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 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 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 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 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!


Pamela said...

I remember those days. I just laugh when I read your entry. Thank God for nurses like you who have the stamina to still do that kind of work.

Amanda said...

But wait Jen....she had 5 kids in 6 years!!! Patients are insane

Julie said...

I love the doctors putting in their orders, bad thing, 4 in the morning they will decide to order a test that requires the patient to be NPO since mid. And they don't call us and tell us they put in new orders because in perfect world you have time to check every 15 minutes for new orders instead of every 2 hours. Still, at least I can read them.