Thursday, February 19, 2009

Wow, whoa, what?????

Ahhh, it's a lovely Thursday afternoon....meaning it's pouring down rain & I couldn't be enjoying it anymore than I already am...unless I decide to go outside & dance in it. Which I won't. Because I really don't feel like it...mostly because it's raining too dang hard & I imagine it's probably cold out there. Why do I enjoy it so much - because it justifies me staying home, indoors, doing nothing. It's a mind thing.

It was a busy week at work, but still a good week. I cannot say enough how much I enjoy my co-workers. They are more than co-workers, they are friends & they are reliable & dependable & helpful & most of all...funny. With all the twists & turns we are forced to withstand at work, I know that for at least part of the 12 hr shift, I'll be smiling.

My patients were fact, I don't think I had to call a doctor once this week. Those are always nice weeks. I did talk to a cardiologist as he was rounding & I noticed he doubled one of my patient's Coreg doses. I said "His systolic BP is right around 100, do I still give this med?" He replied "Do you want him to have sudden death?", not during my shift anyways. He replied "Then give the medication." Ok, no argument there. This patient I am speaking of was a little strange. I kept referring to him as the serial killer.....NOT because he was one, he just had that look about him. Like if I saw his pic on tv saying he just killed 10 people, I wouldn't be thinking "wow, he doesn't look like the type." Don't try to understand my mind, it goes off in various directions. Anyone warped like me will understand what I'm saying, so I won't explain it any further. Of course when I mentioned this to one of my co-workers...she was worried that he was a serial killer. She obviously doesn't have the warped mind set that I have.

I had an older man....91 to be exact. He was a sweetheart, but he also had a very stubborn side. Luckily, I didn't have to deal with the stubborn side as it only seemed to show itself during the days. That is most's usually when the sun goes down that we get new personalities in some of our patients. He had a lot of things wrong with him....aortic stenosis, kidneys were shutting down, very distended abdomen...but he was refusing all treatment to remedy those situations. He'd keep repeating "I'll be 92 next month, why do I want them to start cutting me open now?" I understood, but it still made me a little sad to think that his body was beginning to fail him. He was a sweetheart. It made me want to go the extra mile for him.

Every once in awhile I get a patient like that...where the rapport is really good. Not that I get attached....I don't get attached to any of my patients - at least not yet. I am able to keep from crossing that line, but it doesn't mean I don't care about my patients deeply. I do...but if I let their situations get to me, I'd be crying all the time & falling apart myself. Somehow not crossing the line is not a struggle for me. I think it would be different if I were working with kids.......I don't like seeing kids or animals suffering. Therefore I stay away from pediatrics and ER's...where the kids in pain are. That's what I do...I avoid the line.

I had another patient who was in with respiratory failure. After having her for 2 nights, I can see exactly why she goes into respiratory failure. She is very confused & she removes her oxygen every chance she gets....then has trouble breathing. She had advance dementia so trying to reason with her did no good. Of course that didn't stop me from trying, but it did no good. She would take the oxygen off, I'd put it back on, she's ask "What's that for?" I'd reply "So you can breathe." She'd say "I don't want that, I don't want to breathe. You take it." Over & over & over...that's how the conversation went. She would keep yelling out for help. I would ask "What do you need help with?" She'd reply "I don't know." So I'd tell her "You need to get some rest, get some sleep." She'd reply "I don't know how, show me how to sleep." Huh??? She was pleasantly confused, obviously living in her own little world. It's kinda scary because it makes me wonder if I'll end up like that one day. I mean it feels like my memory is already going & I'm not even 40 yet or have kids to blame it on. Scary.

Wednesday morning was the busiest. Our computers were down for 5 hours...which meant we had some time to chat with one another. Then we had fire school at 6, since our clinical leader agreed to watch our patients. We were told fire school only lasted about 20 minutes. 6:25, our fire instructor was only on the letter A in the acronym RACE. What happened to the 20 min only class? We ended up leaving because we had to chart & get ready for shift change. We manage to do that & I'm told I need to transfer one of my patients downstairs because we don't have enough nurses during the day shift up here. I have to transfer someone at shift change? What?

I call report to the other floor...the nurse is not happy, but I tell her neither am I. Then I get two ICU nurses to take my other patients..........they were floated over to my unit. All they seemed focused on was complaining that they had 5 patients as opposed to their usual 2. Welcome to my world! Then as all that is going on, another patient had a seizure. It wasn't my patient, but I called a rapid response as this was an obvious change in condition. Our clinical leaders get there after the seizure was over & say "Oh, looks like she's ok now, you don't need us" & they walk out. This is all at the change of shift.

Grrrr...that sorta annoys me. It's change of shift plus we have a staff meeting in 30 min. I think the clinical leaders should have jumped in, gotten that patient downstairs for her stat CT & left us to finish our shift & get out of there. But apparently that only happens in the movies (ha!) or in my dreams. So before I help take this patient down so this patient's nurse can call doctors to get this patient what she needs....I do put a call into the clinical leaders & tell them we need help. I told them my patient that had to be transferred was still here & they would have to take care of it. They agreed & said they would.

So me & another nurse take this seizure patient to the CT dept & there is only one person there. She says "The rest of the dept is in a meeting." Ummm, great. So we help her get the patient onto the CT scan equipment & we are ready to get out of there & to our staff meeting. The CT tech says "This will only take a couple of minutes." Ummm...I have been a nurse long enough to know that a couple of minutes in hospital time means at the very least...15 minutes. So I tell her we are nightshift, that she will have to call the floor & have the dayshift staff come get the patient when she is done. Mind you...if I didn't have a staff meeting to get to...I would have stayed as long as it took. But this was a staff meeting I did not want to'll know why later.

So the other nurse & I run up to the room where the staff meeting is to be held. The reason I didn't want to miss it was because we got the announcement that our manager/director (whatever she is) was resigning and our new director introduced herself. This is the 5th director I've met in the 5 years I've been at this hospital. Needless to say...I'm thinking it must be a pretty stressful position. I'm not sure what I think of her just yet. She is very direct, not exactly my style...but time will tell.

With this comes multiple managers, new director, new administration......same old staff who I am hoping will come thru it ok. We have been thru so many different things & somehow we still seem to have great teamwork - that just seems to come naturally.

On top of all that...I got my yearly evaluation & a raise. I am grateful that I have a job & got a raise....even if it was lower because administration claims we don't have the money for higher raises (even though they got $40,000 bonuses...grrr). My goal for next year is not to call in so much....eek, didn't realize I called in 7 times in the last year. I think I can meet that goal. We also had to fill out a "criminal record" this really necessary? And somehow they include speeding tickets as having a criminal record. Huh???? I said a speeding ticket is neither a felony or a misdemeanor. They replied "Well then, what is it?" Ummm...a driving infraction. Ridiculous....although I am in agreement that they should be doing yearly criminal background checks...but I don't think a speeding ticket or an expired tag ticket should be considered a criminal offense. Now that I'm thinking...I probably shouldn't even wrote speeding ticket as it was simply a "failure to obey traffic device" that really a criminal offense? Should I be on America's Most Wanted?

They also had a list of questions to ask...because as administration put it...we feel the best way to make this a better workplace is to start at the bottom up rather from the top down. nursing considered the bottom of the chain of command in a hospital? That's pretty sad as it seems we do the most work around there & keep them out of a zillion lawsuits. They are supposed to come around once a month & ask us how we are doing & are we surviving the economic changes, etc. I bet this lasts 2 months.....3 months top.

That was my wonderful week at work. Last night I went to see "He's just not that into you" with my best friend Maria. It was a good movie....except it had a girly ending, which I know is not how the real book is. Oh well.....gotta give a chick flick a chick flick ending I suppose. I liked the actors/actresses that were in was pretty good....typical chick flick so how can I complain?


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