Tuesday, April 28, 2009

The Magic Words

I'm back....wondering why I'm posting a new post so soon? Because I got sent home early from work tonight...due to the census dropping. Swine flu? What swine flu? Nah, it seems our ER was quite packed with people thinking/overreacting about any symptoms they might have, but not many were being admitted tonight for anything.

The night before wasn't that great...I was a patient care tech. Why am I always patient care tech when our floor is full? Never when there's only 8 or 9 patients...noooo, always when there is 15 or 18 patients. And of course there is always one that is incontinent & can barely move that is drinking Golytely...always! I don't think I've changed so many diaper/briefs in my life like I did Sunday night. It's not fun...trust me!

Monday night I got to work & the day nurse immediately says to me...the magic words...."you have two discharges." Which I immediately reply "Nooooo, YOU have two discharges." She should know me by now....I don't put up with slacker nurses that try to push their afternoon discharges off on me at shift change. She tried to tell me that the order was justttttt written. Ok, show me. Ummmm 4:25 in the afternoon is not the same as 7 pm. It's your discharge.

The other one didn't have a time when the discharge order was written, but I know it wasn't 7 pm. Luckily we had a discharge nurse on duty.....of which the day nurse tries to tell me she's tried calling her but can't reach her. Huh? I thought you just got these discharge orders at 7, how could you have already attempted numerous times to reach the discharge nurse?? Uh huh...it's a lot easier to tell the truth than to have to keep lying to cover up the lies...right? I wanted to say that, but I didn't. So I pick up the phone & wow...guess who answers on the first ring...the discharge nurse. So I tell her there are 2 patients to be discharged & she tells me she'll be there as soon as possible. Cool.

Then I find out my second discharge is actually going to a skilled nursing facility. So I ask...has case management arranged this? The reply: "I called case management but they aren't calling me back." Are you kidding me? Case management is probably the easiest group of people to get in touch with because they want to discharge people as quickly as possible. So again, I pick up the phone & amazingly get case management....who arranges the SNF placement so quickly...that I tell the day nurse she may as well just call report over to the SNF herself.

I sound bossy, but I'm really not. I actually make my requests sound more like great suggestions than orders. Usually it works.....the one patient was discharged before we were even done with report. See how nice that works....within 30 minutes of me getting there...the patient was being wheeled out the door. This is the reason day shift stalls....because if they get rid of a patient...they worry they'll get another one right away. I can't blame them for stalling....but if it's 6 pm...you're not going to get another patient...so discharge then instead of piling it onto the night shifts work. That's not asking much, is it?

I had another patient that came in with some unknown strange disease. A small portion of me wonders if it could be the swine flu......fever, dehydration, purpura. They were working him up for Rocky Mountain Spotted Fever, Syphillis and Pneumococcal Meningitis. They had him in a semi-private room with no precautions....even though he had a rash & was itching everywhere. I didn't want to go near him or touch him or even breathe the same air as him. As luck had it...a private room opened up on the other end of the unit, so I quickly transferred him over there. Ugh, now I'm feeling itchy. Just kidding...I think....yeah.

So that left me with one patient. Add in the other 5 or 6 discharges we had at shift change (grrrrr) & one of us had to go home. No one volunteered because we're all scheduled to work again Tuesday night. So the clinical leader looked at the list & said I was next to be called off. Oh well...that's the way it goes sometimes. I ended up going to Wal-Mart for food & then the gas station. Exciting, right? Try to keep up with me.

And now it's 4:38 in the morning & I'm still wide awake. Guess I'll go watch tv & try to fall asleep. Only one more night of work to go for this week...yay! Movie with a guy friend Wednesday night, hanging out with my best friend Thursday night (hi Maria) & then Friday is Shay's birthday.....my puppy dog will be 2 years old already!

Ok, off to go watch Dancing with the Stars...bye everyone!

Saturday, April 25, 2009

Walk 5 Miles??? Why????

Hmmm...how do I even start off this week? No real complaints. Shocked, aren't you? I had a good 3 nights at work. Most of my patients were very nice and easy to take care of. Actually, looking back...I think they were all really good. I don't remember anything out of the ordinary. Just a few calls to the doctors for minor things like blood pressure meds or Tylenol. Nothing earth shattering or critical.

Monday night shift change was a bit hectic. I had one patient being wheeled into her room at 6:35. We are not supposed to have any admissions between 6:30 & 7:30 (shift change), but our ER doesn't usually listen. I give up complaining because nothing ever changes when it comes to that. Then I had a doctor come in & discharge a patient. He tells her she'll be ready to go in 20 minutes. Ugh...I hate when doctors do that. It's not the old days where they write a prescription & send the person on their way. No, no, no....we have to do all this computer stuff and go over every medication they ever had taken when they came in. 20 minute discharge will never happen in my hospital.

Luckily we had a discharge nurse floating around the hospital. So I call her & she says "Well, I have 2 other patients to discharge ahead of you. Can't you do it?" I thought for a second & decided no. She is the "discharge nurse"...that means she handles "discharges." I may have felt differently if this wasn't change of shift & I didn't have a new admission sitting in a room waiting for me. In nursing, it's tough to say no...it's tough to delegate. We are used to being expected to do everything without a second thought. I am learning that I don't need to do it all. That's the reason we have other staff to help us...so we don't feel like we need to do it all. Except this other staff often tries to bounce it right back to us...doctors, patient care techs, other nurses, etc.

So I said no....just come handle this discharge when you're done with the other two. I don't think she was happy, but again...she is the discharge nurse & all she does is handle discharges. It's not so bad. After that patient was finally discharged, I immediately get word that I will have a new admission...again. Ok, whatever, bring it on.

I lucked out though. They didn't bring the patient right away. We had a couple of PCU nurses in the ER handling the overflow of PCU patients waiting for a bed. The nurse that had my patient was kind enough to do the entire admission. Thank you, thank you, thank you! It makes it easier when they get to the floor. You can talk to them, focus on their needs & get them to sleep sooner as opposed to asking them 34290384023 admission questions.

Tuesday I had 5 patients, but I started the night with them & that makes it easier than throwing an admission in the mix. So my week at work ended well & I'm hoping this coming week is just as good. One can dream, can't they?

On a different note...a friend from nursing school called & asked if she could walk with me & my exercise buddy. I said sure. We met up with her & oh boy...did we get a workout. She made us walk FIVE miles....in the Florida heat...at a fast pace. It was brutal. I don't know how I made it back. And I had to work that night! That was on Monday morning. Yesterday my exercise buddy & I decided we would walk it again...only at our own normal pace....and it wasn't bad! In fact, we saw a lot of little bunny rabbits hopping around all over the trail. Too cute! Don't they know Easter is over?

Today marks a month since I started eating better & exercising. I'm proud to say I've lost 17 lbs as a result. I still have a ways to go...but it's a nice start. We're also doing Weight Watchers...which amazingly isn't that hard to do. I have totally cut out the fast food restaurants...which used to be practically the only place I would eat. And I've cut out mostly all candy. It's not to say I won't ever have any...but it's not a daily or even weekly thing anymore. I've started buying the 100 calorie bags of things I like....for portion control. My big weakness is cheese pizza...but I found Pringle Wheat Stix....pizza flavored & it totally takes away the craving for pizza - plus it's only 90 calories!

I went to The Olive Garden today & could only eat half my meal. I was so full...yet shocked. Normally I can eat salad, my meal & dessert without any real problem. Not today - I brought half my food home & skipped dessert. I think what helps the most is staying away from the fast food & the sit-down restaurants, plus walking. Eventually I know I'll need to add more...like weights and different types of exercise, but I'll deal with it then. Now if only I could lose 17 lbs every month.....lol.

Hope everyone is having a great weekend!

Saturday, April 18, 2009

Here kitty kitty...

Work wasn't too bad this week. I did have one patient who claimed he doesn't drink...yet his blood alcohol level was 335....normal is below 10. And he smelled like a brewery. I just went along with it....it's not as though we're doing an intervention. I had heard from the ER nurse that he was agitated & combative...great! When he got to the floor, luckily he had a roommate that he seemed to bond with & they talked for awhile & both went to sleep. By the next night, he was irritated because all we were feeding him was a clear liquid diet. He had elevated liver enzymes & they weren't sure whether it was pancreatitis or not. So they lay off the food & let the organs rest. He wasn't happy though. Then he was NPO (nothing to eat or drink) after midnight. He went walking off down the hall that morning all mad. Luckily I had just given report & was leaving = not my problem anymore.

People like that irritate me though. He was in the hospital because of abdominal pain as a result of his elevated liver enzymes which was a result of drinking too much for a long period of time. Yet he is the first one to yell at us because we aren't treating him the way he would like...meaning food & pain medication. Lay off the booze, buddy & you wouldn't have abdominal pain, nor would you have to be hospitalized. While we're at it...spend your money on food rather than booze & save us all the aggravation you imposed on us.

I had another patient that shouldn't have even been admitted to the hospital. She went to see her primary doctor because she had vomiting & diarrhea for 1 day. Apparently, the communication between her & her doctor was off that day because after she told the doctor her symptoms...the doctor freaked out & told her she had to go to the hospital right now. And then sent her with direct admit orders for a GI bleed. She wasn't bleeding though...at all. Her H&H was perfectly fine. The GI doctor called in after being consulted & said to schedule her for an EGD. The patient didn't want an EGD...she wasn't bleeding! She asked me to call her doctor & tell her so....but that isn't the way it works. I think a doctor would laugh at me if I tried that. I told her she'd have to talk to the doctors the next day when they came in. So she went to sleep & was very easy to care for...considering she had nothing more than a 24 hr virus that seemed to have already cleared up by the time she got to the hospital.

Another nurse had a patient in his 20's that faked a seizure. How do we know it was fake? There were numerous signs....like he was only shaking on one side of his body & it wasn't the typical seizure like shake. His face was so relaxed....he was squinting with his eyes trying to watch our reaction. When we said "Wow, so weird to only be seizing on one side of his body"...suddenly his other side started shaking. He was wanting Oxycontin. He had a bottle from a fake pharmacy & the doctor would not give him any at the hospital. It is ridiculous what some people will do in hopes of getting pain meds. After his fake seizure was over, he opened his eyes & asked what happened. We told him he was just shaking a little....like he was having a bad dream. As soon as we left the room, he called his wife to tell her the details of his "seizure." Tell me...has anyone ever had a seizure patient do this? His room also smelled like pot. So nasty!

I'm at my parents house...near the beach. They've been watching my dog while I work...so I came out to visit. They tell me that a neighbor saw a Florida Panther walking around. What??? No one believed her until she showed them the huge paw prints this animal left on the ground. My parents live on the intercoastal waterway & inbetween their house & the water is an area of wetlands. My dog ran into the wetlands the other night, barking her head off...but came right back out. I told my parents they better not allow a panther to kill my dog. They aren't the greatest at keeping her on a leash...ugh. In case you aren't sure what a Florida Panther looks like...

Pretty, huh? Pretty darn big! Most people have cats in their yards, my parents have something equivalent to The Lion King. Scares me! When I let Shay out at night, I have my niece stand at the door just in case Shay & I are attacked by this endangered species....we have someone that could call 911. :)

I've been sticking with eating better...for the most part. I've stayed away from the fast food & I do miss Chick-fil-a. I feel like I'm going thru a break up. Sad! It's been 3 weeks...I've lost 11 lbs. Still a long way to go, but nice to see progress. I still need to get better at exercising...but I didn't want to go all out on both exercise & changing my eating habits...cause I know I'd burn out. I'm also going to have to start drinking a protein shake, because I rarely eat red meat & have cut way back on eating chicken....mostly because the only way I like it is fried. I am experimenting & will be trying a few different recipes with baking chicken & fooling my mind into thinking it tastes good. Little changes...here & there.

Ok, time to go get some sun before heading back into the work week tomorrow. Have a good weekend!

Wednesday, April 15, 2009

Saturday, April 11, 2009

Flesh Eating Bacteria???

I went into work last night & saw that I only had 3 patients. Yay! I wasn't sure how long it would last, but it was definitely a reason to have a celebration in my head. I wish our patient load was 3...or even 4. When it gets to more than 4, I can barely remember the patient's names, much less what they are even in the hospital for. It's kind of ironic that they want to talk about all the mistakes made in hospitals...yet they don't do anything realistic to cut down on how or why those mistakes are made.

The first thing that should be addressed is nurse to patient ratios. There are some floors where the nurse has up to 10 (or maybe more) patients. How in the world can you take care of 10 different sick people & have any time to really devote to knowing their background/reason they came in and spend time taking care of them? You can't. You are lucky if you can speak to them for a minute, pass meds, assess and chart. Me, personally, there is no way I would ever take an assignment with more than 6 patients. I would not only be jeopardizing the care for my patients, but my nursing license. I couldn't work somewhere that they would be so foolish as to put anyone in that situation.

Ok, back to my night at work. I was getting report on my patients when the day nurse was telling me that one of my patients has a recent history of necrotizing bactereria aka flesh eating bacteria. Ummmm....ewwwwww. I don't like those words or that description. This is the first time I've ever knowingly come into contact with someone that had it & I wasn't convinced she no longer had it. Apparently the hospital was convinced as she wasn't on any precautions & they had another patient in the room with her. That meant nothing to me. Every time I set foot in that room....I applied gloves & prayed silently that this bacteria would not be able to get thru the gloves...although if it can eat thru flesh, why couldn't it eat thru a thin layer of latex?

She still had active wounds of where this bacteria damaged her skin. We were still doing dressing changes on those areas. I still don't get why...at the very least...we didn't keep other patients out of this room & have this woman on some type of precautions. They don't know how she picked it up to begin with which causes me even more concern. I would expect that she got it in a hospital, but then again...I guess it is out there roaming around in society. Ugh, creeps me out & I'm not even OCD about germs. Of course now every time I have a little itch - I'm convinced this bacteria is feasting on my skin from underneath. Ickkkk!

My other two patients were men. I usually like having men as patients because they tend to be easier to care for than women. I mean.....they can use a urinal in bed. How much easier can it get than that? And they aren't really big talkers. Some of these women...I swear they either purposally choose to come to the hospital to have someone to talk to or their families drop them off because they are tired of hearing them talk. I'm not kidding!

Men though....they are usually not big on talking except to ask for what they want. Last night though...I had two chatty cathy's...or I guess I should call them chatty chuck's. They talked & talked & talked to ME. One of them....every 2 hours he needed snacks...and more snacks, and juice, and cereal, and pudding. It was endless. I was ready to say "What you need is sleep!" Cause I know he would not be up at home eating 2 bowls of cereal, 2 things of pudding, drinking 2 cups of grape juice....every 2 hours.

The other one...I wasn't convinced his diagnosis was even real. He claimed to be having a seizure at home....but nothing was showing any real evidence of it...not even the symptoms he was describing. He told me he had double vision & that he saw 2 of everything. Yet when I would go to hand him some water or his pills or anything....he had absolutely no trouble finding my hand every time. The day nurse had the same feeling I had...that his story/symptoms weren't matching up. His wife was about to go out of town & we both were thinking he didn't want her to go. So these symptoms started & she cancelled her trip. I guess we'll see if the MRI shows anything.

I managed to stay at 3 patients until about 4:30 in the morning. I was actually happy to have an admission as the night was going soooo slow. This one was a man in his 40's with chest pain. My favorite kind of patient. The admission took about 15 minutes tops & off to dreamland he went.

I love my uneventful nights, but when they are slow like that...it makes me so tired. I came home & went to sleep. I woke up much earlier than usual after working 13 hours. I'm going to go meet a friend & take a walk. I've been walking every day since last Sunday. This is a first for me! I actually feel bad if I don't walk...like a guilty feeling. I don't like that feeling, hopefully it will pass. I'm still eating way healthier than ever before. I miss the junk food, but trying not to think about it. I'm craving hot chips...they are sooooo good. I didn't even buy 1 bag because I know I'd want to eat way more than I should. So, for now, I am staying completely away from it. My body is sore, but I know it's a good sore...means my muscles are feeling the exercise.

Have a Happy Easter everyone! Eat some chocolate & peeps for me!

Tuesday, April 7, 2009

A Few Changes Here & There

I've been trying to make a few changes recently...and after just now rereading my last 8 or so posts....I certainly need the changes. I'm trying to eat better & exercise. It definitely hasn't been easy....my mind is constantly thinking of all the fast food I've avoided for the last 2 weeks. So much of losing weight is psychological....lightbulb moment. I've also started taking walks...starting off slow...like a mile or two daily. I plan to work up to more, but know better than to overdo it in the beginning & jinx myself entirely. Besides...my toe that I injured a couple of weeks ago is still sore...so it's a reminder that I need to not overdo it. I wish it would hurry up & heal!!!

I know I won't be 100% good at making the right choices when it comes to eating & exercising...but these little changes will hopefully multiply & result in more energy while losing some weight. And maybe my memory will get better...haha...one can wish, can't they?

I've been at this for just about 2 weeks & have lost around 7 or 8 lbs. I have a long way to go...but it's a start, right? I'll keep you updated on my progress.

Sunday, April 5, 2009

She's Escaped!

My week at work last week went pretty well. I was a PCT (patient care tech) on Monday night....it's a good reminder of how hard they work - when you have a good one that does their job & doesn't have the attitude that the nurse should do it all. I think sometimes us nurses forget because we are too busy running around doing our own thing. I didn't give any baths that night....all 16 or so patients were alert & oriented. I don't wake up alert & oriented patients at 4, 5 or 6 am to take a bath. I just don't do it. They need sleep. Sleep is valuable & I think we don't let them sleep uninterrupted ever. I wonder how sleep deprivation affects one's ability to get well. Which is more important to you.....sleep or a bath at 4 am?

The other two nights I worked were fairly ok. I don't remember much, but I do remember not complaining or feeling overwhelmed. It was a good week...no real emergencies. At least not for me.

A certain nurse on med-surg might have a different viewpoint. One of her patients went missing around 1 am. Normally this isn't too alarming as we have patients on med-surg that will sneak around to smoke. This patient though...was an elderly woman...a confused elderly woman. Not a good combination to be missing. Two of our nurses went outside towards the man-made pond we have. I don't think any of us ever stopped to think that the beautiful pond could possibly kill someone one day. And I'm wondering now if they will put a fence around it...as it would be veryyyyyyyyy easy to fall into & probably not quite as easy to get out & it's only steps from the Med-Surg exit. That's not what happened though...so don't panic.

The nurses came back & reported that they found nothing. So we started searching every patient room & every other room that this confused patient could gain access to...although I doubted she was on our floor because it's not easy for someone to sneak around & confused people aren't exactly the best at sneaking around unseen. The two nurses grab flashlights & head back outside. It was then that they found her...hiding in the bushes near the pond. When asked what she was doing...she replied something like "I'm scared. They are trying to kill me." It's always sad to see someone in that mental state. It has to be extremely scary & very realistic for them. The patient made it back to her room safely & all ended well.

However, the staff on my floor were amused. Not because a patient had been missing....but because our hospital administrators & managers were convinced we'd be having a JCAHO (Joint Commission of Healthcare) inspection the next day because we are due & they have been inspecting the other local hospitals for the last 2 months in our area.

We were envisioning police cars and news helicopters lingering overhead as JCAHO inspectors showed up on our property. If you work in healthcare...you know how anal the hospital administration can be about making sure everything looks better than perfect...as if your hospital has absolutely no flaws...ever. It's been drilled into us for months about what to say, how to act, etc. We were laughing at how all the time & money they have spent making sure we appear to be up to par...would all be thrown out the window if we had a patient go missing the morning JCAHO arrived. I hope the humor in this makes sense. We are tired of the JCAHO drill....every week they tell us "JCAHO will be here...be ready".....only to find out that JCAHO is not there & we'll hear the same stuff a week later & a week later & a week later. So we were cracking up envisioning the scenario that our imaginations were compiling.

I changed my schedule for this week....I work Thurs & Fri rather than my usual Sun, Mon & Tues. My niece & nephew are on spring break...so I figured I'd spend a few days with them. I was going to take them places, do things, etc.....but they are content to simply stay home, play video games, watch movies, hang around town......so I said ok, we'll do that. I could use some of that myself.

Have a good week everyone!