Let me start by saying...Sunday & Monday night at work was pleasant....maybe even enjoyable. It's hard to recall specifics...but I remember not being stressed one bit & I was able to finish up the 3rd book of the Twilight series.
That all changed on Tuesday night. You see...Tuesday night was our night that the computers would be down for an upgrade. This was not sudden news......we've known about it for at least a month. Silly for me to go in expecting things to be organized...or at least moderately prepared. Ha! I must have still been sleeping because it was totally a dream to think the administration would prepare us for a downtime scheduled for 10 hours. We all knew it would be longer than 10 hours, but for some reason, that was what they told us. We've learned in the past not to believe anything they say when it comes to downtime.
I don't know who the wise person was that decided downtime should begin at shift change...but whoever they are...they obviously never worked a day on the floor. I strolled in later than usual.....7 pm. The same time the computers would be down. I already knew it would be of no advantage to start earlier, but I was hoping that we'd at least have our downtime packets ready & waiting as well as our MAR's (medications sheets for each patient). Ha! Once again, I must have been off in fantasyland. Nothing was ready. Nothing was prepared. No one knew what we were supposed to do. We had no way of redlining any of the orders of the day because the computers were down at shift change. And to top it all off......we get this pleasant email saying something like "We are off to a smooth downtime process this evening. Everything went exactly as planned." Huh?????? What kind of drugs is the person that wrote that email on? I highly doubt their plan was to leave the nightstaff hanging as everyone from days rushed out of the building to avoid the chaos & the complaints of nightstaff.....BUT if that was the plan, then it did go off smoothly.
I started the night with all new patients. I had been there the past 2 nights...why I didn't get my same patients back...who knows? The other nurse had already started report & I wasn't going to steal them back for her. So I get report on my new patients from an ICU nurse. Now I am not knocking ICU nurses at all....I think a majority of them know what they are talking about & are far more experienced than me when it comes to patient's conditions. However, when you double the amount of patients they are used to taking care of.....they seem to fall apart. I expected the report to be thorough & complete.......instead I got like 2 facts on each patient & that was about it. Not to mention, we also had a direct admit.
I'm beginning to think direct admits should not even be allowed. Why? Because they are usually very sick - hence the reason the doctor is sending them directly to the hospital to be admitted.....but they are coming directly to the floor with no work-up from the ER. They are being thrown into the mix of an already chaotic floor with absolutely nothing known about them other than the doctor thinks they are so sick that they need to be in the hospital with a heart monitor. I don't like not knowing what their labs are or if they need tests done or medications, etc. They usually need all 3 stat. Only when they arrive to a floor out of the blue, stat is more like slow motion. It causes anxiety for everyone involved & when you already have 4 other patients....throwing another one in that has extremely high needs at the moment is very stressful & frustrating.
My direct admit was neutropenic & having abdominal pain. The doctor wanted her to have a CT of the abdomen...so she had to drink oral contrast. While this potion smells somewhat good (fruity), by the reaction on her face....it didn't taste nearly as good as it smelled. She immediately began dry heaving. So I call the doctor & he says "If she can't drink it, put in an NG tube & get the contrast into her." I'm not crazy about NG tubes...especially on people that are alert & oriented...but I share this news with her & suddenly she is able to drink the contrast. She got most of one bottle down, but gave up on the second bottle. I chatted with the CT scan tech & she said we can wait a few hours & have her drink the second bottle & it should be fine. So I tell her she has a 5 hr reprieve until the drinking will begin again.
It's about this time that I begin wondering what her lab results are...because as I mentioned before....our computers are down & we have no access to any results. So my clinical leader calls the lab dept & they also state they have no access to any results. Hmmm...this doesn't sound right. They hemmed & hawed (are those words?) & eventually got me the results. Her platelet level was 13. As the doctor replied to me when I told him the news..."Not good." Uhhh, yeah, more like critical. Her white blood cell count was 0.4. She had just been thru a round of chemo a few days earlier & that is why she was doing as poorly as she was. Her Magnesium level was low too. I manage to transfuse some platelets, supplement her with Mag, admit 2 more patients & while I was still breathing - I was sooooooooooooo frustrated.
On all the nights that we could have used an admitting nurse...did we have one that night? No. It makes no sense to me whatsoever. The only good thing about that night is that it went by quickly. I kept meeting up with another nurse & we had like 1 minute venting sessions with one another....just to make each other smile, because I seriously could have beat someone up that night.....that's how frustrated I was by how administration left us hanging with the downtime. I am usually a very easy going, calm person......but that night really stressed me out. To top it off...my relief nurse the next morning showed up TWENTY-FIVE MINUTES late!!!!!!!!
I had to keep reminding myself to take deep breaths & think pleasant thoughts. The only good thing about the downtime...it still was not up at shift change, so I was not redlining a single thing. In fact, I didn't care whether the orders were even correct on the chart. I didn't have the time to care about that stuff. While I hate dumping anything onto the next nurse, they left us in that position & frustrated me also. And on top of that....I saw another email went out saying how everything ran perfect, we had no problems whatsoever. Ughhhhhhhhhhh....I wanted to reply "You are a liar, it was miserable...ask anyone that worked that night." But I figured it was better to stay silent so I could keep my job.
Ok, I'm done venting. If the above makes no sense to anyone...I apologize. I went out last night with my friends.....who happened to also be my best friends in high school. I love getting together with them....partly because they make me laugh & partly because it takes me back about 25 yrs to when we would hang out all the time while in high school. I lucked out in the friend category...that's for sure.
After dinner my friend Maria (hi Maria!) & I went to see Underworld: Rise of the Lycans. I blame it on Twilight for wanting me to see another vampire movie.....it was brutal. And I didn't know it was part 3 of some Underworld series. While it was not boring, it left me wondering what it all meant at the end. There is no way I'm watching the first 2 in order to understand this one. I'll go back to only seeing chick flicks that don't require much thought at all.
Speaking of Twilight...I'm finally starting the 4th book. I still have yet to understand the desire of this series. While I liked the movie, I just don't understand how anyone can read all 4 books in like 4 days...or even 4 weeks. I will finish the book though...since I've come this far. Only something like 750 more pages to go....woo hoo. Hopefully I'll be done by spring.
Want to hear something funny? I have a nephew that is turning 10 in February. As a gift, his mother decided she will let her boyfriend take him snowboarding in North Carolina for a couple of days. When I picked him up the other day...he said "My mom says you can buy me a snowboard for my trip. It will cost $200." He was dead serious. Who in the world does she think she is? And she implied to him that if I don't do it....that I must not love him enough. Ugh! Luckily he is smart enough to realize that buying him things or not buying him things has nothing to do with the love I have for him. I also explained to him that I don't ask her to pay for things when I take him on trips, so she should not be expecting/demanding I pay for things when he goes on trips with them. She really annoys me...but that's another story all in itself & something I'm not going to go into.
Hope everyone has a good weekend.....stay warm.....stay safe & enjoy the Superbowl!!!!!!! Go Cardinals (I always have to pick the team with the warmest weather...it's the law...lol).
Friday, January 30, 2009
Thursday, January 22, 2009
Another Year Down
Wow, another year has gone by. I've been a nurse now for 4 entire years. This may be the longest I've stayed not only in one field, but with the same company. So much for starting where you don't want to stay. I am still very content with where I am...my co-workers still feel like family. There is so much teamwork that seems to come without any effort.
Like for instance, the other night I got a patient with cellulitis of the lower extremities. From the moment she got into her room, my other 3 co-workers were in there helping...from making her comfortable in bed, to getting vital signs, to not only getting the digital camera to take pictures of the cellulitis, but also cleaning her up since the ER doesn't always seem to make personal cleansing a priority. What would have taken me well over an hour to accomplish, we had it all done within 20 min. Add to that an admitting nurse who had already done the admitting process in the ER....this patient was well on her way to dreamland within 30 min of reaching my floor. I really need to take the time to fill out a share card.
The week started out slow...I went in Sunday night & saw that they had floated me to ICU to be the secretary/PCT. I don't like being a PCT in ICU. The nurses tend to float their work over to you...since you're a nurse too. "Can you give this med? Can you bathe my patient? Can you change their sheets?" I don't feel comfortable in ICU....and the last thing I want to do is move someone around that's on a vent or is unstable. I prefer my little cocoon of PCU work where I am familiar with my surroundings & the majority of the patients are stable. So around 7:30 pm I offered to be sent home. They told me no, that they had to look at who was there & figure it out later. Around 9:30 they gave me the option to leave & I took it. Granted, it probably would have been an easy night...but those nights tend to go by veryyyyy slowly.
The hospital was practically empty when I left....very few PCU patients & really no one in the ER. I figured it would remain that way the rest of the week, so the next day I called in & volunteered to be called off. I was told that wasn't happening. So much for a slow week. PCU was filling up & the ER was packed. It was the same Tues night also.
That's good though...I want it to be busy...I could use the money. I want to pay off my credit cards. Seems endless though. Everything I make goes right back out. Plus they've taken away our overtime bonuses....but made sure to point out that they will still pay us time & a half for overtime....as if they are doing us a favor. Helloooo, it's the law. And our 3-5% annual raises have been dropped to 1-2% since we have a new Chief Financial Officer. Ugh, I'd like to see him spend one shift on the floor, but that will never happen. I am grateful I still have a job though. I know many people are dealing with situations far worse than my own. So I'll stop complaining.....for a little while anyways.
I'm off now until Sunday night. I need to do some cleaning, but I'm so tired & it's so cold...for Florida. I think it was in the 20's last night. I like it cold, but that's a little too cold for me. I plan to open the windows though...get some cold fresh air in this house. Maybe it will reenergize me. I'll wait until after my shower to do that. :)
Have a good week everyone!!!
Like for instance, the other night I got a patient with cellulitis of the lower extremities. From the moment she got into her room, my other 3 co-workers were in there helping...from making her comfortable in bed, to getting vital signs, to not only getting the digital camera to take pictures of the cellulitis, but also cleaning her up since the ER doesn't always seem to make personal cleansing a priority. What would have taken me well over an hour to accomplish, we had it all done within 20 min. Add to that an admitting nurse who had already done the admitting process in the ER....this patient was well on her way to dreamland within 30 min of reaching my floor. I really need to take the time to fill out a share card.
The week started out slow...I went in Sunday night & saw that they had floated me to ICU to be the secretary/PCT. I don't like being a PCT in ICU. The nurses tend to float their work over to you...since you're a nurse too. "Can you give this med? Can you bathe my patient? Can you change their sheets?" I don't feel comfortable in ICU....and the last thing I want to do is move someone around that's on a vent or is unstable. I prefer my little cocoon of PCU work where I am familiar with my surroundings & the majority of the patients are stable. So around 7:30 pm I offered to be sent home. They told me no, that they had to look at who was there & figure it out later. Around 9:30 they gave me the option to leave & I took it. Granted, it probably would have been an easy night...but those nights tend to go by veryyyyy slowly.
The hospital was practically empty when I left....very few PCU patients & really no one in the ER. I figured it would remain that way the rest of the week, so the next day I called in & volunteered to be called off. I was told that wasn't happening. So much for a slow week. PCU was filling up & the ER was packed. It was the same Tues night also.
That's good though...I want it to be busy...I could use the money. I want to pay off my credit cards. Seems endless though. Everything I make goes right back out. Plus they've taken away our overtime bonuses....but made sure to point out that they will still pay us time & a half for overtime....as if they are doing us a favor. Helloooo, it's the law. And our 3-5% annual raises have been dropped to 1-2% since we have a new Chief Financial Officer. Ugh, I'd like to see him spend one shift on the floor, but that will never happen. I am grateful I still have a job though. I know many people are dealing with situations far worse than my own. So I'll stop complaining.....for a little while anyways.
I'm off now until Sunday night. I need to do some cleaning, but I'm so tired & it's so cold...for Florida. I think it was in the 20's last night. I like it cold, but that's a little too cold for me. I plan to open the windows though...get some cold fresh air in this house. Maybe it will reenergize me. I'll wait until after my shower to do that. :)
Have a good week everyone!!!
Thursday, January 15, 2009
3 Second Pauses
Brrrrrrr....it's cold here in Florida....we're talking in the 30's...brrrr. I want my 70 something degree weather back!
Work was ok this week. We are trying something new at our hospital = admission nurse. I am loving this idea because it helps us floor nurses tremendously. I will be sad when they take this idea away, because they always take the good ideas away. For now though, I will enjoy it!
Last night was my somewhat stressful night. I am getting back into the swing of things and while it has been hectic at shift change and for about 4 to 5 hours after shift change, I find that I am not feeling overwhelmed anymore. You just do what needs to be done & try not to stress about it because it really won't do anyone good if you're stressed out. That's my attitude anyways.
Last night I had a good reason to be stressed though. One of my patients had a heart rate that would climb up & sustain at 145 to 150, then suddenly drop to 35....and repeat over & over. So I call the cardiologist who happens to be the chief of staff too. Amazingly, he calls me back within 5 minutes (record time for him). He gives me an order for Lopressor & that's it. Doesn't ask if she's symptomatic or even what her blood pressure is....just "give her Lopressor...". So I give the Lopressor and about 30 min later she starts having 2 to 3 second pauses about every 30 to 90 seconds. Eeeekkkk! Basically her heart is ceasing to beat for 2 to 3 seconds, every minute. We were all watching the heart monitor, just amazed by what we were seeing.
I called my clinical leader to come assess the situation. The patient's blood pressure was good, she was asymptomatic...but still...her heart was stopping & restarting just about every minute. So I call the cardiologist again....wait 15 min, page him again, wait 15 min, page him again......this is his norm = no call back. Ridiculous...did I mention he's also chief of staff at this hospital? Ridiculous! The patient is continuing with her every minute pause, heart rate dropping to 30 & then climbing up to 145 & repeat the pause cycle. After my 3rd attempt to reach the doctor, I make my co-workers swear to me that if I ever end up in this hospital & I am in a coma or unable to make any medical decisions & this doctor happens to be consulted.....pleaseeeeeee make them get someone else. They promised they would take care of that.
I inform my clinical leader that the doc isn't returning any of my pages so we involve the nursing supervisor who promptly gets him on the phone. I explain to him what's been going on...3 second pauses every minute for the last hour....I was fully expecting he'd be sending her to ICU. His reply "Just continue to watch." What????????? Sit here & watch her pause all night? "Yes, nothing else." Ughhhhhhhhh...I repeat the promise my co-workers have made to make sure this doctor is NEVER my doctor & I wrote out what he said as an order..."Continue to monitor pt's HR/pauses." I wasn't going to be the one looking like a moron if this patient coded. I did what I could do. I was a little stressed because I knew this was not a good situation & at the very least, we should probably have an external pacemaker at bedside...but we didn't.
By some miracle (or maybe my repeated prayers), about 15 min after I talked to the doc, her heart stopped pausing & she was back into her normal rhythm & pretty much remained there the rest of the night. I was shocked....yet very relieved.
I'm exhausted today...I got about 2 hours of sleep because I had to pick up my brother's kids from school. I'm ready to take a shower & go to bed now (it's not even 7 pm yet...ahhh). I have an early lunch tomorrow with my mom, sister-in-law & aunt. It should be a good time.
Update on the Twilight saga (mostly for Amanda's benefit...lol). I am currently on the 3rd book & still have yet to become obsessed with this series. Is there something wrong with me? Everyone else I know has read all 4 books in about a week or less...some are even rereading it (that I cannot imagine myself ever doing). I did see the movie twice & I will admit...I couldn't really stand Edward at first, but he is growing on me....although at the moment I think he's a freakish, obsessed, controlling wuss...lol. I like Alice's character though. And Bella too. I think the actor that played James is hottttttt even though my niece calls me a trader for liking James. :)
Come on....hot or not??? He didn't exactly look like this in the movie, but still....very hot!
Ok, time to shower, watch AI, maybeee read a little more & then catch up on some sleep. Take care!
Thursday, January 8, 2009
"5 kids in 6 years..."
If I heard that once, I heard it 10 times from my new admit. I'll get to that later though.
First things first...the baseball player I wrote about earlier...he's doing better. He's out of ICU, his memory is coming back to him and he's starting rehab to gain back his strength. Hopefully he'll be able to come back & be able to play baseball.
Work has been kicking my butt. I've worked 5 shifts since Dec 31, and 4 of them have kept me super busy. The last busy shift was this past Monday night...
I get to work & no one is ready to give me report. So I start looking stuff up on my own. Then one nurse starts giving me report saying "This patient can go home." Ummm...ok, why couldn't he have gone home before you started to give me report? She informs me that his wife is a patient in the hospital also & she doesn't think he can go home alone...but good luck to me in figuring it all out. Huh? Case management was also involved, thank goodness, but not before the patient's son (who is a dr. up north) called me & basically asked me 1,000 questions of which I knew 0 answers because I was barely out of report. His questions were legit & it was nice to see a doctor with some common sense. I assured him I would not be sending his father home that night. I called the primary doctor & told him the family's concerns. His reply "I don't care what they want, I'm not changing my discharge orders. As far as I'm concerned, he's discharged. If you have to keep him to arrange a skilled nursing facility placement, then that's fine...but it's not my fault he's staying another night." I could understand his take on it because the insurance companies are cracking down as well as the hospital for keeping anyone in the hospital that no longer needs hospital care. However, how do you send an elderly man home all alone? Case management tells me they would arrange placement in the morning. I had a feeling that would get cancelled in the morning, but at that point - my part was done.
My second patient was quite forgetful. The gist of our conversations went like this: Patient..."can I have something to eat?" Me..."No, you have a test in the morning, you can't have anything to eat or drink until after the test." Patient..."What time is the test?" Me..."I don't know, sometime in the morning." He rang his call light on a hourly basis & that is pretty much all we said to each other from about midnight on.
My third patient was a sweet lady, but also downgraded to the med/surg floor. I quickly transferred her as I heard I was getting an admission. Turns out that admission needed open heart surgery and they were trying to transfer her to another hospital. They were unable to, so she ended up in ICU awaiting a transfer. Whew...glad she didn't come my way.
Instead I got a direct admission. I don't like direct admits. There is just so much that needs to be done for them...like IV's, labs, x-rays, etc. She was supposed to be a direct admission to the ICU per her doctor, but our hospital apparently doesn't allow direct admits to the ICU. I wish they'd rethink this policy because she certainly belonged in ICU. By the time I got her settled into bed and labs drawn....it turned out her hemoglobin was 6.3, blood sugar 36...critical values. She was pale...kinda looking like shady gray color...not good. We had an admission nurse that night...luckily, so while she was asking the patient all the admission questions....I was trying to interpret the doctor's orders.
The one I had a bit of a problem with was "Consult surgery to determine source of bleed." I couldn't understand why he would look to surgery instead of gastrointestinal as it was a rectal bleed. Sooooo when the surgeon calls & asks what's the story on this admission...I say "The doctor would like you to find the source of the bleed." He laughs at me! He's as baffled as I am as to this order. He proceeds to tell me he isn't a magic man nor does he have super powers and to let the other doctor know this. I call the admitting doctor with the patient's critical lab values and I let him know the surgeon did not think he could find the source of the bleed. I left out the part of magic man and super powers.
The admitting doctor tells me to tell the surgeon to use his imagination to figure out where the bleed is & ask him if he can go in laparscopically & look for something spongy. What???? I had enough of being the middle man. It's not my job! They can talk to one another, right??? I get an order for 4 units of blood, but spread them out so the patient doesn't get fluid overload. And he says to me "6.3 isn't bad, last time she was 5.2." As if that's supposed to make me feel better. By now I have invested 2 hours into just caring for her. I hadn't been able to medicate my other 2 patients. I went to my clinical leader & told her this patient belongs in ICU. It wasn't so much that she wasn't stable...although she wasn't with her lab values, but she obviously needed closer monitoring & I am unable to do that in progressive care. I did ask her how long she had been bleeding. Her reply..."30 years." What???
Turns out she has this chronic bleed & she is non-compliant in getting the tests she needs to have done to stop the bleed. It irritates me when people are non-compliant...especially with something like that. I see it most often in dialysis patients...they think they can skip dialysis...but you can't. Anyways, transferred her to ICU and prepared myself for another patient.
I got an ICU transfer. She was a wacky one. Only 53 yrs old, but a DNR because she has inoperable cancer. I don't know what kind of meds they had given her, but she was off the wall when she got to our floor. At least she was pleasant.
I got one more admission around 4 in the morning. She was my patient who had a story about everything. The main one being "I had 5 kids in 6 yearsssssssss." It basically went like this:
Me: Let's go over your health history. Do you have any type of cardiac history?
Patient: I had 5 kids in 6 years.
Me: Ummm, ok. Let's move on. Do you drink anything with caffeine in it?
Patient: Some tea in the morning. Did I tell you I had 5 kids in 6 years?
Me: Do you want our chaplain to visit you?
Patient: Sure, why not. I had 5 kids in 6 years.
Do you get what I'm saying? If she wasn't talking about the kids, she was relating some type of story to whatever I was saying. Such as I asked her if she drinks any alcholic beverages. She said "No, in fact, when someone would give us alcohol as a gift, I'd sell it to my next door neighbor because she liked to drink before going to bed." Ummmm...ok. A little too much info.
If she wasn't talking, she was coughing & clearing her throat & spitting in tissue. It wasn't pretty. Did I mention we put her in the room with my patient that was off the wall? What a combination. That patient was jumping around on her side of the room in response to the new admission coughing repeatedly. I just had to laugh to myself & be glad that they were pleasantly anxious rather than angry or mean.
I had tons of charting to do that night & was a bit stressed. I don't like staying late at work...especially when I have to work the next night. So I focused on getting the charting done. I was so tired by the time I left...I went straight to bed & slept for 8 straight hours.
Tuesday night I somehow got floated & I did not argue one bit. I didn't want those patients back. I was due for a good night & I got it. We had a meeting Wednesday morning - it was to show us how they are tweaking our computer system and how in 2010 the doctors are supposed to be putting in their own orders. I cannot wait to see this happen. I am so looking forward to it, although I will miss the "try to figure out what the doctor wrote" game or "guess which doc wrote this order because all you see is a scribble mark for a signature." It must be JCAHO making this a future requirement...so that the patient gets ordered exactly what the doctor wants. No more middle person trying to interpret what the doctors write. I love it! 2010 sounds far away, but it will be here before we know it. No more redlining, no more doctors complaining something wasn't ordered right...how nice will that be???
It's hard to believe I'm starting my 5th year in nursing & I'm still at the hospital I started at. I don't think I've worked anywhere for 5 yrs straight. I'm watching the college championship game...Gooooo GATORSSSSS!
First things first...the baseball player I wrote about earlier...he's doing better. He's out of ICU, his memory is coming back to him and he's starting rehab to gain back his strength. Hopefully he'll be able to come back & be able to play baseball.
Work has been kicking my butt. I've worked 5 shifts since Dec 31, and 4 of them have kept me super busy. The last busy shift was this past Monday night...
I get to work & no one is ready to give me report. So I start looking stuff up on my own. Then one nurse starts giving me report saying "This patient can go home." Ummm...ok, why couldn't he have gone home before you started to give me report? She informs me that his wife is a patient in the hospital also & she doesn't think he can go home alone...but good luck to me in figuring it all out. Huh? Case management was also involved, thank goodness, but not before the patient's son (who is a dr. up north) called me & basically asked me 1,000 questions of which I knew 0 answers because I was barely out of report. His questions were legit & it was nice to see a doctor with some common sense. I assured him I would not be sending his father home that night. I called the primary doctor & told him the family's concerns. His reply "I don't care what they want, I'm not changing my discharge orders. As far as I'm concerned, he's discharged. If you have to keep him to arrange a skilled nursing facility placement, then that's fine...but it's not my fault he's staying another night." I could understand his take on it because the insurance companies are cracking down as well as the hospital for keeping anyone in the hospital that no longer needs hospital care. However, how do you send an elderly man home all alone? Case management tells me they would arrange placement in the morning. I had a feeling that would get cancelled in the morning, but at that point - my part was done.
My second patient was quite forgetful. The gist of our conversations went like this: Patient..."can I have something to eat?" Me..."No, you have a test in the morning, you can't have anything to eat or drink until after the test." Patient..."What time is the test?" Me..."I don't know, sometime in the morning." He rang his call light on a hourly basis & that is pretty much all we said to each other from about midnight on.
My third patient was a sweet lady, but also downgraded to the med/surg floor. I quickly transferred her as I heard I was getting an admission. Turns out that admission needed open heart surgery and they were trying to transfer her to another hospital. They were unable to, so she ended up in ICU awaiting a transfer. Whew...glad she didn't come my way.
Instead I got a direct admission. I don't like direct admits. There is just so much that needs to be done for them...like IV's, labs, x-rays, etc. She was supposed to be a direct admission to the ICU per her doctor, but our hospital apparently doesn't allow direct admits to the ICU. I wish they'd rethink this policy because she certainly belonged in ICU. By the time I got her settled into bed and labs drawn....it turned out her hemoglobin was 6.3, blood sugar 36...critical values. She was pale...kinda looking like shady gray color...not good. We had an admission nurse that night...luckily, so while she was asking the patient all the admission questions....I was trying to interpret the doctor's orders.
The one I had a bit of a problem with was "Consult surgery to determine source of bleed." I couldn't understand why he would look to surgery instead of gastrointestinal as it was a rectal bleed. Sooooo when the surgeon calls & asks what's the story on this admission...I say "The doctor would like you to find the source of the bleed." He laughs at me! He's as baffled as I am as to this order. He proceeds to tell me he isn't a magic man nor does he have super powers and to let the other doctor know this. I call the admitting doctor with the patient's critical lab values and I let him know the surgeon did not think he could find the source of the bleed. I left out the part of magic man and super powers.
The admitting doctor tells me to tell the surgeon to use his imagination to figure out where the bleed is & ask him if he can go in laparscopically & look for something spongy. What???? I had enough of being the middle man. It's not my job! They can talk to one another, right??? I get an order for 4 units of blood, but spread them out so the patient doesn't get fluid overload. And he says to me "6.3 isn't bad, last time she was 5.2." As if that's supposed to make me feel better. By now I have invested 2 hours into just caring for her. I hadn't been able to medicate my other 2 patients. I went to my clinical leader & told her this patient belongs in ICU. It wasn't so much that she wasn't stable...although she wasn't with her lab values, but she obviously needed closer monitoring & I am unable to do that in progressive care. I did ask her how long she had been bleeding. Her reply..."30 years." What???
Turns out she has this chronic bleed & she is non-compliant in getting the tests she needs to have done to stop the bleed. It irritates me when people are non-compliant...especially with something like that. I see it most often in dialysis patients...they think they can skip dialysis...but you can't. Anyways, transferred her to ICU and prepared myself for another patient.
I got an ICU transfer. She was a wacky one. Only 53 yrs old, but a DNR because she has inoperable cancer. I don't know what kind of meds they had given her, but she was off the wall when she got to our floor. At least she was pleasant.
I got one more admission around 4 in the morning. She was my patient who had a story about everything. The main one being "I had 5 kids in 6 yearsssssssss." It basically went like this:
Me: Let's go over your health history. Do you have any type of cardiac history?
Patient: I had 5 kids in 6 years.
Me: Ummm, ok. Let's move on. Do you drink anything with caffeine in it?
Patient: Some tea in the morning. Did I tell you I had 5 kids in 6 years?
Me: Do you want our chaplain to visit you?
Patient: Sure, why not. I had 5 kids in 6 years.
Do you get what I'm saying? If she wasn't talking about the kids, she was relating some type of story to whatever I was saying. Such as I asked her if she drinks any alcholic beverages. She said "No, in fact, when someone would give us alcohol as a gift, I'd sell it to my next door neighbor because she liked to drink before going to bed." Ummmm...ok. A little too much info.
If she wasn't talking, she was coughing & clearing her throat & spitting in tissue. It wasn't pretty. Did I mention we put her in the room with my patient that was off the wall? What a combination. That patient was jumping around on her side of the room in response to the new admission coughing repeatedly. I just had to laugh to myself & be glad that they were pleasantly anxious rather than angry or mean.
I had tons of charting to do that night & was a bit stressed. I don't like staying late at work...especially when I have to work the next night. So I focused on getting the charting done. I was so tired by the time I left...I went straight to bed & slept for 8 straight hours.
Tuesday night I somehow got floated & I did not argue one bit. I didn't want those patients back. I was due for a good night & I got it. We had a meeting Wednesday morning - it was to show us how they are tweaking our computer system and how in 2010 the doctors are supposed to be putting in their own orders. I cannot wait to see this happen. I am so looking forward to it, although I will miss the "try to figure out what the doctor wrote" game or "guess which doc wrote this order because all you see is a scribble mark for a signature." It must be JCAHO making this a future requirement...so that the patient gets ordered exactly what the doctor wants. No more middle person trying to interpret what the doctors write. I love it! 2010 sounds far away, but it will be here before we know it. No more redlining, no more doctors complaining something wasn't ordered right...how nice will that be???
It's hard to believe I'm starting my 5th year in nursing & I'm still at the hospital I started at. I don't think I've worked anywhere for 5 yrs straight. I'm watching the college championship game...Gooooo GATORSSSSS!
Saturday, January 3, 2009
Happy New Year 2009!!!
It's a couple days late....but Happy New Year 2009. I hope everyone had a wonderful time celebrating yet another new year. I love the holiday traditions & the hope that a new year inspires. I haven't set any resolutions or anything like that....because I know they'll just end up broken. Well, at least the things I really should be doing...eating better, exercising, finding positive ways to release stress. It's not to say that I'm not going to work on doing all of that, but I'm not going to add the pressure of making it a resolution.
I worked the 31st and the 1st. Both nights were really busy. The patients seem to be sicker (is that a word) than ever. I don't know if it's the season or they simply delayed treatment to get thru the Christmas holiday. Out of the 5 patients I had Wednesday night, 3 of them needed assistance using the bedside commode. I don't mind doing that, but I was worried about reinjuring my back. It started to give me a little trouble last night, but thankfully....today it feels better than ever.
I had a patient last night that was 100 years old. She had pneumonia and was also having a heart attack - but she didn't even know it. It was mild. Of course I worried about her though when the cardiologist didn't want to do anything for it. I guess her age makes the difference, although she was more alert, oriented and active than all of my other patients. Plus she was very kind and thankful.
I did have a typical change of shift Thursday night with the day nurse trying to stick me with a discharge. She was an agency nurse, but she knows our hospital well enough that she couldn't pretend she didn't know how to do the paperwork. If it was a simple, easy discharge & the majority of the stuff is done...I don't mind taking care of it. However, there are signs which I pick up on quickly when I know the difference between what they are saying & the truth. She was in too much of a hurry to get out of there....which basically meant she hadn't done ANY of the paperwork even though the discharge orders had been written at 9:30 that morning. The only thing that should have been holding that patient up was waiting for the portable oxygen tank to be delivered.
The day nurse had at least 10 hours to go thru the prescriptions and discharge instructions. 10 hours! I look at the stack of prescriptions...we're not talking 3 or 4....there was at least 10-12 prescriptions written...which didn't include what she was already taking at home. So I ask "Have you put all of these medication changes in the computer?" She doesn't answer except to say "I made copies of all the prescriptions for you." As if she had done some huge favor. By this time it was 7:30 pm and I still had to get report on 2 other patients. She says to me "Ok, you're going to handle it right now, right?" Nope. I'm going to continue to get report on the rest of my patients. I told her she can tell the patient I will handle the discharge, but it's probably going to be at least another hour. The patient was already furious it was taking as long as it was & I don't blame her.
So I asked the clinical leader to go over the medications with the day nurse while I continue to get report on my other patients. 20 min go by & now I'm done with report. I look over & they were deeply involved in trying to figure out all of the medications. So much for a quick & easy discharge. I wasn't about to step in & help...because she should have had this stuff done. She only had 3 patients anyways...so absolutely no excuse for not getting the paperwork done. I made myself scarce, visited with my patients & before I knew it...it was 8:30 pm & they were finally done with the paperwork. I can only hope the day nurse will not slack next time someone is discharged. I know she was furious being there because I don't think they get paid extra to stay - since she is agency. Not my problem.
I got a new admit around 10:30 pm. It was a rather sad case. The patient was 60 yrs old and had been getting confused for months I was told. They had her in 4 pt restraints, gave her Ativan, her heart rate was 145 and her blood pressure was 180/63. I talked to the ER nurse about it & she thought it was because she was so agitated. When she got to the floor, it turns out her temp was 101.3. They hadn't taken a temp in the ER since 5 pm. Her blood pressure was a little better, but the heart rate was in the 140's. She had Digoxin PO ordered, but I didn't think I'd be able to get her to take it since she was so agitated. I attempted though...to which she bit down on the straw & didn't let go. So much for that.
I called the doctor & he was half asleep. I told him her vital signs.....mostly focusing on the temperature and heart rate. He replies "Ok, so what are you calling for?" Ummm...something to lower her temp & heart rate. He was totally out of it - which is really scary if you think about it. So I suggested Tylenol for the fever & IV Digoxin until she was able to take medications by mouth again.....to which he replies "Why can't she take medications by mouth right now?" I explain to him that she's very confused, in restraints and very uncooperative. He skips right by that & says nothing. So I suggest a consult with infectious disease since that doctor just happened to be sitting at the nurses station. He asked "What is he doing there?" Ummmm...working. He asks "Why do you think she needs an ID consult?" Because she is very confused, has a temp...could she possibly be septic? She has a UTI also. So he agrees to that & is ready to hang up...I asked again about medication for her heart rate to which he didn't want to do anything about it. He figured when we got the temp down, the heart rate would follow.
The ID doctor wasn't crazy about a new consult at 11:30 pm, but he cheerfully assessed the patient and wrote orders. He restored my faith in doctors for another day. The patient managed to drift off to sleep. The tylenol suppository did bring down the temp and her heart rate while still tachy, was in the low 100's. Much better for me. She was awoken by the lab tech around 6 am and while she was a tad bit more with it, she was still thoroughly confused and yelling out. The husband wants her tested for early alzheimer's. She's so young, I hope they are able to figure out why she is behaving the way she is. Her drug screen was 100% negative.
I had another patient who was to have a hospice consult today. The doctor made me a little mad as he was doing everything in his power to avoid the family. Maybe he's just not a people person, but he asked for a family meeting to be arranged and then he didn't even show up. And this morning he rounded sooooo early that it was pretty obvious he was once again avoiding the family. The patient is in her 90's and doesn't want anymore treatment. She's barely eating, her kidneys are failing, she says she wants to die. The family finally gave in to her wishes, although as of last night we were still pumping her full of different IV fluids. I felt like all those IV fluids were going to put her into heart failure, but who am I to say?
Taking care of her was like taking care of a baby. I tried to get her to take some Tylenol for her back pain. I'd mix it in apple sauce & she'd just end up spitting it back out. This happened over & over until I finally gave up. She was cute though. I think her vocabulary consisted of 4 or 5 sentences...."I'm hungry, I'm thirsty, I'm cold, no more and I love you."
Between my 90 something year old and the 100 yr old, it got me thinking about how much those 2 have seen in changes over the years. I wish I had more time to sit & chat with my patients to see what life was like back in their day...when they were in their prime. I'm sure they have many interesting stories. All of my grandparents passed away years ago.
On a sad note, one of our older doctors passed away on Christmas Day. His family had called the hospital looking for him because he told them he'd be doing rounds. Turns out they found him at his office slumped over his desk. Apparently it was a heart attack. Sad....and on Christmas Day of all days. RIP Dr. R.
I have to go get some sleep. I work Sat night, off Sun night, work Mon & Tues night, off Wed & Thurs night, work Fri night. Ahhh, such a mess of a schedule. I wasn't supposed to work Fri night, but I'm helping another nurse out.
Have a good weekend everyone!!! Happy New Year!
I worked the 31st and the 1st. Both nights were really busy. The patients seem to be sicker (is that a word) than ever. I don't know if it's the season or they simply delayed treatment to get thru the Christmas holiday. Out of the 5 patients I had Wednesday night, 3 of them needed assistance using the bedside commode. I don't mind doing that, but I was worried about reinjuring my back. It started to give me a little trouble last night, but thankfully....today it feels better than ever.
I had a patient last night that was 100 years old. She had pneumonia and was also having a heart attack - but she didn't even know it. It was mild. Of course I worried about her though when the cardiologist didn't want to do anything for it. I guess her age makes the difference, although she was more alert, oriented and active than all of my other patients. Plus she was very kind and thankful.
I did have a typical change of shift Thursday night with the day nurse trying to stick me with a discharge. She was an agency nurse, but she knows our hospital well enough that she couldn't pretend she didn't know how to do the paperwork. If it was a simple, easy discharge & the majority of the stuff is done...I don't mind taking care of it. However, there are signs which I pick up on quickly when I know the difference between what they are saying & the truth. She was in too much of a hurry to get out of there....which basically meant she hadn't done ANY of the paperwork even though the discharge orders had been written at 9:30 that morning. The only thing that should have been holding that patient up was waiting for the portable oxygen tank to be delivered.
The day nurse had at least 10 hours to go thru the prescriptions and discharge instructions. 10 hours! I look at the stack of prescriptions...we're not talking 3 or 4....there was at least 10-12 prescriptions written...which didn't include what she was already taking at home. So I ask "Have you put all of these medication changes in the computer?" She doesn't answer except to say "I made copies of all the prescriptions for you." As if she had done some huge favor. By this time it was 7:30 pm and I still had to get report on 2 other patients. She says to me "Ok, you're going to handle it right now, right?" Nope. I'm going to continue to get report on the rest of my patients. I told her she can tell the patient I will handle the discharge, but it's probably going to be at least another hour. The patient was already furious it was taking as long as it was & I don't blame her.
So I asked the clinical leader to go over the medications with the day nurse while I continue to get report on my other patients. 20 min go by & now I'm done with report. I look over & they were deeply involved in trying to figure out all of the medications. So much for a quick & easy discharge. I wasn't about to step in & help...because she should have had this stuff done. She only had 3 patients anyways...so absolutely no excuse for not getting the paperwork done. I made myself scarce, visited with my patients & before I knew it...it was 8:30 pm & they were finally done with the paperwork. I can only hope the day nurse will not slack next time someone is discharged. I know she was furious being there because I don't think they get paid extra to stay - since she is agency. Not my problem.
I got a new admit around 10:30 pm. It was a rather sad case. The patient was 60 yrs old and had been getting confused for months I was told. They had her in 4 pt restraints, gave her Ativan, her heart rate was 145 and her blood pressure was 180/63. I talked to the ER nurse about it & she thought it was because she was so agitated. When she got to the floor, it turns out her temp was 101.3. They hadn't taken a temp in the ER since 5 pm. Her blood pressure was a little better, but the heart rate was in the 140's. She had Digoxin PO ordered, but I didn't think I'd be able to get her to take it since she was so agitated. I attempted though...to which she bit down on the straw & didn't let go. So much for that.
I called the doctor & he was half asleep. I told him her vital signs.....mostly focusing on the temperature and heart rate. He replies "Ok, so what are you calling for?" Ummm...something to lower her temp & heart rate. He was totally out of it - which is really scary if you think about it. So I suggested Tylenol for the fever & IV Digoxin until she was able to take medications by mouth again.....to which he replies "Why can't she take medications by mouth right now?" I explain to him that she's very confused, in restraints and very uncooperative. He skips right by that & says nothing. So I suggest a consult with infectious disease since that doctor just happened to be sitting at the nurses station. He asked "What is he doing there?" Ummmm...working. He asks "Why do you think she needs an ID consult?" Because she is very confused, has a temp...could she possibly be septic? She has a UTI also. So he agrees to that & is ready to hang up...I asked again about medication for her heart rate to which he didn't want to do anything about it. He figured when we got the temp down, the heart rate would follow.
The ID doctor wasn't crazy about a new consult at 11:30 pm, but he cheerfully assessed the patient and wrote orders. He restored my faith in doctors for another day. The patient managed to drift off to sleep. The tylenol suppository did bring down the temp and her heart rate while still tachy, was in the low 100's. Much better for me. She was awoken by the lab tech around 6 am and while she was a tad bit more with it, she was still thoroughly confused and yelling out. The husband wants her tested for early alzheimer's. She's so young, I hope they are able to figure out why she is behaving the way she is. Her drug screen was 100% negative.
I had another patient who was to have a hospice consult today. The doctor made me a little mad as he was doing everything in his power to avoid the family. Maybe he's just not a people person, but he asked for a family meeting to be arranged and then he didn't even show up. And this morning he rounded sooooo early that it was pretty obvious he was once again avoiding the family. The patient is in her 90's and doesn't want anymore treatment. She's barely eating, her kidneys are failing, she says she wants to die. The family finally gave in to her wishes, although as of last night we were still pumping her full of different IV fluids. I felt like all those IV fluids were going to put her into heart failure, but who am I to say?
Taking care of her was like taking care of a baby. I tried to get her to take some Tylenol for her back pain. I'd mix it in apple sauce & she'd just end up spitting it back out. This happened over & over until I finally gave up. She was cute though. I think her vocabulary consisted of 4 or 5 sentences...."I'm hungry, I'm thirsty, I'm cold, no more and I love you."
Between my 90 something year old and the 100 yr old, it got me thinking about how much those 2 have seen in changes over the years. I wish I had more time to sit & chat with my patients to see what life was like back in their day...when they were in their prime. I'm sure they have many interesting stories. All of my grandparents passed away years ago.
On a sad note, one of our older doctors passed away on Christmas Day. His family had called the hospital looking for him because he told them he'd be doing rounds. Turns out they found him at his office slumped over his desk. Apparently it was a heart attack. Sad....and on Christmas Day of all days. RIP Dr. R.
I have to go get some sleep. I work Sat night, off Sun night, work Mon & Tues night, off Wed & Thurs night, work Fri night. Ahhh, such a mess of a schedule. I wasn't supposed to work Fri night, but I'm helping another nurse out.
Have a good weekend everyone!!! Happy New Year!
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