Thursday, July 17, 2008

It's official!

I have a second job! I got the job at the other hospital and it turns out, another nurse from my unit also got hired there and starts orientation with me on Monday. I didn't even know she was applying nor did she know I was. Small world! Hopefully it will be a positive experience.

My patient that coded a couple of weeks ago passed away last week. He had been in hospice care and ended up passing away after his wife left to make a phone call. Some say that he was waiting until she left the room. I'm not so sure he was even aware enough to know whether she was there or not. I think it was the transfer from ICU back to PCU that did him in. It seems like when we have patients that are very close to passing - that when you move them around - such as giving a bed bath or transferring to another bed - that's enough to push them over the edge.

I had a patient this week that had been made hospice and was supposed to be transferred the next day to the hospice care center if he "survives" the night. Not exactly the words I like to see written about my patients. I informed my patient care tech that we would not be bathing or moving this patient at all - because I know the moment we start doing that stuff - bad things can happen. He was developing a fever...he had been for awhile, but now that the antibiotics had been stopped...it seems the infection was causing his temperature to rise. We had an order for Tylenol, but it didn't make sense to me to even have that order....because Tylenol wasn't going to stop the infection which was the reason his temperature was rising. I tried to cool him down with cold washcloths - it helped a little bit, but we all knew it was just a matter of time.

One word of advice to those that may become hospitalized in the future....when the doctor is visiting you, that is the perfect time to ask questions and make requests. Don't wait until 10 pm or even 2 am to start making requests...because chances are the doctor is not very receptive at that time or he's not even the doctor on call.

I had 5 patients the other night all making requests thru the night that required doctor's orders. That's fine...I'm used to it, I'll make the call & try to meet your needs. I don't mind waking up sleeping doctors if the reason warrants that. But every one of the patients had told me "Oh, I didn't want to bother him while he was here." What? Bother him? He's there to see how you are doing and what you need. If he is talking to you - that is the time to ask questions and make requests...so he can write orders.

For example: I had a patient in with chest pain. They put nitropaste on him and the major side effect of that is a bad headache. So Tylenol was given at 9 am and the nitropaste was removed. The Tylenol didn't help, but the admitting (primary) doctor was in at 2 pm - even gave the patient his business card. Now it's 8 pm and the patient is very upset that he still has this headache. Ok...did you tell the doctor you had a headache? No, I didn't want to bother him with that. How is that going to bother the doctor? Plus the cardiologist was also in to visit and he didn't want to tell that doctor either. So I call the primary and of course his partner is on call who knows absolutely nothing about this patient. I tell the partner that this patient is complaining of a headache. The partner is concerned now that it might be more than a headache and should we order a CT or MRI of the brain. Ummm, I don't think so, but of course I don't want to be the one to decide that. He's running through all sorts of theories of what it might be....as opposed to a nitroglycerin induced headache. He finally decides we'll try Lortab and see if that takes care of it...which it did. But then I had to wait another 45 minutes for pharmacy to process the order and before you know it...it's about 10 pm before I can give this patient anything to help. I'm just saying it would have been easier if he had told the doctor standing in front of him at 2 pm that he has a headache unrelieved with Tylenol so we could resolve it then instead of 8 hours later.

Oh and another thing...if you want/insist on a private room...do that while you arestill in the emergency room. The time not to do it is when they are wheeling you into a semi-private room. My new admit started crying while still on the ER stretcher...declaring "I can't do this! I need a private room." I've never seen anyone react quite like that. The thing is...once the room is assigned, it's rather difficult to change the assignment unless we have plenty of extra room available - which is rare. So either insist on a private room and wait in the ER until one is available or suck it up and deal with being in a semi-private room. Don't get me wrong, I am a strong advocate that ALL rooms should be private - however, I don't get to make the decisions. I, for one, would be the one insisting on a private room if I ever have to be hospitalized. So don't feel bad if that's what you want also. :) Just make it known sooner than later.

1 comment:

cah601 said...

Congrats on your 2nd job Jen.   Let me know how it goes.  Carole