Last post of 2008

Wow, the last post of 2008....hard to believe!!!!

The other night I went to see The Curious Case of Benjamin Button & wouldn't you know it.....with about 40 min left to go (the movie is nearly 3 hours long)....the fire alarm at the theater went off. So we all had to go outside & they said they would give us a free ticket, but we couldn't go back & watch our movie. What??? Luckily the fire dept got there quick & cleared it so we were able to watch the ending & get a free ticket too. Whew! It kinda helped that we had a fire drill as the majority of women seeing the movie seemed to need a bathroom break anyways....so that worked out. The movie was pretty good.....good message I suppose, but I certainly wouldn't call it one of the best movies of the decade like the commercials say. I did admire Brad Pitt as an actor though. I don't usually like him all that much, but he did a good job in this movie.

Last night I didn't work, but I heard they had a Code Black. That is a bomb threat. Eeeeekkkk...scary!!!!!! Turns out it was some idiot in the ER that made a comment in passing about how we hope we don't remember his name when this place blows up later. Ummmm, not the thing to say in a hospital because staff takes that seriously. Police were called, hospital was on lockdown, 2 hour search for a possible bomb and the idiot was arrested & taken to jail. Maybe he learned his lesson.

This friend of my nephew's....I probably mentioned him a long time ago in this blog somewhere. I don't want to say his name, but he was drafted in 2006 & got over a million dollar sign-on bonus because he was such a good baseball player. Anyways, he thought he had the flu...but it turns out it was meningitis. He passed out while at the gym & was rushed to the hospital. He's been on life support for the last 2 to 3 weeks. Every time they try to take him off the respirator, he would have major seizures. No one really knows why. As a result, the respirator would have to remain in place. He's only 20 yrs old - he should be getting better, not worse. Because of the seizures....they would have to give him major doses of anti-seizure medication (hence the reason he needs a respirator). So basically they've had him in a medically induced coma to control the seizures. As of yesterday, he has been breathing on his own & hasn't had anymore seizures...but he has major memory loss. I'm not sure how extensive it is, but I'm hearing it's serious. If you all could say a prayer for him, it would be appreciated. I will keep you updated on his condition. There was a time during the last 2 or 3 weeks that they didn't think he would live. He's not out of the woods yet, but hopefully on his way to a good recovery.

I've got to go now....I'm working tonight....ugh. Oh well, I got to have Thanksgiving & Christmas with my family, so it's time to work the holiday I signed up for. I hope everyone has a safe night tonight & Happy New Year!!!!!!!

The Best Reason of All

I heard yesterday the greatest news ever....my sister-in-law is now cancer free!!!!!! She had the double mastectomy just over a week ago and they had taken a couple of suspicious lymph nodes at the same time...they turned out to be non-cancerous. Ahhh, I couldn't be happier. Definitely the best reason of all to celebrate.

Merry Christmas!!!!

A Few Good Reasons to Celebrate

The first reason to celebrate...it's almost Christmas! I love Christmas even though it seems like it goes by so fast. And I'm 99% done with my shopping thanks to the wild shopping spree I did yesterday. Now I need to wrap...ugh, wrapping. Luckily my niece has volunteered to wrap - so that will help.

Second reason to celebrate...my sister in law is doing quite well after her surgery. She sounded upbeat & like her usual self when I talked to her on Saturday. I'll see her on Christmas day as she is insisting she wants to continue to have the big Christmas celebration we have at her house. It started becoming the tradition 21 years ago...when my oldest nephew was born on Christmas Day. Man, time flies!

Third reason to celebrate...I don't go back to work until Dec 31st. Yay for me! I stopped by last night to drop off my secret Santa gift. I brought my youngest niece with me. It's always so pleasant bringing a non-hospital person into the hospital to see their reactions to all that goes on. According to her...the hospital smells.....I guess I have become immune to that.

Fourth reason to celebrate...no more team nursing at the other hospital. It's about time they came to their senses! Needless to say, it wasn't in time as my other hospital hired yet another one of their nurses. We don't need any more nurses at my regular hospital. Stop hiring! I got called off last week because we are too overstaffed.

Fifth reason to celebrate...no snow. I am watching on tv all the snowstorms around the country & am pleased that it is predicted to be 79 degrees & sunny here on Christmas Day.

I could go on & on.....there are just so many reasons to celebrate life. My back is so sore, my house is a mess & I have a million things to do....but I am happy & thankful for all that I do have.

I bought myself a couple of gifts this year & because I bought them, I get to use them early...lol. I bought myself a new digital camera and a new cell phone.

I wish you all a Merry Christmas!!! Stay safe & warm!

Is this legal?

I went to the staff meeting today and found out that starting next year (which is next month...eek), my employer is requiring us to divulge any type of history we have. Let me clarify this - they started out saying we need to report if we have been arrested in the past year. Now that is sort of understandable as we don't want some wacko working with the public. Then they went on to say that this includes anything to do with tickets.....except parking tickets. So if we jaywalked, sped, car accident, etc....they need us to be "honest" & list everything that has happened with the law in the last year in our personal life outside of work. What????

Is this even legal? What does my driving record have to do with being a nurse? I swear it's a ploy to decrease the 3% raise we usually get. Is there anyone else whose employer does this? Please let me know!

Just Awesome

Saturday was awesome....just awesome. I got to sleep in, my back felt a million times better, I finished the book Twilight and immediately went to see the movie. I liked the movie better than the book - which was surprising, but they are both pretty entertaining. I'm still not hooked, but I will continue to read the series & see if it gets better. Especially since I heard they are making possibly 3 more movies to follow the books.

The best part of Saturday was seeing Carrie Underwood in concert. She was fantastic. I took my niece Elizabeth and we met Linda (hi Linda!) before the concert to hang out. Our seats were perfect, the music sounded great and Carrie is so beautiful. The concert was long...started around 7:30 and I don't think it ended until about 10:30. Little Big Town opened the show - they were pretty good too, even though I'm not much of a fan of theirs. Time flew....it was so much fun. And best of all...my back didn't bother me at all!

Now it's late Sunday afternoon & I have to go get ready for work. Hopefully it will be a good night and that it will go by quickly.

Have a good night everyone!

A Whole New Respect

I have a whole new respect for people that are actually able to comply with being on bedrest. Not that I've been ordered to be on bedrest or anything...but I think my back is screaming loud & clear that it would prefer to be in a horizontal stationery position. I just am not able to stay in bed for more than an hour at a time unless I am sleeping.

I've seen plenty of those baby shows on tv where the mom-to-be is ordered to be on bedrest & then they show the mom not complying at all. I remember thinking "I wish someone would order me to stop working and be on bedrest." Now I understand why it's so difficult.

I'm sure it's psychological because if my back were fine and I was able to do the 29,304 things that I need to do, I would be procrastinating by lying in bed for hours at a time. That's just the way my brain works.

Things I have been doing (while trying to rest) to pass the time:

1) Watching the 10 ER's that I had on my DVR. I'm gonna miss that show since this is the last season.

2) Playing "Hospital Hustle" online to make up for calling in sick twice this week. They actually have a game where the nurse runs around doing patient care!

3) Started reading "Twilight", but have yet to see what is so thrilling & addictive about this book. My 12-yr old niece swoons just looking at the cover - she read it in less than 2 days. I'm on page 70...still not loving it, but hoping that I will. I bought the other 3 books that go with the series....as a present to my niece of course (which I plan to read, if I can ever get thru the first one). Amanda....will this pick up or am I just not a Twilight follower???

4) Checking Dell.com repeatedly to see if the laptop I got for my niece has shipped yet. They say Dec. 18th, but I'm hoping it will be sooner. I got her a pink laptop!

5) Celebrating that I saved about $100 on xbox 360 elite...thanks to fatwallet.com. If anyone likes the latest deals...that's the place to look. My nephew is gonna be thrilled.

6) Comparing routers as I attempt to get both my niece (with her laptop) and my nephew (with his xbox 360) online. It's confusing to me as 10 people can say "this is the best router ever" while the next 10 say "this is the worst thing ever made." I guess I need to just buy one, hook the stuff up & hope for the best.

7) Thinking of other Christmas presents to buy.

8) Soooooooooo glad I didn't schedule myself to work between Dec 19th & Dec 31st.

9) Thinking about my sister-in-law, her surgery is this Monday.

10) Thinking about my cousin who has stage 4 breast and liver cancer. :(

11) Enjoying facebook.com as I have run into so many high school classmates on there. And I also get to see (via pictures and video) how my oldest niece is doing in her first year of college.

12) Missing my puppy dog Shay...as she is at my brother's house as I try to get better.

13) Only 2 more days until my niece & I are going to see Carrie Underwood in concert. Luckily when I bought the tickets...I picked the last row in the first section - which means I don't have to walk down many stairs. And now with the achy back, I can stand up & stretch whenever I want as no one is behind us. Weird how those things work out.

I called in sick to work again yesterday. It was the same charge nurse, but she seemed to be in a better mood. She joked around, didn't ask what was wrong....just said "If you're sick, you're sick." My thoughts exactly. And yes, hardly being able to walk counts as being sick in my world.

It is raining today & I love it. Gives me even more of a reason (mentally) to stay home & inside & in bed.

Hope everyone is having a good day!

Psst....Santa

That guilt I was feeling earlier about calling in to work...it's gone. My back is improving, but now it's like the parts of my back, legs & hips that have been compensating for my lower back...well they are stiff & achy. There is no way I could have made it 12 hours at work.

Pam...are they not allowed to ask us why we are calling in? Because they still ask us specifically what is wrong.

Pssst....Santa....please bring me a new heating pad and massager to help this back pain go away. What I have now isn't working.

Thanks!

Why Is It.....

Why is it that when a nurse calls in sick to work, the charge nurse has to act like the end of the world will be here at shift change? I could maybe understand if my hospital didn't have enough staff...but trust me when I say the nightshift is filled to its capacity & beyond. Why can't they just say "I hope you feel better soon" instead of "Oh nooooo, that means I need to find another nurse...%@$%&."

As you could probably tell from the paragraph above, I called in to work today. I am still very achy, stiff & sore. It's better...but I haven't really walked around for more than 5 minutes at a time...so the thought of dedicating 12 hours straight of the unknown...well, that's not happening for me tonight.

I am fine if I am sitting or laying down, it's the walking around part that is difficult. I'm trying to think back to last year when I hurt my back very badly or the times before that - how long it took until I was feeling much better......but I can't remember. I suppose that is a good thing as I also can't remember how painful it was either. Guess that's the mind's way of blocking out the pain...erase the memory nearly completely.

Hopefully I'll feel better tomorrow as I am scheduled to work. If not, I won't hesitate to call in - no matter how much of a guilt trip they try. I'm not going to prolong my pain, I want to heal & be better. I know moving around is good & I'm fine with that...but some shifts can be non-stop & I know I can't handle that physically right at this moment. And really...what patient wants their nurse to be hobbling around in pain? How safe would that patient feel? So it's not only good for me, but also my potential patients.

I'm left wondering & hoping some of you will respond...am I the only one that gets the guilt trip when calling off of work? I mean we are entitled to sick days - so why do they make such a big deal when we actually use them?

Another Why Did I Do That?

I was taking a shower before going to work last night. I leaned over to start shaving my leg & I heard a "pop"....then pain. Ugh! It was after 5, so I couldn't call in....I hobbled to work hoping for a good night. It was my lucky night - when I got there I saw that they had me down as a unit secretary. I love that because it is an easy job & I mostly was able to sit in one spot so I wasn't really straining my already injured back. Plus I got to go home at 11 as it wasn't very busy.

I came home, went to bed and woke up sorer than ever. Back pain like this happens to me about once or twice a year - so I'm no stranger to it. Of course, at the moment, it feels like this pain will never get better...but I know it takes time. I'm off of work until Tuesday. I hope I feel better by then...back to bed I go.

Why Did I Do That?

I went to work last night and forgot to bring some coke. Not the illegal stuff, but the drink brand. It's not so much that I forgot it, rather I left it in my car & I was too lazy to walk out to my car to get it. So what happens when one (such as me) does that? It makes me crave it more than ever. I'm sure if I had it sitting in my bag, I wouldn't have wanted it...but reverse psychology got me.

I left work & while driving by a Wendy's restaurant - it suddenly dawns on me that a large diet coke sounds like a lifesaver at 7:30 in the morning. I'm not a coffee drinker, but a coke drinker. Fast forward approx an hour & my 64 oz of diet coke is gone. No, not gone as in missing.....but gone as I drank the whole gigantic cup.

Now I'm asking myself...why in the world would I drink 64 ozs of liquid right before going to bed??? Why??????

My evening started out a little chaotic last night - due to staffing. They have this new rule that when they float us an ICU nurse...she can only float to the second floor - because the poor lil ICU nurses are not used to having to take care of 5 patients at a time and we need to keep them as close to their unit as possible - because they are familiar with their unit & supply location, etc. So then that forces the 2nd floor PCU nurse to then have to float to Med-Surg or the 3rd floor.

Needless to say, we 2nd floor nurses are getting tired of being moved all over the place to accomodate everyone else. Personally I think that is ICU is overstaffed...then send home the extras rather than calling off PCU nurses in order to make room for ICU. I know this isn't making sense to most of you, but I think any nurse would somewhat understand this.

I'm exhausted...heading to bed.

Team Nursing - who came up with this crappy idea?

Anyone ever had to do team nursing before? Does it ever work? At the other hospital I work at PRN, they decided to try this concept (yet again) starting last August or so. I think it's the main reason why I don't work there very often. This is the scenario:

One RN, another RN or an LPN and one PCT....to care for up to 12 patients. The RN does all of the assessments and all of the charting. The other RN or LPN does the meds, dressing changes, etc. And the PCT does the patient care. Now it sounds ideal on paper, but in reality, it's a lot of responsibility for the RN. So on the night shift, we tend to cheat a little bit...instead of one nurse assessing 12 patients, we split the patient load and make it 6 patients for one nurse, 6 patients for the other nurse. You know....what normal nursing is....you take care of your patients, I'll take care of mine. If you need any help, let me know. Well, seems administration has caught on to this & wants it stopped. They want us to follow the exact model they have laid out.

I just don't think my brain has the ability &/or the capacity to take care of 12 patients. 5 seems to be my limit, but I can adjust to 6 if I absolutely have to...but that's pushing it. I am willing to bet that I wouldn't even be able to remember 12 patients names & room numbers - much less why they are here, what the treatment plan is, how they are doing, assessments, meeting their needs, etc. At first I thought maybe I was getting old & alzheimers (or mad cow if you're a Boston Legal fan) was kicking in...but there have been about 10 staff RN's at that hospital that have quit due to the stress of being forced to take care of up to 12 patients at a time. Something like 5 of them are now hired at my usual hospital - because we do normal nursing with a max patient load of 5 per nurse.

I think if we were well-staffed, it could maybeeeeeeee work...but how often is a hospital well-staffed? For instance, the other night we had one patient care tech for almost 30 patients. That is insane. This isn't a nursing home we are running - it's an acute care hospital. So all the tech was capable of doing was vital signs. The rest of the patient care fell on us...the nurses. It's impossible to do what they require us to do. And it's unfortunate because administration is determined to make it work. Hence, I will not be working there all that often unless things improve. Not only is my nursing license at risk, but patient care is also risky. I wish that the administrators would come to the floor & work as a nurse even if for only one shift. Yes...I know, I'm dreaming. That would never happen.

I also wish that instead of administration looking for ways to cut costs, that they'd instead focus on finding ways to increase revenue. I know...yet another dream of mine.

I can see why so many nurses leave bedside nursing these days. So much responsibility and stress falls on us....we can't please administration, we can't please the doctors, we can't please the patients....we can't even do the true job of nursing the way it should be done.

I had to call a doctor last night at 2:30 in the morning because my patient's heart rate was sustaining 140's-150's. This is not a pleasant doctor, but I had to make the call. I wake him up & he's trying to figure out who the patient is that I'm calling about. He says to me "Isn't she a DNR?" Even if she was.....we still treat the elevated heart rate. DNR does not mean do not treat. Anyways, I assure him that no...there is no order in her chart saying she is a DNR. He says "Well, make her one." What? No. I'm not taking that order considering the circumstances...I just woke him up, he isn't even sure which patient this is or what her code status is...so no, I'm not taking that order over the phone. He can write it when he comes in.............really though, out of all the forms we make patients sign while they are in the hospital - I don't understand why we don't have a mandatory code status type form - so there is no doubt whatsoever. Nope, all a doctor has to do is write DNR and it's an order. We don't truly know if the patient or their family has consented to it - we're just supposed to take the doctor's word for it. Kind of ridiculous, if you ask me.

So, after refusing - politely of course - to take that order....he starts to order a medication to treat her heart rate. He has this accent that makes it nearly impossible for me to understand what he's saying & add into it that he's still half asleep. So I keep trying to repeat what I think he might be saying...which annoys him even more. I mean how awful of me to want to confirm the order to make sure it's correct. What's wrong with me? So half way thru that order he says forget it & starts ordering another medication. He was making me mad because he was ordering Cardizem...which is fine....but by mouth. How long will that take to kick in & lower her heart rate? A few hours? I looked it up on the drug handbook & sure enough...it said it takes 2 to 3 hours to start working. Ugh....I don't like seeing my patients heart rate tacking away at 150 for 3 hours waiting for the medicine to take effect. I don't know if the doctor was just an idiot & didn't know to order something IV or he was just going along in his mind that she was a DNR & there was no real rush to do anything to help her. So aggravating. By the time I left, her heart rate was still in the 120's.

I'm working 3 more shifts this week - need to make a little extra money for Christmas. I'm at my usual hospital - so even if things are awful - it's still ok. We don't have team nursing there, but we work together a zillion times better than this other hospital. Someone is always willing to help...most times without you even having to ask. I think it's because as staff...we get along well & it makes us want to help each other - as opposed to being forced into it.

I have a travel nurse recruiter offering me a job in West Palm Beach. There are some days I feel like I should take it....

Insane I tell you...insane

I have been quite happy the last few hours and you want to know why? Because for the first time in about 3 or 4 months...I finally got the schedule I wanted at work. This is the highlight of my week...maybe even my month. You see...we have self-scheduling, which is kind of a joke now that we have 93428094 night nurses all vying for approx 12 openings on the night shift per night. I am usually one of the last to know about when the schedule is available to sign up & by the time I get there - I am pretty much guaranteed the only thing open is Wednesdays and the weekends. I don't mind working Wednesdays and the weekends...just not every single week!

I managed to sign up today on the very first day the schedule was available. This is rare...purely lucky. I'm thinking I should run out & buy a lottery ticket. I'm insane I tell you...insane!

I hope everyone had a nice Thanksgiving. Mine was happy and sad. It is always nice having the family together. As I get older, I cherish this more & more. In the back of my mind, I'm always thinking "I wonder how many more of these we have left." I know...that's grim - not a good thought. My greatest fear is losing someone close to me. So it was a blessing to all be together if only for a few hours. We have fun Thanksgivings too. No fighting - everyone gets along rather well.

The downside of Thanksgiving was seeing my sister-in-law's sister who had the brain aneurysm. She was so different than usual. Any noise really bothered her - her head hurt. She spent most of the afternoon laying down and left early. This is not the woman that I know. She is usually perky & fun. I hope she is able to recover from this.

I also got news that my sister-in-law's surgery is scheduled for Dec. 15th. She's having a double mastectomy and they will also be checking to see if any of the lymph nodes have cancer. I'm praying she will be ok. In a weird way it has made our family closer, but still, I wish she didn't have to be dealing with this. She is one of the most wonderful women that I have ever met. It just isn't fair.

I'll be off of work from Dec 19th until the 30th...to be available if she needs me. It will also be the break I need before heading into January & focusing on a month full of overtime. It's our busy season at work & my savings account is really hurting. So it's time I buckled down & do what I need to do.

I worked last night. It was rather bizarre. I don't think I've ever encountered so many confused patients before. And they feed off of what the others are doing. One man...no joke, would press his call light at least 50 times an hour. He didn't want anything...just felt like pressing it. He said it was his schizophrenia making him do it. Ummm, ok. One of my patients...she would literally be drinking water & at the same time...yelling at me for not getting her any water. I'd have to remind her it was in her hand & she was currently drinking it...to which she'd reply "Oh." Then 10 seconds later it would start all over again. Another patient was a 100 yrs old & at 2:30 in the morning, she decided she had to be somewhere. Anywhere but at the hospital. She didn't know where she was going, but she had to be there. We had another patient yelling from her bed "Are you all running a restaurant out there? You seem pretty busy." You can't help but smile with some of the comments they come up with. For all those nursing students who are declaring they don't want to go into psych nursing....trust me....all nursing is a form of psych nursing!

I had a doctor come up to me this morning - he wasn't on call over the weekend and another doctor admitted a patient under his name. So he asks me what is going on with the patient. I give him the brief rundown & he remains standing there looking at me. Ummm...what else ya need to know doc? His reply "What am I suppose to be doing for this patient?" What kind of question is that? You're the primary doctor, go in & assess him & take it from there. I know it's a Monday, but come on!

On a final note...vampires seem to be the latest trend in my house. My 12 yr old niece decided this past weekend she had to read the book Twilight. I figured it was a good idea - as she wants to see the movie & why not read the book first. This book has something like 500 pages. I thought it would take her at least a week to read it. Nope....in less than a day & a half...she was finished & repeatedly saying "This is the best book ever!" We ran out on Sunday hoping to find the second part - but it's nowhere to be found. I ordered it on Amazon, but it seems to be backordered & who knows when we'll get it. I plan on reading Twilight in the next week or two.

Plus I discovered HBO's series "True Blood." Is anyone else watching this fascinating series? I'm hooked! More later.

Woo hoo

Nurses Voted Most Ethical

Poll Ranks Professions by Values

See Which One Is at Bottom of Barrel

Something Shocking I Just Realized Last Night

Remember back when we were young & James Bond was usually a sexy OLDER man. I realized last night that I am only 1 yr younger than the current James Bond!!!!!! GASP!!!!!!!

It's been confirmed

My sister-in-law has breast cancer. We found out a couple of weeks ago. Both of her parents died from some form of cancer, so she's been vigilant about getting checked every 6 months for any signs of it. This last time it was confirmed....well, not at first. Her doctor saw something, but said let's just wait and see what happens. Luckily, she didn't follow that advice and got a second opinion. It is breast cancer. I believe it is stage 1 or maybe they haven't staged it yet because they need to see if it has spread anywhere else. She'll be going for a bone scan and a test to see if it's in the lymph nodes. She hasn't had any symptoms whatsoever, which in a way is a good sign...but with cancer, you never can tell. It can be very sneaky and unsuspecting.

She also has decided to have a double mastectomy if that's what it takes to get rid of the cancer. I cannot even begin to imagine the stress and worry she and my brother are going through. I'm going to call them tomorrow and see how they are doing. I haven't been able to do that yet...as we normally don't chat on the phone. It's more of a "when I see them in person, we catch up on things" type of relationship. I will call them tomorrow though.

To make matters worse, her sister - who would be there for her 24/7 - ended up having a brain aneurysm just about the same time my sister-in-law was told about the cancer. Her sister had to go through an 8-hour brain surgery and is in rehab now....hopefully she will be ok.

It's weird, a month ago I was out to lunch with my mom, aunt and sister-in-law....we were sitting there trying to plan another lunch - because we recently decided to try to get together once a month for lunch. Now it's a month later and we are trying to plan how we are going to help her get through this.

Life really can change right before your eyes and the only control you have is how you react to it. All of this has reminded me to be grateful for the simple things in life - because you never know when something may change life as you know it.

A Day to Celebrate

Today is a good day. The chief of nursing at my hospital no longer works there. Now before you all think I'm cruel and mean - this is a woman that verbally threatened to write me up when I called in sick ONE time.

I'm not sure if I blogged about it when it happened...but I was like the 5th person to call in sick that day so they were shorthanded. She got on the phone with me, talked down to me, told me if I didn't show up - consider myself to be written up. I remember asking her if she was also writing up every other person that called in sick for the year and she snidely remarked "I'll review it on a case by case basis." I knew she could not write me up as I hadn't called in sick in over a year - but listening to her repeatedly threaten me truly aggravated me.

The call basically ended with her saying once more "If you don't show up, consider yourself written up." I replied "I will not be there tonight." Of course I was a little scared the next time I went back to work. I kept expecting to be called in for a meeting regarding the threat...but nothing ever happened. Of course if she had written me up, I would not have taken it lightly because she had no reason to write me up, much less threaten me.

I feel like she always held that against me. We never said anything more than "hello" if we happened to be in the same room. Most of the time we just ignored one another. Probably not the smoothest move for me considering she was so high in administration, but her job title didn't mean squat to me after the way she behaved on the phone that day. It was truly immature and uncalled for.

Sooooooo....there was some kind of falling out in administration and she is history. Karma.........

Update on Shay

Here's my sweet little princess....Shay Delilah (yes, she has a middle name!)

Cutest little puppies!

And one more...........how could I not share this???

http://www.youtube.com/watch?v=jCnAjel02lM

Christian the Lion

I just had to share......so adorable.......

http://www.youtube.com/watch?v=adYbFQFXG0U

Puts the Patience in Patient

Another week down - I only worked 2 nights this week, but the way my feet feel....it feels like I've worked 7 nights straight. I must find more comfortable shoes. Well, I did have super comfortable Skechers, but as most shoes - they started to not look squeaky clean. As clunky as Skechers are though, they are the only brand I have found that my feet are not sore after running around for 12-14 hours. So what do I do...throw them out & start wearing a pair of Avia and a pair of Nike. Yeah, silly me. I'm going back to Skechers for when I'm at work.

Wednesday night I was floated to med-surg to take care of PCU patients. We have something like 10 beds on the med-surg floor that are for PCU patients if our other 60 PCU beds are filled. I started out with 4 patients, discharged one and got 2 admissions. One of my admissions I was seriously worried about.

She was a woman in her late 70's admitted with TIA and cardiac arrythmia. The ER didn't elaborate on what the cardiac arrythmia was exactly...but I soon found out when she arrived on the floor with a heart rate in the 30's...hitting as low as 32 beats per minute. Normal is 60 to 100. Suprisingly, that didn't worry me as much as her "TIA"...she had right sided weakness to the point that she couldn't even raise her right arm. The CT of the brain was negative, but still....something wasn't right. Add to it that her speech was slurred. I was told by the ER nurse that the family believes she took too much Lopressor. Her dose is 50 mg twice a day, but they believe she was taking 100 mg twice a day. Big difference! Still though, what was causing her slurred speech and right sided weakness?

My clinical leader discussed with the nursing supervisor whether it was a good idea to keep this patient on the med-surg floor. They decided it was ok.....I'm not really sure why, but I couldn't really argue with them. Looking back though - I should have just called the doctor and gotten an order for ICU. Her heart rate alone with the possible Lopressor overdose would have warranted closer monitoring. Sure enough, by 3 pm the next day, she was transferred to ICU. I was on PCU the next night & ICU is just a few steps away. I noticed that her heart rate had made it up to 38...but she was having 3 second pauses. She also had a MRI of the brain, but I didn't see any results. I hope she'll be ok.

Last night was yet another crazy shift change. I probably should have done a couple incident reports, but it's getting to the point of why bother? It doesn't seem like they do anything with them anyways. The two issues were:

1) Surgeon ordered a patient be started on Heparin - order came in at 2 pm. It is now shift change & no Heparin ever started. Hellooooo...there is a good reason doctors order Heparin. The day nurse claimed he tried calling the doctor's office, but figured he'd round sometime tonight and he would talk to him. What? Talk to him about what...just start the Heparin.

The reason he wanted to talk to the surgeon was because we are coming out with this "new" Heparin protocol starting this coming Monday - it was what the surgeon ordered. The nurse didn't feel comfortable using the new protocol guidelines. I took a look at the new protocol (this was the first I had ever heard of it) and it was fine to use. It had parameters, we are good to go. What's the problem? Let's prevent those clots from forming!

Luckily, the surgeon rounded while the day nurse was still giving me report and I hear him say "Why hasn't this Heparin that I ordered 5 hours ago been started???" He must have been in a good mood, because he didn't even get mad about it - which is strange - because he has his moments of errupting. The day nurse shows him the new worksheet with the guidelines and tells him "you can't use this, it doesn't start until Monday." Hahaha...have you ever told a surgeon they can't do something? They have the biggest egos out of all the doctors....so I warned the day nurse not to use those words with this doctor, because he will find a way to do what you are telling him he can't do.

Sure enough, he took the new protocol worksheet out of the nurse's hands, grabbed some scissors, cut out the parameters for this new low-dose Heparin protocol, taped it to a doctor's order sheet and signed it. Waaa laaaaa....an official order to follow. The day nurse was stunned. He asked me "are you actually going to follow that order?" Ummm, yeah, what's wrong with it? It has guidelines & parameters - that is all I need.

2) Another patient with the same nurse - was started on the "alcohol withdrawal" protocol (I love these protocols - they basically take the thought process away from the doctors). Well, basically this protocol is done so the patient can be started on folic acid, multivitamin and thiamine....to reduce the effects of alcohol withdrawal. There are more things on the protocol, but those medications are important. Guess what....the patient hadn't been started on any of the medications.

For some reason, the pharmacy opted to make a banana bag with these medications instead of having the patient take them by mouth. It must have been a miscommunication or something, because this patient was fine to take the meds by mouth. No reason to hang a banana bag for 12 hours and run the meds in by IV. Anywayssss...I questioned him on it when I saw that the banana bag was ordered & hadn't been started. His reply was "It shows on the MAR that it's not suppose to be started until 9 pm." Huh? The patient has been here now a day & a half with the order and it hasn't been started? He didn't get it. He didn't understand why those medications are important for alcohol withdrawal. Sigh. I ended up getting the banana bag discontinued and switched the meds to PO (by mouth.

Needless to say, I didn't write it up even though harm could have come to the patient as a result of the delay of medications in both cases. I tried instead to explain to the nurse the reasoning behind both issues.

My patient needing the Heparin accidentally pulled out her IV prior to the Heparin being started. She was a tough stick to get another IV site, but she was a trooper. I told her she puts the word patience into patient. It made me stop & think....why are patients called patients? Ever think of that before? Most of my patients are rarely patient...lol. This one was though...thank goodness.

I had a new admit around 5 am. A woman in her early 30's with chest pain. When I asked her how long she had this chest pain, her reply was "3 years." Huh????? 3 years???? It definitely made me wonder about her.

Look at the time - I should be in bed!!! Have a good weekend everyone!

Sad Day

It's a sad day for a few reasons...

1) I have to work tonight

2) I started lifting weights on Monday & right now my arms are sooo sore

3) The election & life as we know it - I only hope our taxes don't go up & our freedoms aren't taken away

p.s. Katie - hang in there & thanks for leaving a comment. I don't know why some of the more experienced nurses can be so uppity rather than helpful. I've run into a few. I think they are just insecure. What I don't understand is when I hear the day nurses complain that they have students today - I think "What is wrong with you??? The more the merrier." Then again, I guess I'm thinking more about the patient & their satisfaction than I am of myself. Most patients love having someone at their beck & call and students are so eager to be there......that sounds like paradise to me. Oh well, anyways...hang in there...you're a great nurse!

70 Things

I'm not sure everyone wants to know this much about me, but here goes...

70 THINGS YOU PROBABLY DON’T KNOW ABOUT ME

1. DO YOU SNORE? - I hope not!

2. ARE YOU A LOVER OR A FIGHTER? - Lover

3. WHAT’S YOUR WORST FEAR? - Losing someone close to me

4. AS A KID, WERE YOU A LEGO MANIAC? - I wouldn't quite classify myself as a maniac, but I did like my legos - I used to build a hospital all the time, no joke...lol

5. WHAT DO YOU THINK OF “REALITY” TV?- I like it, well most of it

6. DO YOU CHEW ON YOUR STRAWS? - Nope

7. WERE YOU A CUTE BABY? - Oh yes...lol

8. IS THE SINGLE LIFE FOR YOU? Since I'm still single, I'd have to say yes...but it would be nice to meet someone wonderful

9. WHAT COLOR IS YOUR KEYBOARD? grey

10. DO YOU SING IN THE SHOWER? - Nope

11. HAVE YOU EVER BUNGEE JUMPED? - No way

12. ANY SECRET TALENTS? - Uh huh...shhh, it's a secret

13. WHAT’S YOUR IDEAL VACATION SPOT? - a nice beach

14. IS JAY LENO FUNNY? - He can be

15. CAN YOU SWIM? - Yes, since the age of 4 I believe

16. HAVE YOU SEEN THE MOVIE “DONNIE DARKO”? - Yes, long time ago & don't ever plan on watching it again

17. DO YOU GIVE A DAMN ABOUT THE OZONE? - Yes

18. HOW MANY LICKS DOES IT TAKE TO GET TO THE CENTER OF A TOOTSIE POP? - Too many

19. CAN YOU SING THE ALPHABET BACKWARDS? - Definitely not

20. HAVE YOU EVER BEEN ON AN AIRPLANE? - Yes

21. ARE YOU AN ONLY CHILD? - I have two older brothers

22. DO YOU PREFER ELECTRIC OR MANUAL PENCIL SHARPENER?Either

23. WHAT’S YOUR STAND ON HUNTING? - I don't like it

24. IS MARRIAGE IN YOUR FUTURE? - Only God knows

25. DO YOU LIKE YOUR HANDWRITING? - I wish it was better

26. WHAT ARE YOU ALLERGIC TO? - No known allergies

27. WHEN WAS THE LAST TIME YOU SAID, “I LOVE YOU?" – Earlier in the week to my niece

28. IS ELVIS STILL ALIVE? - No way

29. DO YOU CRY AT WEDDINGS? - I haven't so far, am I supposed to?

30. HOW DO YOU LIKE YOUR EGGS? - Scrambled

31. ARE BLONDES DUMB? NOOOOOOOO!!!!!!!

32. WHERE DOES THE OTHER SOCK END UP? - Good question

33. WHAT TIME IS IT? - 10:02 am

34. DO YOU HAVE A NICKNAME? - Jen, Jenny, Jennerizer, Jenny the Great...lol...it's true!

35. IS MCDONALD’S DISGUSTING? - Noooo, love McDonald's fries

36. WHEN WAS THE LAST TIME YOU WERE IN A CAR? – last night

37.DO YOU PREFER BATHS OR SHOWERS? - Showers

38. IS SANTA CLAUS REAL? - If you don’t believe, you don’t receive.

39. DO YOU LIKE TO HAVE YOUR NECK KISSED? Mmmmm

40. ARE YOU AFRAID OF THE DARK? No, love the dark

41. WHAT ARE YOU ADDICTED TO? Caffeine at the moment...and junk food

42. CRUNCHY OR CREAMY PEANUT BUTTER? - Crunchy

43. CAN YOU CRACK YOUR NECK? - Not on purpose

44. HAVE YOU EVER RIDDEN IN AN AMBULANCE? Yes, once, back in 1996, it was a dark & stormy night.....just kidding! I had a gallstone attack - only I didn't know I had gallstones at the time & thought I was dying, plus I figured it would get the ER staff to help me faster, I can't remember if that theory worked or not

45. HOW MANY TIMES HAVE YOU BRUSHED YOUR TEETH TODAY? - Once

46. IS DRUG FREE THE WAY TO BE? - Yes

47. ARE YOU A HEAVY SLEEPER? - Not really

48. WHAT COLOR ARE YOUR EYES? - Blue

50. DO YOU LIKE YOUR LIFE? - It could be tweaked a little, but as of right now...things are pretty good - I hope my sister-in-law & her sister are ok...say a prayer

51. WHOSE IS BETTER? - I don't compare myself that way to others

52. ARE YOU PSYCHIC? – Sometimes = womanly intuition

53. HAVE YOU READ “CATCHER IN THE RYE”? - I don't think so

54. DO YOU PLAY ANY INSTRUMENTS? - No, but I wish I could play the piano

55. HAVE U EVER STOLEN MONEY? - No

56. CAN YOU SNOWBOARD? - No

57. DO YOU LIKE CAMPING? - Nooooo

58. DO U SNORT WHEN U LAUGH? - No

59. DO YOU BELIEVE IN MAGIC? - It's all an illusion, not that that's a bad thing either

60. ARE DOGS A MAN’S BEST FRIEND? - To a degree

61. YOU BELIEVE IN DIVORCE? - It's nice to have options I guess, some marriages are mistakes, sometimes people grow in different directions...to each their own

62. CAN YOU DO THE MOONWALK? - No

63. DO YOU MAKE A LOT OF MISTAKES? - No, I'm perfect! Yeah, right!!!! Is it a mistake if you learn from it?

64. IS IT COLD OUTSIDE TODAY? - It's beautiful outside

65. WHAT WAS THE LAST THING YOU ATE? - Coldstone Ice Cream

66. DO YOU WEAR NAIL POLISH? - Sometimes

67. HAVE YOU EVER BEEN KISSED? - Yessssss

68. WHAT’S THE MOST ANNOYING TV COMMERCIAL? - anything political lately - living in Florida, every other commercial seems like it's either Obama or McCain.....grrrrr = annoying

69. DO YOU SHOP AT AMERICAN EAGLE? - No

70. FAVORITE BAND AT THE MOMENT? - Maroon 5, Lifehouse and Tim McGraw & his band

Ok, now you know me a little better...if you made it this far! I've been off of work all week - trying to get my house organized. I got one big project done, but my house is a mess - wish me luck!

I'm not going to comment very much about work last week - mostly because I've blocked it out of my mind (and partly cause of short-term memory loss = hey, I'm almost 40, it's allowed!). I do remember one of my patients had an order for Cardizem because his heart rate was in the 150's...but the nurse never bothered to start the Cardizem drip. She didn't even know it was ordered. When asked how long the patient's heart rate was in the 150's, she said "about 3 hours now." Ughhhhh! I stopped report right then & insisted she go hang it right now. Scary stuff.

Anyways, I saw "Nights in Rodanthe" last night. It wasn't bad. Half the movie I spent staring at Richard Gere & Diane Lane while thinking "They are getting old!" Which then reminded me that if they are getting old, I must be getting old too. Sigh!

Today, my brother & I are taking his kids to the county fair. The weather is beautiful & I just know there is a funnel cake waiting for me!

Happy Halloween everyone!!!!!

Frazzled??? lol

I had a patient last week that reminded me of that story in one of my posts..."The Patient I Failed." My patient had come in with respiratory failure. She also was end-stage renal disease and on the verge of going on dialysis. When I got report, they had her on a bipap because she was having difficulty breathing. I was told that it was crazy during the day because the patient wanted to die and her husband was fighting her wishes to be a DNR. Three of her doctors were at bedside as well as her family. The patient was in her 70's, she was totally alert & oriented.....she was tired of having breathing problems. The slightest of movements tired her out. Her husband was not ready to say goodbye. The doctors took him into another room and tried to make him understand how his wife was feeling, but it didn't matter - he was not going to be a willing participant in her wishes to die. The grown children were on board - they understood their mother's last wish & agreed to do as she pleased. It sounded like a heartbreaking day. I never met the husband, but I felt for him.

When I took over, the patient's heart rate jumped up to the 150's. She had agreed to wear the bipap for the night, but wanted it off first thing in the morning. I didn't even think to ask her what she wanted to do about the heart rate....I just immediately called the cardiologist figuring he'd order Cardizem or Digoxin. I've never had to stop & think..."hmmm, does this patient even want us to treat the increased heart rate?" I got an order for a Cardizem bolus and drip. It was then that I realized she may very well refuse the medication since she had chosen to be a DNR. It's against my nature to just do nothing, so I went in there & started setting up the IV medication. I explained to her what her heart rate was & what this medication would do. Thankfully she was fine with it. She actually got quite a lot of sleep - most people don't with the bipap. It's a big gawky mask type thing that is tight on the face & it basically forces you to breathe.

About 5:00 in the morning I answered the phone. It was a man saying he was trying to call my patient & wasn't getting a response. My patient had already told me she was refusing all phone calls because it's pretty much impossible to have a conversation while wearing the bipap. I told him it was too early in the morning for phone calls to patient's rooms. He says to me in a desperate voice..."Is she still alive?" OMG...it was heartbreaking. I knew instantly who he was - the husband of my DNR patient. I told him that she was. He replied "Are you sure?" I guess he figured she wouldn't be & was so elated to hear that she was. I told him yes & reassured him that if anything were to happen to her - he would definitely get a phone call. He went on to ask me more information, but I couldn't release it to him as he didn't remember what her password was. Darn HIPPA! Due to the privacy laws, we can't release information over the phone unless the person knows the password the patient set up. This man was elderly, he couldn't remember the password. I reassured him that she was stable and definitely alive. I don't think I'll ever forget his voice.

I never had that patient again, but I was told that the following day she was feeling better respiratory wise and didn't have to be on the bipap any longer. I believe she went home a few days later. At least her husband gets more time with her. I can't imagine what it's like to feel like you are about to lose the love of your life.

I worked last night & go back again the next 2 nights. When I got to work last night, it was chaos as usual. The day nurses refused to allow voicecare to come back...grrrr. They are the reason we need it. Change of shift report takes on average 60 to 90 minutes at night. That is ridiculous!!!! Anyways...I get there & see that I have 4 patients. I am waiting around 20 min just for the nurses to start report. One nurse has 3 of my patients & she's running around frantically. I see that one of my patients has her heart monitor off - so I go in to investigate. She's dressed & ready to leave. Tells me she's been waiting over a 1/2 hour for the discharge papers. I tell her I will work on it so we can get her home quickly. I find the nurse & she had no intention of discharging this patient herself. She wanted to give me report & let me take care of it. That alone will take at least another hour. So no...not gonna happen that way. I tell her to work on the discharge paperwork & I will get report from the other nurse. She wasn't happy...but seriously...the patient was ready to go. There was no reason to hold it up any longer. In the time it takes her to give me report, she could have the discharge finished.

So I get report on one of my patients...no problem. I come back to the other nurse & she has the discharge paperwork printed out. Yay! She then announces to me that another patient of mine has orders to be transferred to ICU. What??? And he's still here on PCU? Again - she wanted to give me report on him, then I could handle the transfer. Nope, not happening. I call the clinical leader & let her know we have a patient that needs to be transferred to ICU now....so that she could arrange bed placement. I then tell the nurse to discharge the patient, I'll take her downstairs and she can call report to the ICU nurse while I'm downstairs. That makes sense, doesn't it? Again, she's not happy....but there's no sense in both of us being unhappy...lol.

I come back & report has been called, the clinical leader is transferring the patient and I am ready to get report on the only patient she has left. This patient should have been discharged. All she needed done was PFT's (pulmonary function test) that was ordered at 1:30 pm. It was never done & they don't do them at night. So this patient had to spend another entire night at the hospital as well as be billed an additional day waiting for this test. Ridiculous! The day nurse was frazzled (is that a word?).

Luckily, I had a great night. I had one admit - a gentleman with chest pain that was already telling me he was going home tomorrow. I've learned not to argue with them when they talk like this. I simply say "Ok, let your doctor know when he comes in to see you tomorrow."

I've got to go get ready for work. Maybe one day I'll win the lottery...ahhh....

D50 Recordsetting shift

I finally managed to get myself on a day schedule (sleepwise) - yay! Somehow I believed that this would make me more productive on my days off. Nope, not true. I was supposed to go thru my closets this weekend and get rid of clothes and things I no longer need. What do I have to show for this effort = some clothing I managed to iron and hang up but has not yet reached my closet, some clothing I ironed but still in need of hangers and plenty of clothing that still needs to be ironed and oh.....one shirt to give away. ONE SHIRT! Something is better than nothing, right?

Work has kept me busy. I had decided to move to the 3rd floor PCU permanently - but about 2 or 3 shifts into that decision, I was feeling like it was the wrong decision. I'm just out of my comfort zone up there. They say PCU is PCU...but not true. Our 60 or so PCU beds are split between the 2nd and 3rd floors. I have worked 95% of the last 3 1/2 years on the 2nd floor. There are things I like and dislike about both floors. I did email the manager or director - whatever she is and requested to go back to my comfort zone on the 2nd floor. I never got a response. Hmmm. So now the last 2 weeks I have been floating back and forth between the two floors. I'm feeling like I have no home...lol. I did find out that we are probably going to be opening up an observation unit in January and I did tell them I was "somewhat" interested in "possibly" working there. (am I a commitment phobe or what??) We'll see what happens.

I did set a new record for myself and probably or should I say hopefully no one else can match it. I had a patient that came in with renal failure. When my shift started, his blood sugar was 64......and he had already had D10 running at 50 ml/hr and already had dinner. I wasn't messing around. I gave him a 1/2 amp of D50...fully anticipating that this would keep his blood sugar in a decent range for the rest of the night. Nope, not happening. I recheck it about 30 min later and he is in the 80's, but it should be much higher after what I gave him as well as having D50 running. About 30 min later, the patient tells me he feels like his sugar is low & this is after watching him eat a candy bar within that 30 min period. So I recheck and sure enough he's something like 54. Gasp! So I give him the other 1/2 amp & recheck 30 min later...he's back in the 80's. I'm not so confident that this is going to keep him ok overnight. So I call the doctor to report what I am dealing with. He says that's fine - just keep following the protocol.

30 min goes by, the patient again says he's not feeling right - recheck = 56. Grrrrrrr....this isn't good. Another 1/2 amp as well as a turkey sandwich, milk, juice...whatever he could possibly bear to eat or drink. Inbetween all of this, he's asking me why his blood sugar is so low. I asked him what medications he had taken prior to coming into the hospital & he says "I don't know." I told him I tend to think that low blood sugar for diabetics is usually medication related & that it could be awhile before his blood sugars stabilize. We go through another round of rechecks and it's still not over 70. He is sick of eating & drinking....so I give yet another 1/2 amp of D50. Recheck shows his blood sugar is even lower than before I gave the 1/2 amp. It's midnight now and I decide to call the doctor again - mostly because I have never in my life given more than 1 amp of D50 to a patient with low blood sugar & I am not confident this is what we should keep doing as it's obviously not working.

So I call the doctor - luckily he is one of the nice doctors who doesn't get upset with phone calls. I explain to him the situation. He tells me to give a full amp of D50 and also 1 mg of Glucagon IM and increase the D10 IV to 75 ml/hr. Ummm....ok....since he says so. Then he follows it up with "You don't need to keep calling me, just follow the protocol." Uhhhh....ok, just wanted to be sure you were informed as I have never had to repeatedly keep giving D50. His blood sugar should have been over 500 with as much as I had already given him.

So I give the full amp, give the Glucagon, turn up the IV...recheck 30 min later and it's 108. That's a little better, but seriously...it should have been in the 600's at least with all that medication. Tick tock....30 min later and he's complaining about not feeling well again. He's back in the 50's. How is this possible??? It was a cycle of that the entire shift. Luckily I only had 3 patients that night and the other 2 were sleeping with no problems. Looking back, I should have asked the doctor to upgrade this patient to ICU status as we don't tend to have the time because of our usual patient load (4 to 5 patients) to be doing accuchecks every 1/2 hour. However, I found it intriguing....so I kept at it!

I felt bad for the patient. He never really got any sleep because I was constantly in there assessing him. Finally it's about 6 am & I feel the doctor really needs to be updated as the protocol wasn't working and I was worried. I had given in 12 hours.....4 full amps of D50 IV as well as the one time dose of Glucagon and the patient had D10 running at 75 ml/hr....and his blood sugar at 6 am = 53. I hadn't called the doctor in 6 hours, he should be happy I left him alone for that long. So I update the doctor and inform him that I have never ever given this much D50. He can hear the worry in my voice and says to me "What's the alternative?" True...no D50 = the patient dies. Still though - he was in for renal failure and I know D50 is rough on the kidneys. The doctor assures me that we have no other alternative. I ask if he wants to increase the D10. His reply..."I don't want to put the patient into renal failure." Ummmm....doc....that's what he came in with.

So he agrees to up the rate as well as continue to follow the protocol. He tells me there is a slight chance the patient could have an insulin producing tumor in his body. I was doubtful...I mean what are the chances that he would be in the hospital on the very night this tumor decided to start producing insulin? Not likely.

I gave report to the dayshift nurse only to come back that night and find they transferred him to ICU. He needed closer monitoring. I found out he was discharged a few days later - so chances are it was medication related and not a tumor.

Sooooooooo....on another note.....I haven't been back to the other hospital in over a month, I think. I don't like the team nursing concept at all. The last time I was there, I felt like my fellow team nurse (let's call her "nosy") interferred in my patient care & I didn't like it one bit. Nosy knew nothing about my patient, yet felt it necessary to make a scene in the nurses station, proceeded to call the doctor (even though the primary doctor had just been there & assessed the patient) and when he began asking her questions, she panicked & handed the phone to me & ran out of the nurses station. I didn't think the doctor even needed to be called in the first place & I told him that. Nosy was ready to call a rapid response. My patient was a DNR....do we call rapid responses on DNR's? I had never been faced with that dilemma before - not that I felt my patient even needed a rapid response. He ended up being discharged the next day with hospice. He was a 94 yr old with congestive heart failure, aspiration pneumonia and c-diff....he wasn't going to get better. His body was tired out and filled with fluid. We can't save them all.

I don't like being forced to work with nosy....ooops, I mean that closely with someone that is virtually a stranger to me. She ended up leaving at 11 pm and the next nurse that came on...my "new partner"....I walked up to her and tried to be cordial & said "I guess we're partners." She basically thru her hands up in the air & said "Whatever" & walked off. Ok, just the way I prefer it - you do your thing, I'll do mine. If I need help...I'll seek out another nurse or the charge nurse...not a "partner."

I'll go back there sometime this next month, but the majority of my shifts will be at my usual hospital. I am still contemplating travel nursing, but my youngest niece begs me to not leave her - so I'm sticking around for now.

On a not so great note...I got a speeding ticket today. Actually I should say...again. It was the same darn cop as last time! I opted for driving school with the last one, so this time I'm gonna have to take the points...grrrr. $181 out the door. Oh well, my bad. So much for having a RN magnet on the back of my car.

I figured I'd end this post with a few things that not many...heck...absolutely no one knows about me....

1) I love half-frozen bottles of coke. It's messy when I first open the bottle, but that icy cold coca-cola can't be beat.

2) I'd say 90% of my scrub tops have hearts on them. I'm not even a heart-type of a person....if that makes sense! Why in the world do I have so many scrub tops with hearts????????

3) I could watch Travis Barker play the drums for hours. Don't ask me why...I don't know....I go into a trance watching him play the drums. It's not even that I like him...not that I dislike him either.....but there's something stress relieving and soothing about him playing drums. I have a video of him on my myspace page...check it out so you can see what I'm talking about.

Ok, that's enough for now! Have a good week everyone!!!!!!

As you all know

As you all know...or at least most of you know...AOL is getting rid of their journals. I will be looking for a new place to blog and hopefully be able to transfer all of my old entries over. If anyone has any suggestions, let me know. I'll be in touch.

The meeting and a story

Thanks to everyone that leaves me a comment or writes me an email. I really do appreciate your feedback! I went to the meeting today - it was more like a training session. It was mostly centered around our upcoming Joint Commission survey. They are the ones that give our hospital accreditation. I am sooooo thankful they don't visit at night...lol. Not that it really matters because we know the right answers to anything they ask - but none of us like being interrogated about our patients or their care. I'm glad I got the meeting over with. Now I have the next 2 days to take it easy.

I read this story on another web site and wanted to share it. It touched me and I'm sure it will touch others. I hope it's ok to post it here...

The Patient I Failed

She knew what she wanted.

She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.

So, she wrote a living will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

"I wish nature to take its course, with only medication to prevent pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

Snake Bites and Pizza

Well, the flood situation is over at my hospital. We still have a lot of water, but none of it is on the roads. Hopefully this will never happen again. As if it wasn't enough that we had a monster tropical storm and flooding...that same week AHCA made a surprise visit. AHCA is the Agency for Health Care Administration. As a result - we have a mandatory nursing meeting type thing to review what we are doing wrong. It's a 4-hour meeting...ugh. I'm going to try to go tomorrow afternoon just to get it over with.

The patients that stand out this week for me are the ones that got bitten by snakes. One of them for some reason decided to adopt a rattlesnake he found during the recent flooding. Not only did he decide to adopt it, but he considered it his pet & would play with it. Huh??? Who plays with a rattlesnake??? With their bare hands??? This guy did & sure enough - he was bitten. Luckily he responded well to the treatment and was discharged home a few days after getting bit. I asked him if he planned on keeping the snake...........nope.

The second guy that was bitten....well, let's just say the only people I've seen bitten by snakes have been males. Hmmmm. This guy's children found the snake and this guy decided to try to pick it up. Apparently he did not know what kind of snake it was. The snake bit him on the left hand. What does he decide to do? Call 911? Seek help??? Nope, he tries to pick the snake up with his right hand. Guess what...bitten again. Sigh! Turns out it was a pygmy rattlesnake. He ended up killing it & bringing it to the hospital with him. Apparently he's going to be ok & hopefully he's learned to stop trying to pick up snakes with his bare hands.

On a different note, I had female patient the other night that asked me something no one has ever asked me before at the hospital. She rang her call light & asked to see her nurse immediately....me. It was 1 am and I had already spent the majority of my time in the room with her that evening as she was a very needy type patient. I had given her a sleeping pill earlier and was fully expecting her to get some sleep any time now. So I go in the room & she's sitting up in bed & says "I need pizza now." Ummm, excuse me? She says "I am craving pizza and I need some right now. Can you help me?" Huh??? I looked at the clock & it's 1 am. I told her I didn't think any pizza place would be open this late on a week day. She asked me if I could please call around and find out. I told her I really did not have the time to be calling restaurants, but she was welcome to call or look them up on the internet (she had her own laptop computer in the room). She was ready to start crying...not from pain, but from possibly not getting pizza when she wanted it. I really didn't think she'd find any place still open....but I was wrong. Domino's was open until 1:30 & sure enough - she ordered a pizza. I asked my charge nurse if that was ok...because I've never had a patient order pizza or any other delivery type food while they were in the hospital. She said "We can't stop her." I just had to laugh because of the situation. She got her pizza and was a happy camper after that. Yay!

I'm trying to like the other hospital I work at, but it's tough. There are a lot of similarities as far as charting, but the flow of the place is just very different than my usual hospital. The staff is much different too. I feel disorganized & I don't like that feeling. The team nursing is not really being done even though it's supposed to be. I don't like the team nursing. I prefer to have my own 4 or 5 patients and not have to worry about anyone or anything else. After 5 patients, I find that it's hard to retain any more info. For them to think we can take up to 12 patients and do quality nursing care...well, it's impossible. So the night shift nurses have been splitting the teams/assignments. We're not supposed to, but the charge nurse doesn't seem to mind. I'm sure it's only a matter of time before administration figures it out and either gets stricter or listens to the nursing staff and changes things.

I'm debating about trying another hospital. The downside is that the other hospitals are further away and more traffic which means I'd have to leave earlier to get there and take longer to get home. Plus I don't want to burn any bridges. For now I'll try to give this other hospital more of a chance. I've only been there 3 times...so I will make more of an effort to be comfortable there. All I can do is see what happens. I would like to get into a bigger hospital and get into an ICU training program. Perhaps I'll do that at the beginning of next year.

I'm off until Friday...unless I pick up some shifts. Well, I do have that meeting tomorrow. I think I'll enjoy having the rest of the week off.

Have a good weekend everyone!

Another Update

The storm is gone, but the damage is not. My house made it through just fine - there are some minor roof leaks, but I know the roof needs to be replaced soon. What isn't fine is all the flooding locally. I've lived in Florida for 28 years and have never seen the St. John's River overflowing like it is. It's usually way low in fact. It's kind of scary to think of what could happen if "all" that water comes pouring out.

My hospital is continuing to look like an island. There is nowhere to drain the water because the river is obviously at full capacity. I'm not kidding when I say in some parts of the property, the water is up as high as a stop sign. I've enclosed a picture so you can see just how bad it is. Look at how high the water is on the guy that is simply standing in the hospital parking lot.

I worked Sunday & Monday nights...it was pretty easy - went by so slow though. I was supposed to work tonight, but they were cancelling people due to overstaffing. I volunteered to be off as I did not get much sleep today. I keep wondering what all this water sitting around the hospital can do. I mean...can a sinkhole start because of it? Can the building collapse? It scares me because I know to some degree - anything is possible & nobody knows for sure.

It's 9 pm and I'm heading to bed. I need sleep....obviously.

Update = Still Raining

When will this rain stop? I am not kidding when I say it has not stopped raining in the last 48 hours. Roads are flooded, schools have been closed for the last 4 days, my yard is handling the water - but I do have a few leaks in the roof. I am thankful though - I did drive around town a little bit and there is a lot of flooding. I have never in my life seen anything like it. I mean you see it on tv around the country, but this is the first time I have seen with my own eyes - roads closed due to flooding. I am thankful that it's ok around my home.

I've heard conflicting reports regarding my hospital. The news was reporting that the first floor was flooded and patients needed to be moved to different floors or transferred to other hospitals. I haven't been to the hospital, but according to their emails, none of that is true. I guess I'll find out on Sunday when I return to work.

Speaking of work, I have finally had enough with shiftchange report taking on average an hour to two hours because dayshift is so unorganized. I communicated (nice word) my frustrations with my manager and director. It seems the manager took it to heart because an email was sent to everyone yesterday regarding shift change report and organization. I doubt that will do the trick, but at least they are aware of it.

I have to come up with another strategy to decrease the lenght of time it takes. I think I will start using the Kardexes as my report sheet - that way they will be filled in & up to date at least. I am pushing hard for them to bring back "voicecare"...which is basically where you record the patient's history, what they are there for, who the doctors are, etc and then an update as to anything pertinent going on. That's all I need to know. I feel like the dayshift nurses I deal with fluff up report with many details that I don't need to know. It wastes valuable time. I can only wish that one day evening shift change will be as smooth and calm as morning shift change. I absolutely hate getting out of report at 8:30 pm (when I start my shift at 6:45 pm)...and I have a discharge to do, a new admit is being brought up from the ER and my remaining patients are wanting their medications so they can go to bed - not to mention the orders missed, the orders that need to be clarified, dealing with pharmacy, dealing with the lab...ahhhhhhhhh....I just want a nice start to my shift.

Dayshift may say nightshift is easier because the patients are sleeping.....which isn't true.....but nightshift starts out like crap because of all the loose ends we have to tie up that didn't get done during the day. Ok, enough venting & I am not generalizing or stereotyping. We have some good dayshift nurses who are organized and know how to use time management to their advantage. We also have those dayshift nurses that are looking to milk the clock and waste valuable time. I'm sure we have some disorganized nightshift nurses also. All I'm asking is for a decent shiftchange report that doesn't take 90 minutes on 4 or 5 patients. That's not asking too much, is it?

Maybe that's my sign to try out some other aspect of nursing. There's not a whole lot to choose from at my hospital.....but other hospitals have different fields. Perhaps ER or Labor/Delivery would be worth venturing into. I'm sure all areas have their problems & I'll gripe about something........but I can't see it taking 90 minutes to get report.

My other gripe for the past week...I come in last Sunday evening and see that there are 4 isolation patients on the floor. Three of them have c-diff (nasty frequent diarrhea) and one is on respiratory isolation until they rule out menningitis. I think "Ok, there are 3 nurses tonight, surely they will divide up the c-differs between us."

Ummm...wrong. Guess who got ALL FOUR isolation patients......ME. I immediately began to investigate who the dayshift clinical leader was & why doesn't she like me? I think for a moment that I could complain about this assignment, but figure...nah, we have a patient care tech who will help me clean up my patients when they frequently go to the bathroom. Wrong...another patient on the floor became a Baker Act (patient is threatening to hurt themself or others) and they pulled our patient care tech to be a sitter for him. So I lost our tech for about 5 hours. Luckily they found someone else to come in & help out. It turned out to be an ok night. The next two nights were also ok.

Time to get some sleep - have a good weekend every one! Say a prayer that the rain lets up here in Florida!!!