Saturday, June 28, 2008

Best News I Heard All Week

I heard the other day that starting in July/August, my hospital is beginning a training program for the DOCTORS to enter their own orders.  For the life of me, I cannot see them doing this.  I mean half of them barely have legible handwriting - how are they going to be using a computer and ordering their own things?  One of them I know can't even figure out how to sign onto the computer, much less look up any results or enter his own orders. 

I wonder how much the redlining process will decrease - since their orders won't be written anymore unless given over the phone.  I have a feeling, a lot of these doctors will be traveling with "assistants" to enter their orders.  I cannot wait to see this take place.  I'm not sure when it's going to be implemented, but it seems like it's just around the corner. 

I interviewed at another hospital yesterday.  I'm not sure if I'll get the job or not.  Hopefully I'll hear something by next week.  It's a per diem (as needed) position.  She seemed like she was ready to offer me a full-time position, but I don't want that. I'm not planning on leaving my hospital - I just want to see how it is working somewhere outside of my comfort zone.  I figure it will be a good experience and increase my confidence also.  We shall see!

I worked 4 nights in a row this week.  I'm debating about going back tonight.  I should...for the overtime money, but once I get home - the last thing I want to do is go back to work.  I'll see how I feel later.

I started off the week on the Med/Surg floor with 5 PCU patients.  We have patients on Med/Surg when PCU fills up and for some odd reason - our hospital is super busy this month.  So I was down there as the lone PCU nurse - which is sometimes good because you are basically on your own.  It has shown me that I can do just fine on my own.  I didn't even know who the charge nurse was - she never once talked to me the entire shift.  Nice, huh?  I had a patient with an active MI (heart attack).  While I was getting orders for her, the Med/Surg staff was busy celebrating someone leaving and were having a party basically.  They seem to eat a lot on that floor now that I think about it.  Anyways, they were trying to get me to join in - which was nice - but ummmm, I have a patient with an active comes first.  Their reply "You can never be too busy to eat!"  Yeah, ok!

Luckily my patient was stable and unaware she was even having a heart attack.  As the night wore on though, she was becoming a bit more confused - yet she could remember my name perfectly.  How do confused people do that?  They can forget who they are, where they are, what year it is....but they always seem to remember the nurse's name to yell out continuously.  I don't get it.

I put a call into the PCU charge nurse & said "Please don't send me back down here tomorrow night."  So the next night I was back on my usual floor.  I'm not sure it was much better patient wise - but at least I had the usual staff around.  I had one patient that was in with Altered Mental Status - but I am convinced what I was seeing was how she always is.  She sure did love her call light.  Every 15 min, she was calling - sometimes sooner, but never later.  At one point, she asked how she can cover the call light so she stops pushing it. about if you just stop pushing it? 

We had another patient that was convinced she had bird mites all over her body.  Obviously she didn't, but there was no making her believe that.  She had bottles & bottles of "at home remedies" set up all around her bed.  It was pretty bizarre. 

I had another patient in which the doctors totally forgot to see him.  Try explaining that to the family members that were sitting at bedside since 9 am.  I managed to iron it out, but it wasn't pretty.

Have a great weekend!

Saturday, June 21, 2008

A Disgusting Memory

Ok, 2 McFlurries later and an evening of watching non-stop episode after episode of "Hulk Knows Best" it any wonder why I'm awake at 3:36 in the morning? I swear I'm meant to be a vampire....I dread the days & come to life at night. I can't even blame it on being a nightshift nurse, because I was like this before I went into nursing. Guess that is one reason I did go into nursing - the night schedule works for me.

I've been doing ok. Actually, one good thing that happened this week is that there has been a big change in the way we chart. No longer do we have to spend hours & hours charting after our initial assessment. There is a choice called "No change" and everyone already knows that if you mark the answer "No change" - that one would assume there has been no change in the patient's condition, right? For some reason, even with marking no change, they still wanted us to chart full assessments. Finallyyyyyyyyyy they have come to their senses & we can be nurses again. If there is "no change", all we have to do is mark that and move on. Yay!!!

I'm not going to go into all of my patients and their conditions, but I will tell of one that is quite disgusting...because I feel the need to share and it's something I want to look back one day & be reminded of something so disturbing. I had a male patient in his 40's that was in with chest pain. On the night I took over his care, he was supposed to be discharged after getting the results of his echo (sonogram of his heart). Well, it turns out he had a blood clot in the left ventricle of his heart...therefore no discharge and he was started on Heparin immediately. That isn't the disgusting part.

I was told that this gentleman's heart rate would occasionally increase to the 150's to 170's. Why? Do you really want to know? Sorry for the answer...but this man felt the need to...hmmm, how do I word this as to not offend people...this man would take matters into his own hands to make himself feel good. Everyone get it?

This isn't the first time that a nurse has walked into a male patient's room to find him taking care of himself and it probably won't be the last. I truly don't understand why they cannot wait until they are in the privacy of their own home, but I guess some men just don't think about it to that degree. Heck, maybe they like the idea of having a nurse walk in on them. Anyways....this male had been doing it quite often and was told multiple times to stop. Not because of his heart rate or because it was inappropriate - especially when he wasn't even in a private room...he had a neighbor not more than 3 feet from his own bed - but because he had aids. We all know how aids can be spread....thru body fluids & this guy was proud to be decorating his bed, his hands and anything within reach with his own body fluids. Ewwwww! One of the nurses tried to educate him regarding this matter, but he didn't care.

I tried a different approach - tried to explain to him that he had a blood clot in his heart and to try to avoid all vigorous activity. In fact....try not to move much at all...especially with the Heparin running. That seemed to work...for a night anyways. It was also a good reminder for myself that universal precautions should always be in effect....especially with male patients, because you just never know what they might be up to....sigh.

I had a good week at work...mostly because of my co-workers and also because I only worked 2 nights...haha. I like to mix up my schedule. I'm on for 4 nights starting Sunday. I'll probably be called off as we have way too many nurses now (never thought those words would come out of my mouth). At the same time though, our hospital has been busy, so who knows. It looks like the chest painers are back instead of being diverted to other hospitals. Yay! I love the chest painers.

I'm also going to apply at another local hospital - just to get more experience in a place different from my comfort zone. I don't know if I'll even get hired, but I'm going to fill out an application online and give it a try. I don't plan on leaving my current hospital....just trying to get a per diem position at this other place. The good thing about it is that it's the same hospital chain I'm at if I work my regular schedule at my hospital and pick up shifts at the's considered overtime. Even better! The travel nursing is still in the back of my mind and I will continue to get more information on it.

Hope everyone is having a wonderful weekend!!!

Tuesday, June 3, 2008

So much going on!

It's been quite awhile since I wrote last - so much has been going on - I'll try not to make it tooooo long.

First off - I got to see Tim McGraw in concert! Woo hoo! It was great, but went by way too fast & I probably drank a little too much...but it was fun. On top of seeing Tim McGraw...I got to meet Linda - someone that has been reading my blog here for a long time. She has always been so friendly & was a real pleasure to get to meet her in person. We still have to go out for some margaritas, Linda!

Work has been challenging. There are so many administrative changes and they don't seem to be stopping any time soon. I am getting more and more convinced that hospitals don't care about their patients or the nurses. I can't speak for all hospitals - just mine. They expect us as nurses to do so much, yet won't allow us the staffing that we need. So what it comes down to is basically hardly anytime to really spend with our patients or even speak to them...because we have soooooooooooo much charting and paperwork to do.

That's tough for me to accept. Especially this week as I was reminded that ultimately what most people want in life is someone to listen to what they have to say. That's it....time to listen. I think that is the key to gaining their trust and confidence....and yet we are very limited with the amount of time we can spend with our patients at the bedside. I don't totally blame my hospital because I'm sure it mostly goes back to the insurance companies and all the paperwork they require to be processed in order to pay the hospital for its services...but still. Something needs to change. We are nurses....we are trained to care for patients. Instead I predict in the next 20 years....the majority of nurses will be affected with carpal tunnel syndrome and bad backs because of all the charting we have to do on a daily basis.

The way I was reminded of how important the skill of listening is....I got a patient from the ER that was agitated due to the ER nurse's attitude. I shouldn't say that it amazes me how one person can affect another and change their total outlook on the entire hospital...but that's exactly what happened Sunday night. I'm not going to go into too much detail with why he was at the hospital, but the ER nurse basically accused him of trying to commit suicide and would not listen to why he came to the hospital. I could understand the patient's side of it and I also figured that the ER is busy and understaffed...perhaps the ER nurse didn't have time to listen either. Still though, it agitated this man and I felt bad for him. So I took the time to listen to what he had to say. It took 90 minutes to get through the admission, but he had calmed down and was able to sleep after I was finished. I left work 45 minutes later than usual in order to catch up got it...the paperwork....but it felt good knowing that I diffused a situation simply by taking the time to listen and my patient was calm as a result.

It was a tough night that night though....I had 2 post-op that was nearly 500 lbs and could barely move, but was so uncomfortable in bed that we had to get him up to the recliner chair. It took about 30 minutes to complete that task, but as a result, he was feeling it was worth it.

My other post-op patient was a type A personality - he wanted what he wanted when he wanted it and how he wanted it and that was that. I've dealt with people like that before and have learned it is better to just do what they want rather than upset them - because when you upset them, they become more demanding. Luckily he & I developed a good rapport and he really didn't call for me too often through the night....unlike what I heard from how he's been previously...very needy & always on the call light. When he did call, I was right there & did whatever he needed - to a degree. When he started asking for a back massage and to be iced down on his back....I declined. I'm not a massage therapist.

My third patient ended up being easier to deal with than when I had him the week before...thank goodness. He really didn't ask for anything, just was very unhappy with having to be in the hospital. I've never seen a patient with so many different consults...he had at least 9 different doctors following his case. He came in with septic shock.

My fourth patient had been a new admit at the beginning of the shift. She had been admitted with chest pain...but it wasn't actually chest pain. It was pain near the left side of the rib cage under the breast. She was calm and pleasant - went to bed around 11 pm. Then we got the call...that we had to move her into another room so we could put 2 male patients in the room. We woke her at 2:30 in the morning (ridiculous!!!!!!!!!!) and moved her into another room with another patient. Well, that set her off into crying for nearly 2 hours. When asked why she was crying, the reply was "Because you moved me to a different room." Does that really require crying non-stop for 2 hours? She complained of chest pain rating it a 10 out of 10.....yet was lying in bed reading a book. I don't know, I don't understand what goes through some people's minds.

And my fifth patient - the one that reminded me that listening is one of the best skills a person (not just a nurse) can have. He was admitted into the crying patient's previous room of all places. So while I was busy admitting him, she was still crying.

It was a busy night, but I think I handled it pretty well. Not much really gets to me anymore at work. I just tell myself to get through the night - it's just 12 hours - I can survive. It's not worth getting stressed out or upset.

I had a whole new set of patients last night as I was on my usual floor (the night before I had been transferred to 3rd floor). My group was pretty good. The first one was status post a heart cath. It had been abnormal, but the doctor was unsure of how to treat it and would discuss it with the patient in the morning. The patient was very easy to get along with - so much so I had him laughing at 5 am this morning. I like when I just click with a patient. Makes work much more enjoyable.

My second patient has been in the hospital for about 6 weeks - came in with abdominal pain and turns out it was stomach cancer. How scary is that? I swear...every time I have a headache or the back of my mind I'm hoping it's not cancer. She had just finished up with her last round of chemo - so I imagine she'll be leaving the hospital soon.

My third patient was transferred to med/surg just after the change of shift - so I didn't know too much about him.

My fourth patient came in with chest pain, but it turns out it was back pain and more of an ortho problem than cardiac. He needed pain medication so I gave him 2 mg of Dilaudid. Within 30 minutes, he was itching everywhere! So I got him an order for Benadryl and Solumedrol - it knocked that itching right out...and the patient too...which would be a good thing later in the night. You'll understand in a few minutes....haha.

I got a new admit around 2 am - altered mental status and hyponatremia (low sodium level). What is strange is that in the last week...this is like my third or fourth patient to be admitted with hyponatremia....where it was at 122. Normal is 135 to 145. Usually when someone's sodium level is that low, confusion appears. My other patients weren't confused last week, but this gentleman definitely was. He kept repeating to me "I don't know what's going on." He must have said it 20 times in 10 minutes. Luckily he went to sleep. The only thing I did was hang a bag of normal saline. Well, 2 hours later he is awake...and totally alert and oriented. What the ???? He could answer all of my questions appropriately, he could stand & walk, he was Wow...I'm good! I don't know...I don't get it. I'm not totally believing that the first set of labs were even his. I mean he was confused....but listen to this (and those that know electrolyte levels will understand why I don't believe the first set of labs were accurate). His sodium went from 122 to 136 in 12 hours. Is that even possible just by hangingone bag of normal saline? No. On top of that...his potassium went from 3.1 to 4.4 with NO replacement. And his magnesium went from 1.5 to 1.8 with NO replacement. On top of that....his urine output in 12 hours was nearly 5,000 ml. If anything, his electrolytes should have been wayyyyyyy off after all that urine output. Like I said, I'm good....haha!

This poor gentleman though...he nearly broke my heart. He's 78 years old and his health is declining. He told me that he has been married for 50 years and that his wife recently told him that the marriage has not been what she expected, that she was unsatisfied with it and wants to put him in a nursing home so she can live out the rest of her years without him. OMG....sooooooo heartbreaking. He says she said this to him about 6 months ago...but for him to remember it now....sad. He says she is hateful towards him, but he doesn't want to go to a nursing home, that he still has a few good years left. I wanted to give him a hug! I mean what do you say to someone that is telling you this out of the blue? I didn't get to meet her and I'm sure there is way more to the story, but it still made me sad for him to have that on his mind at 4 am while he's in the hospital. I'm sure he fears that instead of going home on this admission, that they'll put him in a nursing home. So many of our patients have that fear. It's heartbreaking.

I almost forgot - the reason why it was good my 4th patient was knocked out for the night. We got the patient I had transferred to med/surg back around 2 am. A different nurse got him this time since I had just gotten an admission. None of us really knew what the med/surg nurse said to the doctor to get him upgraded to PCU...because he wasn't in any distress, his vital signs were fine, he was asymptomatic. She claimed that when she was suctioning his mouth, that fecal matter was coming out. I know...gross! Still tests were ordered...just a transfer to PCU and some Reglan. It made no sense. When they brought him up....he really bad. So bad that I didn't even want to go into the room and he was put in the room where my fourth patient was. The nurse that got him said she thinks it's his breath that stinks. What? How can anyone's mouth stink so badly that the room and hallway were unbearable to stand in? I didn't send him down to med/surg like that! She suctioned him...nothing was there but clear fecal matter. Then she pulled down the bed sheet & it was very apparent this patient had a GI bleed. Anyone familiar with what a GI bleed smells like? Picture that only a million times worse!

I've had my share of GI bleed patients and although the scent is unmistakable......this was the worst I had ever encountered. The nurse and care tech caring for him had to put on a mask & put toothpaste on the inside of it so they could smell the minty scent in order to clean this patient up. I, on the other hand, was tearing open alcohol pads & holding them up to my nose in order to survive because I had been sitting & charting near the room. I had to move...and even with the move, the smell was making it's way down the hallway. I sprayed the spray they have at the hospital - but that isn't much of a better smell and I gave another nurse a headache because of all that I was spraying.

I was praying my patient was ok, but I couldn't venture in there quite yet. I'm telling you - this was a bad smell. I figured if he needed me, he would call for me. I did check on him a little later and somehow he was sleeping through it all. Maybe the smell knocked him out...I have no idea. Our hospital is full, so I couldn't even offer to move him anywhere else. It seems like that is always the case. Anyways, the GI bleeding patient ended up being transferred to ICU....not so much because he needed to...but because at least he'd be in a private room. He probably could use the closer monitoring too - since he was actively bleeding. Ahhh, what a night.

I'm sure I have plenty more stories I could tell you regarding the patients I've had since I last posted...but I'm getting old & my memory is fading (lol) this is a long post already. I am off now until next Wednesday. Not really sure what I have planned - but I do want to go to the beach. The weather is already unbearable - summer is here. Hopefully the hurricanes will stay away, but we do need the rain.

I got called off of work tonight...yay...actually I volunteered to be called off. My hospital has hired wayyyyyyyyyyyyy too many people and as a result, we're all being called off. They tell us that they hired all these people to prepare for when we are busy in the winter. Ummmm....that's a long way off! I'm sure it will be here though before I know it. I am getting closer & closer to venturing out of the comfort zone. In fact, I'm going to check out some travel nurse web sites online. Any recruiters reading my blog - send me an email!

Have a good week everyone!