Do you miss me???

I've missed you!  It feels like it's been a long time since I've journaled anything.  That's because I haven't been back to work.  I've truly enjoyed having the last 9 days off.  I start back tomorrow night for 4 nights.  Have I ever mentioned that I love the flexibility of my schedule?

I had been debating about whether to work more days this week, but I have had the opportunity to catch up with my friends, my family and have some down time to just relax & have fun...so I took advantage of it.  I have to say that as much as I don't like being locked in to working weekends, I am glad it has allowed me to get back into playing volleyball.  I have been playing volleyball with the same team on & off for the last 15 years.  I stopped playing after I graduated from nursing school almost 2 yrs ago & started working every Monday night.  I didn't realize how much I missed it until I started playing again - not to mention the great work-out it provides.  So until the end of November, I will be playing volleyball on Monday nights rather than working.

I don't have anything to post about work related stuff because I haven't been working.  Hopefully I'll have something to tell you by Sunday. :)  Have a great week!

 

Learning Lesson(s)

Ahh, back to the beginning of another week.  Still feels odd to be off on a Sunday & Monday.  In fact, I didn't even know what day it was today!  So much for me being alert & oriented.  :)

I put in 4 days straight.  It wasn't too bad until the last night because we had no tech & 5 patients each.  It's just too hard because the majority of our patients are older & more needy.  Between patient care and paperwork...we are exhausted.  Not enough time in a 12 hr shift when we don't have a tech to take care of the patient's basic needs. 

I did receive a patient Friday night around midnight being admitted with a DVT (blood clots) in her left arm.  She was started on a Heparin drip in the ER.  When I went to check out her labs before getting report, I noticed they were still pending.  I thought it was odd that they were admitting a patient without knowing the majority of her lab values, but I assumed (lesson #1 - don't ever assume) that they must know she is stable & therefore ready for transport to our floor.  So I get report & am told she's diabetic & that they didn't have time to do an accuchek in the ER (how long does it take for an accuchek?  60 seconds?).  I said I'd check it when she got to the floor (lesson #2 - insist they do it prior to transport while the pt is still in the ER). 

Before the patient even makes it to the floor, I get a call from lab saying her stat PTT is 166.  That is extremely high for someone on Heparin, much less someone that was just started on Heparin & supposedly that is the baseline.  Next call from lab...the patient's blood glucose is 606.  Ugh...this is like deja vu from a couple of weeks ago in which the blood sugar went ignored.  She gets to the floor & I immediately turn off her Heparin drip and place a call to the doctor...who of course is not the same doctor that admitted her just an hour earlier.  I get the doctor on call who knows nothing about this patient.  The patient has an insulin pump & the admitting doctor had marked "no"on the medication reconciliation form to her using it.  I have no idea why as usually when a person has a pump, they are pretty good at regulating themselves.  Why she didn't ask for an accucheck in the ER, I don't know, but regardless, it wasn't her responsibility.  It should have been checked in triage or at the very least, by the time she got a bed in the ER. 

Anyways, so now I'm on the phone with the doctor who is asking me why the other doctor marked no to her using her own insulin pump.  As if I'm psychic or just know everything.  I tell him I don't know, that it's simply marked no without any explanation.  His next question was "What did the patient have to eat today?"  Huh?  Who cares....her blood sugar is 606 at this moment.  I tell him I didn't know, that I hadn't asked her (who asks that anyways?)  His reply "You really should have the answers to my questions."  Oh how I wanted to hit him upside the head with the phone...grrr.  So he tells me to give her some insulin now, change the sliding scale and don't recheck her blood sugar for 6 hours.  Nice...such quality care I swear!  He's ready to hang up & I'm like "Wait a minute, she's also on a Heparin drip & her PTT at this moment is 166."  So he says hold it for 2 hours & repeat the PTT...if it's greater than 80, hold for another 2 hours or if it's less than 80, start at 15 units/kg/hr.  What a strange order!  Turns out the PTT drawn wasn't a baseline...it was drawn after the patient got a Heparin bolus....grrrrrr, the ER nurse started the patient on Heparin prior to getting a baseline PTT or CBC even though the protocol clearly states it at the top of the page.  Luckily the patient was tolerating both conditions rather well.....very lucky for the ER.

I talked to my clinical leader & asked if I should write up an incident report.  She was saying no, that she'd talk to the ER clinical leader about it.  She did call her & it was the same general excuse "we're really busy down here."  Which is fine, I understand that...but compromising a patient is wrong, I don't care how busy you are or what department you work in.  What would have happened if I had allowed the PTT to go unnoticed/untreated as well as the extremely high blood sugar?  I would expect to get in trouble for it as well as the hospital has to be made aware that if the nurses & doctors are that busy that critical lab values are being ignored, then it's time to do something about it rather than end up with a lawsuit &/or the guilt of harming a patient.

I had her again the next night, blood sugar still a little high, but in the 300's-400's...working it's way down & she was managing it with her pump now.  Her Heparin was therapeutic at 8 pm, so I put in an order for the next PTT 6 hours later or 2 am...fully expecting I'd have a result by the latest 2:45 (lesson #3 - don't expect anyone other than yourself to stick to time lines).  The lab didn't draw it until 3:05 - so much for timed studies.  I check the computer around 3:30...it's not even been received in the lab yet.  What the hell?  4:00 comes & goes, I finally decide to take a lunch break only to have someone come in the break room & say "Lab called, they say your PTT is greater than 200, do you want the test repeated stat just to be sure that is correct?"  It's now 4:30 am.  I say "yes, of course" because how could it be therapeutic to now suddenly over 200?  So again, I expect that STAT means quickly (lesson #4 - my definition of STAT is not the same as others).  It's now 5:00 & no lab tech in sight.  I call the lab dept & she doesn't know anything, they are short-staffed (shocking) & says she'll try to page the lab tech.  At that point I give up depending on others & turned off the Heparin drip just to be safe even though I knew it would probably throw off the lab result as it only takes an hour or two for Heparin to get out of the system.  Lab finally calls me at 6:05 to tell me the PTT was 156...so I'm glad I did turn it off. 

I was internally debating about whether to write up incident reports.  Looking back, I definitely should have...because how is the hospital supposed to know this stuff is going on if it's not reported in writing to the higher ups?  How are any changes going to be made if they don't even know it's a problem?  So that's lesson #5 - report, report, report even if it means someone else might get in trouble. 

I had a really sweet patient that was very complimentary towards me.  He was asking me how long until I turn 20...lol.  I told him I'm nearly twice that age.  He thought I was lying.  Ahhh, so glad I look younger than my age...lol. 

I am playing volleyball tonight...yay.  Haven't done that in nearly 2 years.  My hospital called again last night desperate for help because they were short-staffed.  I hope the administration sees that relying on agency nurses to fill in the gaps because they readjusted the staff nurses schedules isn't working out the way they had planned.  I plan to go back to Sun, Mon & Tuesday nights after this schedule is over (beginning of November).  I've heard everyone else that they asked to work weekends fussed & bitched & got out of it.  So it's basically me & mostly all agency & travel nurses.  I like the travelers though...because at least they are around for a few months (or longer) & you get to know them.  Agency...ehhh, not my favorite - they don't know anything about the hospital because they don't get an orientation.  So a lot of it is helping them figure out all that they need during the shift.

Laterrrrrrrrrrr!

Why be mad?

I don't have all that much to write about today.  I started back at work last night.  It was busy, I think I was on my feet the entire time between 7 pm and midnight.  I discharged one patient and got 2 new admits as well as having 2 other patients.  Somehow I managed to keep up with all of the paperwork and was actually looking for things to do to waste away the night.  We're encouraged to give baths, but I am in total disagreement regarding waking a person up in the early morning hours to bathe them.  Personally, I think sleep is more important.  We wake them up enough through the night with vital signs, respiratory treatments, medications and blood draws not to mention the numerous times if a lead from the telemonitor comes off.  So unless they really, really need a bath, I opt for sleep.

I'm not going to even go into the patients I had last night.  There is nothing that really stands out other than I don't understand the attitude one gets when they are admitted to the hospital.  Did you not come to the hospital because you were experiencing a problem so severe that it caused you to seek help?  Why are you mad that the doctors want you to stay the night and run some tests to see what caused the problem?  Both of my new admits were pissed they had to stay the night.  The thing is...you don't have to.  It's not a prison, you can leave if you want...you do have that option.  I realize the hospital is not a lot of fun, but neither is having a problem that worries you so much you seek medical help.  Rather than be mad, be glad that you live in a country that allows you to freely seek medical help.  Be glad that there are resources around you that want to ease your mind & find out what is wrong.  Basically, be thankful for your blessings.  They could very well be the reason that you see another sun rise.

I did pick up another shift tonight - so it's time to go get ready for work.  Have a good night y'all. 

Something cute...

It's Sunday & so very weird that I'm not sleeping in preparation for working tonight...because this is the week my schedule has changed due to being forced to work every other weekend.  I am not scheduled until Wed, then Fri & Sat.  I just might like having the beginning of the week off.  :)

I had my youngest niece & nephew from Friday night to Saturday afternoon.  I took them out to lunch & as I was paying, my 7-yr old nephew Magnus says to me "How do you make your money?"  Before I could answer he says "Oh, that's right...you save lives."  It was so cute! 

I went out last night with Kelly - we had some awful drinks & saw an awful movie, yet still managed to have fun.  I ordered margaritas...but what I got was nothing close to tasting like a margarita.  We saw Talladega Nights - simply because there is nothing else to see.  It was dumb. 

And to take it a step further, my favorite Nascar driver missed the race for the chase.  Darn it!  That's ok, I still love Tony Stewart anyways.  Next year he'll do better.

Hope everyone's having a great weekend.  Peace!

 

 

 

"Code Gray"

Another work week finished up by Wednesday - this is why I prefer to work Sun, Mon & Tuesday nights....so that I've got the rest of the week off. However, due to our new manager, I am being forced to work every other weekend for the next 2 months (at least). Well, unless I finally get motivated enough to leap into travel nursing...I'm still working on it...lol...that's my excuse! So for now, I will try working at the end of the week rather than the beginning. Who knows, maybe I'll like it. I am going to get back into playing volleyball with my friends on Monday nights.

I went into work Sunday evening only to find out I wasn't on the schedule...again...grrrrr. The charge nurse told me she would keep me, that I could be the unit secretary until 11 pm & then she'd send one of the agency nurses home & I could take over that nurses patients. Being the unit secretary on a Sunday night is beyond boring...because we rarely see a doctor in the building (other than the ER doc) on a Sunday evening. I got a call from the charge nurse about 20 min later saying one of the nurses didn't show up & I could take her patients. So I go to that floor & the clinical leader is telling me about one of the patients: "He's out of control, he is threatening to hurt people, rip off body parts of anyone that gets near him, swearing, yelling" and she followed it up with "Whatever you do, don't go into that room alone." Lovely...I'm thinking I should have just gone home when I found out my name wasn't on the schedule. This guy sounded like a lunatic!!!

So I get report from the day nurse & she tells me he just started acting like that when they tried to get him to go from the chair back to bed. He didn't want to go back to bed. Guess what - as far as I was concerned, he could sit in that chair all night long if he wanted...especially if it made him happy. He came to the hospital because he passed out at the nursing home & they wanted to rule out a stroke.

I had 3 other patients in addition to him. I had a male with a hematoma in the abdomen, he also had expressive aphasia (he had a stroke yrs earlier & was unable to speak...he could make noises & a couple of words like yes or ok, but that was about it). Another patient with an infection in his leg as a result of a fem-pop bypass. He also had a MRSA infection in his blood. He was really sick & weak. My last patient was a man that had a right knee replacement who was also confused...but at least he was pleasantly confused. They put him in the room with the lunatic. Nothing like having two confused people in the same room, right?

My assessment of the first patient was done from afar. He was yelling, he was moving his arms & legs and he was asking appropriate questions - he also knew who he was & where he was. As soon as I came in the room he was saying "Oh noooooooooo." He was afraid I was going to make him get back into bed. I assured him that he was welcome to stay in the chair if he wanted. He had wrist restraints on, so it's not like he was going to go anywhere or fall. He kept demanding to have his pants & shoes. The tech & I finally gave in...handed them to him in which he put the pants halfway on (since he couldn't stand up) & he put on his shoes. It was kind of comical to walk in & see that...but hey, he was happy....so I was happy. I managed to get him to take his pills, we gave him a snack & before I knew it....he was telling me jokes & stories. He didn't want me to leave the room! I was kinda cracking up inside comparing the description I had received of him & comparing it to how he was behaving now. Later on in the night, he pulled out one of his IV's. So the tech was giving him a bath & I got him some warm blankets, wrapped him up & he was so very comfortable & just smiling. I was thinking "Wow, I really have the right touch! He's nothing like they described earlier."

Welllllllllll, I threw that thinking right out the window the next night. He had turned back into the lunatic. This time instead of wrist restraints, the day nurse simply had a posey vest on him. I wasn't comfortable with that because he looked like he could slip out of it at any time. He started yelling at the change of shift. The day nurse told me to get his evening dose of Seroquel (antipsychotic medication). I got it, but I was pretty convinced no one would be able to talk him into taking it & I was right about that. When I got back to the room, the day nurse had called a Code Gray (an emergency request for extra manpower). I don't know why she did that because he was still fully restrained with that posey vest on. About 15 people showed up...mostly men. A Code Gray generally works to settle down an out of control patient, but in this case, it made my patient even more confused & agitated. I felt bad for him. Eventually most of them left & I was told to forget the Seroquel, give him Haldol IM (injection). So there was 4 of standing there looking at him while he yelled at us - we were trying to figure out how we were going to give him a shot. They were telling me to put it in his thigh, but I knew that was not going to work. I decided to get behind him in the chair & they would hold his arms & I'd inject him in the arm. I was worried he'd flail around & I'd end up jabbed with the needle...but he was so busy yelling at them, that he didn't even notice me behind him nor did he even feel the injection (what can I say...I'm good...lol).

We then make a decision to move him closer to the nurses station because there were only 2 nurses (me & another) on this unit. We try to tell him what we're doing & he just continues yelling about who knows what. He was already in a chair that had wheels on it, so as they started to push him to the door, he was trying his hardest to stop them by pushing back with his feet on the ground. They turned the chair around & then raced him down the hallway into the new room. It may sound awful, but I could not stop laughing....it literally looked like some type of race they were competing in & the poor patient...the look on his face like "What are these women doing to me?" It was priceless. I decided to leave him alone in the room & watch him from the nurses station...hoping he'd calm down. The respiratory therapist went in to give him a breathing treatment & the patient told him he was f'n useless & to get the hell out. The resp therapist came out saying he gets the same treatment at home from his wife. It was funny.

I'm noticing that now my patient has taken off his gown & is making a really good attempt at getting out of the posey vest. I say to the other nurse "I think we should put the wrist restraints back on him because if he gets out of that vest & is loose...who knows what will happen." So I call my clinical leader to assist us & while we're in there...he's yelling...then starts trying to punch & kick. I called another Code Gray. From that point we moved him (with a lot of assistance) from the chair into bed & put restraints on both his wrists & his ankles so he couldn't punch or kick us. I called the primary doctor to get him something more for his agitation. I really felt bad for my patient as he knew he had no more control & gave up yelling at me & was saying "Please let me out." I can't even imagine all that was going through his mind. The primary doctor asks me what the neuro doc said. Well, I didn't think to call the neuro doc as stroke had been ruled out and the conclusion was this patient had dementia. He gives me an order for Ativan. I call the neuro doctor to see if he wanted anything different....instead I got a lecture that agitation is not a neuro problem & that I shouldn't have been calling him. He orders the same thing & then asks me why this patient hadn't gotten his Seroquel. Ummm, what part of "This patient is out of control & very combative did you not understand?" So he tells me to give the Ativan & just give him the Seroquel later when he calms down. Well, that Ativan knocked him out the entire night. Not another word out of him...he slept through vital signs & even when the lab tech drew blood. I was relieved that at least he was at rest.

That second night was an easy night...both myself & the other nurse only had 2 patients each the entire night until 5 am when we each got an admit. It was a different story on Tuesday night....same nurse & I...only this time we had 5 patients each & no tech....grrrr. Well, we did get a tech around 2 am = Gina, but by that time, we really didn't need any help & she'd disappear for long periods of time anyways. It was the beginning of shift that was so busy & where we could have used the extra help.

My patients were not too bad to take care of...I liked them very much, but their medical conditions scared me. I think at any other larger hospital, half of them would be in ICU rather than PCU. I just had this uneasy feeling that at any time, they could take a major turn for the worse. That was the main reason I didn't go back tonight for overtime. It's not bad when you have 1 or 2 patients that are critical, but when 4 out of the 5 have major issues....the stress gets to me....especially when it's respiratory issues.

One patient was my new admit from the night before...he is at the hospital quite often for respiratory distress. He was on 5 liters of oxygen & sooooooo out of breath. His respirations were labored, you could see his abdominal muscles were doing all the work & he was shaking non-stop. He said he felt fine, but he definitely did not look fine. Another patient was one that just had a new tracheostomy. I don't like trachs...at all. I don't like any "ostomies." I don't know what it is, but I feel pain in my throat area when I see trach. This guy was coughing non-stop & I was worried something was going to get stuck in his trach. I called the respiratory therapist in to have her assess it. He did have a big ol mucus plug (ick...just the word mucus kinda grosses me out...see, even nurses do get grossed out) in the trach. Luckily. the respiratory therapist cleaned it all up even though technically...the nurses are supposed to do it. Which makes no sense to me...why can't the respiratory therapists do it? It is a respiratory issue.

Another patient was a new admit with congestive heart failure. He was a sweetheart, we got along great. I knew he was aggravated from being in the ER for so long & they were super busy down there so none of the patients were getting any food. He was starving, so I made it a priority to get him some food. He was happy. A little shortness of breath, but overall ok for the most part.

I still had the patient from Sunday with the hematoma in the abdomen. He was easy to care for as he mostly slept. I also had a female that had breast cancer & a right mastectomy. She was in the hospital because of nausea, vomiting & diarrhea from chemotherapy. This poor lady had the worst skin breakdown I've ever seen (not including pressure ulcers). The skin on her thighs & peri area was pretty much non-existent...it was so red & so raw & cracked, she cried when she moved her legs. I had to clean her up since she was having diarrhea & my heart was breaking listening to her cry from the pain. I talked to my clinical leader & we decided it would be best to put a fecal bag on her so the diarrhea wouldn't continue to hurt her where the skin was so raw. I tried my best to calm her & make her feel better, but I don't think it was really working. Even the inside of her mouth was all broken down & sore. The poor lady...so sad.

My confused man had been sent back to his nursing home. I don't know how those nurses that work at nursing homes do it. They really are special people to be able to endure dealing with alzheimer's & dementia....not just endure it, but also be able to develop a good relationship with their patients.

Someone commented earlier about my post with the ER nurse. I never intended to make it seem like I am anti-ER nurses or anti-ER department. I know they are super busy down there & don't have the same priorities that I do. I am against nurses that don't do the basics - which is to at least know your patient's labs & why they are at the hospital. As well as against doctors that also don't follow up with critical lab values. 671 is an extremely high glucose level & for it to go unnoticed by every medical professional that saw him before I spoke up about it...it's just wrong. We are lucky he had no ill-effects as a result.

This has been a good week....I've gotten so much positive feedback regarding my journal....thanks y'all. :)

A new season of Nip/Tuck has begun = strange, strange show, but I can't stop watching.

I had dinner this evening with one of my best friends...Maria. We met when we were about 13 yrs old & have been best friends ever since. It's kinda neat to look back & see how many people come in & out of our lives and value those that are here to stay for a lifetime.

Just Can't Believe It

I worked Sunday night & like I usually do...I was checking out People Magazine online around 6 a.m. for the latest stories & gossip...only to find out that Steve Irwin aka The Crocodile Hunter had died. I was stunned. I still can't believe it...even after being drawn to the tv throughout the night last night (at work) & seeing CNN talk about him non-stop as well as replay interviews & episodes they had with him. He was so likeable & charming and had the most amazing enthusiasm & energy for not only interacting with wildlife animals...but allowing us to get a glimpse of things we would never encounter in our own lives.

I just can't believe he's gone. :(

Tributes

I got the most amazing email the other day from a gentleman named Joe. With his permission, I want to share it with everyone...

Hi Jenn,

My name is Joe; After I retired from an Occupational Health career with the State of New York my wife and I decided to move to Florida (where else). That was 4 years ago. Anyhow, I spent some time volunteering at our local Wildlife Park but had this passion to return to bedside nursing.

At 59 and after 30 years away from clinical nursing I decided to take a 200 hour refresher course, a 35 hour IV Therapy course and my BLS. After completion, I interviewed with a local hospital and got the job. I have been there a month and I can honestly say that most of my fears about returning have been eliminated (the only thing I fear now is doing a female Foley)

OK, the reason for this email. About 6 months ago I started reading Allnurses.com and came accross a post of yours that had your journal website attached to your signiture. I got so hooked reading your entries that I went back to your original journal entry and read every one of them. I have got to tell you, it was your words that got me back into nursing and I am forever gratefull to you for that. You are so easy to read, both smart and funny...very funny. I learned so much from you...

Well anyhow, I posted all of this on the allnurses website (my first post on that site). I can't remember the Subject line but it had "Jenns Journal" in it. It lasted about 4 hours before it was pulled. When I asked why they told me it was because it looked like I was promoting your website...uh. The email said that a moderator had to review it.

Just let me say again Jenn, thanks so much for your inspiration. My wife would also like to thank you because I out of the house more often, lol.

Oh ya...Go JR. He came in a strong 3rd last nite at Bristol.

Take care,

Joe

Thanks, Joe. Your email put a smile on my face. :)