna be a mess whenever we do go live. Supposedly the date is October 22nd, but I get the feeling it will be pushed back.

I worked on Sunday - but don't remember much of anything about my patients. It's that short-term memory loss! I worked again last night. I had a patient in his early 60's who will be told today that he has stomach cancer. I don't like knowing information that my patient doesn't know. He was so happy & friendly last night & all I could keep thinking is he has no clue what he's about to be told today.

I also got a new admit diagnosed with chest pain. I looked up his labs before I got report from the ER nurse. I noticed his blood glucose (sugar) level at noon was 671. Wow...not a good number. This is basically the way report went with the ER nurse around 8:30 pm...

ER nurse: I have a patient for you being admitted with pneumonia.

Me: Pneumonia? I thought it was chest pain.

ER nurse: Oh, well maybe it is, yeah...pneumonia & chest pain & possibly even asthma.

Me: Asthma?

ER nurse: Yes, I think so.

Me: You think so? What do the orders say?

ER nurse: They say chest pain & asthma exacerbation.

Me: What about pneumonia?

ER nurse: Oh, I guess he doesn't have pneumonia after all. We also gave him Tylenol for a fever.

Me: How high is his fever?

ER Nurse: I don't know, let me check. Oh, it was 99.1. I guess we didn't give it for a fever, must have been some other reason.


ER nurse:

Me: So has the blood sugar been addressed?

ER nurse: Why would it need to be addressed?

Me: Because it was 671 at noon when he came in.

ER nurse: It was?

Me: Yes, did you not look at the labs?

ER nurse: No, I don't know, I just got this patient at change of shift.

Me: Did the ER doctor not address it?

ER nurse: I guess not.

Me: Don't you think it should be addressed before the patient comes to the floor?

ER nurse: Well, the admitting doctor saw the patient too.

Me: The admitting doctor did not notice the very high blood sugar? (and the fact that the patient has been admitted 5 times in the last 6 months for elevated blood sugars)

ER nurse: I guess not. I'll recheck it & cover it.


That was how it went. Isn't it sad that the floor nurse (me) who has not even layed eyes on the patient nor spent one minute conversing with him knows more than the ER nurse who is caring for him? Or even more about the patient than the doctors that are treating him? She brings him to the floor, says his blood glucose was 384 & she gave him 10 units of regular insulin. Ok, I'm a sucker, I believed her. I decide to give the insulin a little time to work & recheck his blood sugar about 45 min later. It's now 462. Just for those of you who aren't sure what the normal range for blood sugar's 70 to 99. Anything over 400 requires a stat lab draw & a call to the doctor. So we order a stat lab draw...which they come & draw right away.....yet takes an hour to get a result - that's only because I kept calling & bugging them to give me a result so I can call the doctor. Their reading was 447. So I call the doctor...or more like the doctor on call for the doctor that admitted him. I explained the scenario. He orders 5 units of regular insulin IV now. Ok, should I do accucheks on him more often than AC & HS (before meals & right before bedtime)? No, stick with the AC & HS accucheks. So that means I'm not supposed to recheck his blood sugar until at least 6 a.m.????????

I'm not comfortable with that so I have my patient care tech recheck it 2 hours later. It's now 432. Ok, slight decrease, but I still wasn't thrilled at that number...only now I'm stuck. I can't call the doctor & get more orders because I wasn't even supposed to be rechecking it. I run it by my clinical leader, she isn't sure what to do. I decide to give it a little time & hope that it continues to go down. We rechecked it at 5:30 am & it was 226. I'll take that. I'm glad I didn't cover him with anything more as he was NPO (not allowed to eat or drink) & that extra coverage could have made him hypoglycemic (low blood sugar). He was doing fine, just a little irritated that he wasn't allowed to eat or drink anything because of the chance of having a stress test today.

I had to turn in my schedule today for the next 2 months. As I was filling it out, I was thinking "Will I even be working here in 2 months?" I'm really getting that itch to branch out & try something new. I like my hospital, but there is so much change going on not to mention I'm on the low end of the pay scale there. The plus side is that there is plenty of work & our busy season is coming up. Actually, this past week has been super busy. I'm not sure why, but we are completely full in PCU & that's something like 60 beds. I think I will get the ball rolling with a travel nurse agency & at least see what they are offering.

I'm getting sleepy.......bye y'all.

Friday, August 18, 2006

You know you've been working too much when...

You know you've been working too much start dreaming of work-related things.

This past week, I'd say 3 days out of 5...I've been dreaming about work stuff. Even today - I kept dreaming about getting doctor's orders over the phone. I woke up thinking "Did I get the order right??" Another night I dreamed that our hospital made a particular floor for only patients admitted with altered mental status & I was getting 5 admits. It's hard enough dealing with one or two confused patients...but five? Frightening!

I put in 4 days after being sent home on Sunday. It's been a strange week - just very strange patients. Usually when I get new patients, it doesn't take long to develop a decent rapport with them. Even with new admits, usually you can make them comfortable & they are easy to get along with. This week they've all been impossible to please, unable to develop a good rapport no matter what I did & complaining non-stop. It's like why even bother because nothing will please them.

People are starting to expect their hospital stay to be equal to a vacation at the Hilton or Marriott. One of my pet peeves is the changing of the sheets. It's very appropriate when someone is incontinent or blood or some other substance gets on the sheets...but if it's a totally alert & oriented person that is getting out of bed to use the bathroom & the bed remains spotless - what's the point of changing the sheets daily? I had one insisting that she was sleeping in filth. I looked at her like she was insane. You want to say "Do you change your sheets at home every single day?" You know they don't. I've had a patient in the past that wanted his sheets changed every evening at 5 pm. Do you do this at home???? No. Then why are you flipping out that it's not done like that at the hospital? I think they just want to get their money's worth or something. That same person that earlier said they were sleeping in filth - I'm surprised she didn't take the sheets home with her when she left. She took every cup, every alcohol pad,every thing in the room possible to take & then asked for ice water to she's at a restaurant or something. On top of that - she was asking if she could have the supplies that I had in my pocket (tape, pens, etc). Ummm....NOOOOOOO. Strange I tell you...STRANGE!

It was also the week of drug addiction. On Tuesday night I got 2 new admits - relatively young (late 40's/mid-50's) diagnosed with chest pain. Those are "usually" my favorite type of patients because the orders are easy to follow, they are 95% of the time stable & pretty good to take care of. Not these two. These two were experts at knowing how to get seen quickly in the ER & how to get the pain medication they wanted = Dilaudid. I took care of these patients for 3 days - not once did they ever complain of chest pain. One had foot/leg pain and the other had neck pain. I think they learned if they admit that in the ER, they'd be sitting in the waiting room much longer than someone claiming to have chest pain. Drug seekers are pretty easy to spot - they are the most dramatic of them all - "usually." Gina had a patient that could prove that theory wrong, but I'll talk about that later. My drug seekers would cry, shake, act like they were about to die at any moment - until they got their pain meds. Then they were quiet, calm, serene. Don't get me wrong, I find it very sad that they have become addicted to pain medications, but I think it's even more sad that they remain in denial rather than dealing with the real issues head on. The one that was crying - she'd stop crying when she learned she could only have the pain meds every 4 hours. So how real could the pain be if you can instantly stop crying? And the other one - he began referring to Dilaudid as "happy juice." Ugh. I almost got to the point where you just want to kick them out of the hospital to make room for people that really are dealing with a sickness that requires hospital care.

I spoke with the doctor of the one referring to Dilaudid as "happy juice" & come to find out this gentleman's wife went out of town & he didn't want to be home alone - that's why he ultimately came to the hospital. WTF?? That definitely sounds like some kind of psych disorder to me. Out of all the places to go when your significant other goes out of town - the hospital wouldn't even be on my top 100 list.

We had a patient pass away last night. She was a DNR (Do Not Resuscitate) - it's the first time I've seen someone pass away without anyone calling a code. It was pretty quick, she looked so peaceful. The family was called & came in to say good-bye. What I don't understand though - she has had cancer for awhile, the doctor talked to the family earlier in the day about her condition to the point that they agreed to a DNR order, had a hospice consult & she was to be transferred into their care...yet the family was shocked she passed away. So shocked that they want an autopsy. I don't know, I don't get's one thing if you have someone that is awake & talking & hasn't been diagnosed with something terminal to suddenly pass - but she's been non-responsive for quite awhile.......and they knew all of her terminal condition...yet they are shocked. Hadn't even thought of funeral arrangements. Is it denial? Do they think that if they start planning for what happens afterwards, that they somehow will cause it to happen sooner? I think they need to reflect on the fact that she lived a good life & has now moved on. I understand being sad, I would be sad too...but don't hang on to the belief that there's a mystery as to why she died. She had cancer, her body shut down - it's time to let go & grieve.

I helped the nurse with post-mortem care & I have only done that twice since I got into nursing. One time in nursing school & one time when my patient coded & died. It doesn't phase me though - like it doesn't creep me out that I am touching someone that is no longer alive. I don't know why it doesn't...I think it should. It's not like it's happened so often that I've become immune to it. I was talking to a doctor last night & he said he used to work at a hospital that had something like 750 beds & that all he did was work code blues...that was his job. Inbetween he'd eat dinner & people would be like "How can you eat after watching someone die?" It just becomes part of the job he says.

Which leads me to in the world did I end up in healthcare??? Just goes to show that you never know which direction your life will travel in or where you'll end up.

I got another new admit last night...mid-50's with chest pain. As much as I like that our hospital has finally come up with protocols - I am saddened that our ER doctor has no common sense. Part of the chest pain protocol is to administer Lopressor...either 50 mg by mouth or 5 mg via IV. This is all well & dandy when the patient has an increased blood pressure or heart will definitely allow the heart to relax because it slows down the heart rate & usually lowers the blood pressure along with it. However, this patient of mine prior to getting the Lopressor had a heart rate of 66 and a blood pressure of 96/48. Why in the world would anyone...much less a doctor say it's ok to give 50 mg of Lopressor? He didn't need it. By the time he got to my floor...his heart rate was in the mid-30's to 42. Ridiculous that it was ever given in the first place. Luckily his blood pressure was ok & that he was non-symptomatic with such a low heart rate. He was another strange one though - during the admission questionaire, he asks me "Can you tell me if I have cancer?" Excuse me? How would "I" know if you have cancer? He has a feeling he does & would like "me" to find out. Lol...what??? If he said it once, he said it 20 times..."can you please find out if I have cancer?" I told him he would have to express his concerns to the doctor as the doctor is the one that will order the appropriate tests. I also asked him why he didn't seek medical care sooner if he believes he has cancer. He had no answer. Just kept asking for me to find out if he does or not. As if we have the answer hidden somewhere in our chart.

Now to Gina's dramatic patient. This one wasn't a drug seeker, just a patient that loved to scream & cry. She would cry even if you touched her! Flipped out when they put a tourniquet on her to draw blood. Gina asked me to help her put a foley catheter in this patient. Little did I know how dramatic this woman could be. I focused on talking to her calmly, trying to distract her from what was going on, gave her my hand to squeeze, reminded her to breathe....all that went right out the window when Gina tried to insert the catheter. She started screaming hysterically "Stopppppppppp, you're killing me, I've never had so much pain ever in my life." This from a woman that's been through child birth a few times! She continued to scream as Gina & I stood there & watched her. Gina wasn't even touching her & this patient would not stop screaming & crying. She didn't even have her eyes open & continued to carry on as though we were torturing her non-stop. Gina & I looked at each other like what the heck??? It was a bizarre week I tell you!!!!!

I start computer training on Monday night. We are finallyyyyyyyyyyyy switching over to computer charting. The transition day is set for October 22nd - remind me not to work that night as I'm sure it will be a mess. I will be glad to put down my pen though - I am so tired of handwritten charting not to mention the calluses on one of my fingers. It's starting to look deformed. :)

Have a good weekend y'all!!!!

Monday, August 14, 2006


I went to work last night - clocked in & then saw my name was not on the schedule.  I talked to my charge nurse - they didn't need me & had no idea I was even scheduled.  All this after I talked to the girl that does the schedules on Thursday to set up my schedule for the next 4 weeks.  So I ask "Am I at least on there for Mon & Tuesday?"  Nope.  Luckily my charge nurse likes me, so she added me so I can make some money this week. 

I wasn't upset about it - just frustrated that I slept during the day & got ready, came in & then was sent home.  What a waste of time.  There could be worse things going on, so I'll be thankful it's not that bad. :)

Friday, August 11, 2006

Another week gone by...

I got my raise this month - I should be happy, but I still want to make more.  It's my own fault for not getting the paperwork done to go agency.  I keep saying "I'll do it next week."  I'm just so comfortable where I'm at - although more & more they are pushing things to agitate us.  They are trying to get rid of all per diem staff nurses...basically by telling them they either have to become part-time or full-time staff or resign.  It makes no sense to me because now we are back to being a hospital of mostly travelers or agency and less & less regular staff.  Yet they are shocked when our customer satisfaction scores are in the 1th percentile.  We can't get any lower than that...although I don't know how they are arriving at those scores.  I think we treat our patients pretty darn well & all I ever hear from patients & their families are compliments.  Yet we are at the bottom of the barrel when it comes to patient satisfaction.  You would think that we ignore them or torture them with scores like those.  Our goal is to reach the 70th percentile...I don't think we'll ever see it. 

I worked 4 nights straight this week - it wasn't bad.  By the 4th night my feet are so sore though.  I spent so much time at my patients bedside - one night I barely got my paperwork done on time.  I don't like when my patients don't sleep well through the night.  It makes me nervous.  Especially when they seem a little off.  I had one gentleman that has esophageal, lung, pancreatic & liver cancer.  His family didn't like the way his pain meds were making him sedated - so they requested all meds stopped.  Hellooooooooooo......cancer is painful....especially pancreatic & liver cancer.  You would rather have him more alert but in pain than the opposite?  That irritates me.  Besides, this guy was totally alert & oriented - he can make his own decisions.  I ended up getting an order to get him Dilaudid the last night I had him because he was bent over in pain, trying to breathe.  Where are the family members at that point?  No where to be found. 

I had another patient this week that had a hernia growing into his colostomy = not good.  He had to have emergency surgery on Saturday, went to ICU & by Monday he was with me in PCU.  Things were going smoothly Monday night until about 5 am when he was complaining of nausea.  He was being a little overly dramatic - kept telling me he was vomiting a lot, but I barely saw anything.  He then started saying he was going to die unless I called the doctor.  So I called the doctor at 6 am & got him some anti-nausea meds as well as Milk of Magnesia.  He drank that Milk of Mag & within 2 minutes, he was vomiting a lot.  It wasn't pretty.  In fact, I think he had some sort of blockage going on in the GI tract.  I won't go into details.  :)  The anti-nausea med helped him after that.  Tuesday night I had to prep him for surgery to close the old colostomy (he had received a new one during emergency surgery).  He needed 4 units of fresh frozen plasma as well as antibiotics.  The poor guy was continuously being woken up because I was constantly talking his blood pressure to make sure he wasn't becoming fluid overloaded.  Wednesday afternoon he had the surgery, came back & the anesthesia had made him confused & agitated.  It was not a fun night. 

I think my biggest pet peeve is making a call to the doctor only to find that one of his partners is on call.  I don't really like taking orders from someone who has no clue whatsoever who the patient is.  I called regarding my surgery patient because he needed something for agitation.  The partner orders Ambien = sleeping pill.  I don't like Ambien because you never know how it's going to affect someone.  I've found that when you give it to someone that's already confused & agitated - it makes them worse.  So I didn't give it & just hoped that the anesthesia would wear off & he would get some sleep...which is pretty much what happened although it took all night.  I didn't mind being there to constantly reassure him or to make sure he didn't hurt himself.  Some patients are easy to want to take care of. 

I won't go into my other patients I had this week.  Nothing really stands out.  Gina called in to volunteer to work Monday night - she basically got reprimanded & was told that her & I are the reason agency doesn't want to work at our hospital.  Come on!  She says it's because we pick up shifts at the last minute & they have to cancel agency & now the agencies are tired of being cancelled.  Ridiculous.  Then just tell us NO.  Don't give us b.s. about us being the reason no one wants to work there.  What's funny is...I called yesterday because I was not on the schedule at all for the next month - they couldn't find the schedule I turned in.  When I called, she acted like it would be impossible to add me on.  She pulls out the schedule & they basically need help every single day.  I don't get why they are so dramatic about us wanting to work when they are so short-staffed.  You would think we'd be praised for picking up shifts - especially since we are cheaper than any agency nurse & we are damn good  Well, we are! 

Which takes me back to the reminder that I need to get my paperwork done in order to go agency.  I need to get a doctor's approval to work as well as a varicella (chicken pox) titer - they won't take my word that I have had the chicken pox.  After that, I can pick up shifts that pay over $40/hr.  Now that's my kind of paycheck.  I'm a procrastinator - can't you tell??? 

Oh, a few of you have written & I appreciate the support.  For those of you in nursing school - if you need any help, just write me.  I have a lot of class notes to share if interested.  One day I'll get around to putting them on's that procrastination thing 

Have a good weekend everyone!!! 


Sunday, August 6, 2006

Back to work

It's that time again....back to work.  I enjoyed having the last week off, but at the same time I think "I should be working."  I got a little bit accomplished around the house as far as organizing.  It's weird, at work I am very organized - at home, forget it.  Maybe it's because I have to be organized at work or else I'll fall behind & I don't like staying after 7:15 at work.  Plus you never know when a patient's condition is going to make a turn for the worse & when a charge nurse or doctor is asking you questions regarding the patient's history & labs/tests - you have to be prepared.  I have a pretty good little report sheet that I use for each & every patient.  If anyone wants a copy, just email me.  It's a word document. 

I'm gonna go take a nap since I'll be up all night.  Hope everyone is having a good weekend!!!