Tuesday, November 25, 2008

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!!!!!!!

Sunday, November 16, 2008

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.

Saturday, November 15, 2008

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.........

Tuesday, November 11, 2008

Update on Shay

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

Saturday, November 8, 2008

Cutest little puppies!

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


Christian the Lion

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


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!

Wednesday, November 5, 2008

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!