Sunday, May 31, 2009

So Very Sweet

Some co-workers insisted on taking those of us that are leaving - out to lunch.....they are so very sweet!!!!!!! We went to Chili's (yummmm). They bought us lunch & even presents. They gave us cards that made us cry with what they wrote inside. It was so surprising....and so touching. Of course we tried to convince them to come with us. They just might...once their contract runs out in a few months. They aren't happy we are we said "Come join us!"

The new hospital is starting to ask "What is going on at your hospital that everyone wants to leave?" comment. I stuck to the story of being overstaffed. Don't want to sound disgruntled & it is the truth. Well, was the truth...soon they will be scrambling & probably hiring agency to cover the gaps. They seem to think that by hiring new grads with a $5,000 sign-on bonus (yet they have no money for raises???)....that it will make up for those of us leaving. Yeah, ok. Good luck with that.

So far 5 of us will be starting at the new hospital on June 15th. Another 3 or 4 will be out of there by fall & who knows what the future holds. That's just about half of their night staff on that floor. Now I heard some of our techs are trying to get hired at the new hospital too. I hope they get nice would that be....starting not only with nurses I am used to working with, but techs too. Sweeeeet!

I have a meeting with the Director of Nursing this Thursday. She wants to know why I'm leaving. I had started a list of reasons why, but have decided against even talking about it. I'm not here to help make this hospital a better place...partly because I'm leaving & partly because I don't think she really cares. If she did, she'd be meeting with those that are still hopes of retaining them. If anyone has problems with the way the hospital is, then they can convey that to her directly. It's not my job. I am not their messenger. I'll answer her questions, but it will be a very brief meeting. I'm not crazy about having to come into work an hour early to meet with her. Nothing like having a 13-14 hour work day because of this. Oh well...only 4 shifts left!!!!!

I'm off now until Thursday. The plan is to paint my room, buy a king size bed & some nightstands. Get organized...story of my life. One day I will achieve it!!!!!!

Monday, May 25, 2009

A Little Bit of This & A Little Bit of That

I've managed to get a little bit of free time, so I thought I'd write a little. I worked last night....crazy to say the least. Hence, the reason I am too sick to work tonight! I don't know if the patients are just more sick then when I started nursing or I'm just more relaxed then I was back then & have more time to actually think about the patients I have rather than being so task oriented.

I remember the days of when a patient stated they had chest pain, I would start to panic & have chest pain of my own. I'd run around all scrambled to get the nitro tabs & to get their blood pressure & order an EKG stat and calling the doctor. Now...I calmly stand there staring at my patient as if my eyes are a truth gauge as to whether they are a) having true chest pain, b) having chest pain but non-cardiac related chest pain or c) drug seeking. Nine times out of ten the answer is c, but we can't always assume it. I'm glad I don't freak out anymore though. patients...all 6 of them. Let me start off by saying I think having 6 patients is too many, but since hospitals and insurance companies are cheapskates...there's not much I can do to change that - other than phase into ICU nursing (soon....sooooon). My first one is in with AMS = Altered Mental Status. Half the time these AMS'ers are perfectly fine, alert & oriented x 3. This time he was not. However, I don't think this was any change from the way he normally is. Only in his early 50's, was in a car accident a few years ago & ended up with brain damage. He's been this way ever since. Why they decided he needed to be hospitalized with a heart monitor, I'll never know. And the funny thing....standing order to transfer to the psych floor when medically cleared. Medically cleared from what? He's got pre-existing brain damage. We're not going to cure that. Add on top of the brain damage...a three pack a day smoking habit which we so graciously slapped a nicotine patch on his arm hoping for a miracle., not happening. This guy was jonesing for a cigarette. I had to tell him if he even thought about lighting a cigarette in his room, it would probably cause the entire hospital to explode - so think twice. Instead he settled for chocolate pudding & some saltine crackers. He tossed the spoon aside & began eating the pudding with his fingers. Then he starts dipping the crackers in the pudding & if that wasn't enough, he was touching everything in the bed with his pudding filled fingers. You can't help but stop & stare. It wasn't like he didn't know how to use a spoon. I gave him pudding all throughout the night which he ate just fine using a spoon. For some reason...5 am meant finger painting with pudding.

My second patient was a male with a kidney stone. I know they hurt, but there is a side of me that taps into the female way of thinking & is glad God invented kidney stones for men. It gives them a small ounce of what it feels like to be a woman. I'm not talking about being equivalent to child birth, because I've never had a child & I doubt ANYTHING can compare to the pain of that. But the years & years of menstrual cramps & periods....I'm sure is far worse than one kidney stone. I did feel a little sorry for him though...he had a stent placed in his ureter & eventually they are going to laser the stone. The reason I felt sorry...just wait until it's time to take that stent out. He has no clue. Another reason not to feel bad for him & his kidney stone....he had a Dilaudid PCA. Are you kidding me? I swear....a guy comes in with a little pain, they are immediately taken in, the problem is averted within a few hours AND they get the strongest pain medication on the floor???? Come on.

There was a time I had something like 50 gallstones moving around in my gallbladder & blocking the major duct...did I get surgery & Dilaudid quickly? No, I had to wait 3 weeks for my surgeon to get an opening in his schedule & I think I got a week's worth of Percocet tablets by the time it was all over. Sigh. I don't want to hear that a kidney stone is worse than labor or gallstones...unless you've experienced all three. Anyways, you would think this patient would be the happiest one in my bunch since his procedure was basically over & he had a superstrong pain medication at his disposal. Nope, he was basically what I would refer to as gloom & doom. Zero personality & his wife was waiting on him hand & foot. He actually looked annoyed at me whenever I would walk into the room. Sorry bud, just doing my job.

My third patient was the world's loudest ever....and she had no reason to be. She wasn't yelling out in pain or had any needs...she just yelled out for the fun of it. Luckily she was given an Ativan prior to my shift starting & that pretty much kept her asleep most of the night. Every now & then I'd hear her yelling from 200 feet away....but at least she wasn't in any distress.

My fourth patient was an overdose....combination of Valium & Tylenol. You would think she'd be under a Baker Act for trying to harm herself...but no. In fact, I have yet to see a Baker Act at this hospital. (A Baker Act is a 72-hour hold on anyone that is a threat to themself &/or others). Nope, this one was going to be discharged home today with the recommendation to get help. What? Recommendation? I understand that no one will get better unless they want to get better...but she has multiple suicide attempts. I guess it falls back to health care & lack of places that can help these people. It's all about money & unfortunately those that need this type of help rarely have the money to pay for it....much less the desire. And what do they prescribe for her when she's in the hospital for a suicide attempt.....IV Dilaudid every 4 hours for back pain. What? Who are these doctors?

My fifth patient was my chest pain patient. 22 years old & already has 4 he's hooked on Roxicodone....well non-prescription Roxi. Basically means he's buying it off the street & taking however many he feels like. How he affords this habit, I don't know.....maybe he's a sperm donor (see line above about the # of kids he has at age 22). I go in to assess him & he declares he has chest pain on the right side. So I ask "What kind of chest pain?" He replies "I don't know." I reply "You're having pain, but you don't know what it feels like?" Silence. More silence. Then he says "It's not pain, it's pressure." Ok...."on a scale of 1 to 10, how bad is this pressure?" He immediately says "7". Can pressure even be measured on a scale of 1 to 10? So I say to him "I see they are giving you IV Demerol for this, is it working? Does it take away the pressure?" He answers "Not really." I can tell he's hoping I'll get him something stronger...he doesn't know me very well. I say "Ok, let's see what else I can give you." I glance at his med sheet & say "Hmmm, ok, there's Tylenol. Let's try that." He asks "What's Tylenol?" Oh come on!!!!!! I tell him it's a pain reliever that we should try since the Demerol isn't working. He mumbles "No, I'd rather stick with the Demerol."

My final patient was a new admission that arrived on the floor around 3 am. An older gentleman that was in with congestive heart failure. The ER told me he was alert & oriented x 3. So I ask him "Do you know where you are right now?" No. "Do you know what year it is?" 809. "Do you know who the President is?" What's a President? Yeah....alert & oriented all right. He looked & sounded he had this pus or something coming out of his eyes. I have no idea what it was. I tried my best to wipe it off with a washcloth, but I think the end result was now he couldn't even open his eyes. Oh well...he needed some rest anyways. He reminded me of my patient from last week. It wasn't a good feeling. He survived my shift in tact though.

I gave report & silently yelled at myself for scheduling two days in a row here. I knew this morning I would not be going back. Plus I didn't get much rest I'm not going. I have three more nights of work at my usual hospital. It's just much better when you are around people you know. Makes me hesitant about traveling in the future. I never really thought of myself as social, but when I'm somewhere for 12 hours...I need someone to talk to...someone I know.

It's about to storm out...again. I think we've gotten something like 20 inches of rain in the last week. We need it & don't tell anyone...but I like when it rains. It gets rid of the heat.

Have an awesome week!!!

Saturday, May 23, 2009

A Week of Ups & Downs I have a little bit of time. I swear I don't think I've ever been so busy in a long time. I miss my days of doing absolutely nothing, but it seems like everyday something is going on.

I worked Sunday night at my usual hospital. It was the only night they had me scheduled for the week. Word has already gotten around about those of us that are leaving. My co-workers are happy for us, yet disappointed also. I am going to miss many of really has been fun working together, but it hasn't changed my mind. This just feels right - not for a second have I thought "Hmmm, am I doing the right thing." I know without a doubt this is necessary & even though I hate change...I am looking forward to a fresh start somewhere new. My night was fine...patients weren't too bad. The day nurse was a little late getting there, but she took report quickly - so I had no complaints.

Monday night I was scheduled at my other hospital. I ended up getting called off, which was fine with me. It has been raining non-stop here in Florida & I think the rainy weather just really makes me sleepy. So I was glad to have a night of doing nothing. I was hoping the same thing would happen on Tuesday night, but no...they needed me to come in.

I get there & find out I'm floated to a floor I've never been to. It's a med/surg with some nothing I'm not used to other than a different floor with people I've never met. Luckily, they were very friendly & helpful. It was a little hectic to say the least....I had 5 patients. One who recently had her gallbladder removed & now had pancreatitis...which meant an NG tube down her nose to reduce the vomiting and pain meds every 3 hours.

Another patient who was in with congestive heart failure, but was complaining of pain non-stop. I asked her how long she has had this pain & she replies "for years." I don't get what it is about patients or even fellow employees that think when they come to the hospital...all of the pain will be immediately taken care of. Sure we can medicate, but the amount of pain medicine she needed to overcome her years of pain would have been something to knock her out totally & we don't generally do that except during surgery or if they are on a vent. I asked her how she treated her pain at home & she says she sees a doctor for a shot once a month. I asked her when was the last time she did that....ummm, a few months ago. Huh? Why would you stop getting it done if it works?

The doctor gave her a one time dose of morphine....which all that did was make her sick to her stomach. So on top of being in pain, now she was vomiting. Nice! The tech was all upset about this & couldn't understand why I wasn't doing more. What more do you want me to do? Once she vomited, she felt I'm not going to call the doctor at 1 in the morning for anti-nausea medicine and he already addressed the pain medication. Nothing we have is going to touch something a corticosteroid shot takes care of. We don't give those shots in the hospital.

My third patient....I could here her screaming when I started my shift. I said "is that my patient?" because I usually get the crazy ones & have learned that if someone is out of control on a's usually going to be my patient. Not always, but often. That's ok, I don't mind....some nights I even enjoy it. Not tonight though...because this was a floor I was not used to...I was totally out of my comfort zone. She's in with syncope & she's in a vest restraint because she won't stay in bed & she's a fall risk. She pulls out any IV that is inserted, she won't keep her heart monitor on. Basically, she doesn't want to be there & I don't blame her. Even the doctor seemed to understand because his orders were "It's ok not to have an IV tonight, but please put one in tomorrow to give her Rocephin (antibiotic) & then take it out again." Oh...and "Attempt to keep heart monitor on patient." We attempted, she took it right back off...said her heart was fine & we don't need to be watching it. Ok...can't say I didn't try. They had given her an Ativan right before the start of shift & although it took about 3 hours to work....when it did kick in, it lasted the rest of the night...thank goodness!

My fourth patient was simple to care for...a young guy that came in because he just wasn't feeling right. Turns out he has some type of inner ear growth. I'm not sure exactly what was going on, but something was growing inside his head...or so they thought. Tests were pending to rule it out. Other than asking for pudding, he pretty much kept to himself the rest of the night.

My fifth patient....oh my. A older man that came in at the beginning of the month because he fractured his hip at home. They did surgery & afterwards his health just started to decline. This often happens to those that are older & break a hip or a knee. Something like 50% die within a year of surgery due to complications. Anyways, he had just come back after having a G-tube (feeding tube) inserted. He was alert, responding to questions...but he was cold - very cold to the touch. He wasn't complaining of being cold, but when I say his hands & feet were ice cold, it was nothing I had ever experienced before. They don't have a blanket warmer on this floor so all I could do is cover him with regular blankets & hoped he warmed up. I held most of his medications because his blood pressure was in the 90's & I didn't want it going any lower.

My night was going fine...computers were scheduled to be down for 4 hours. I was eating saltine crackers & reading a magazine when the tech says "Your patient is asking for help." Ok, so I go in to see him & he's repeatedly saying "help me, help me, help me." And his hands are picking at things all around him...his sheets, his gown, the heart monitor wires. Not a good sign. I ask him what he needs help with & he says he doesn't know. Then starts repeating it again "Help me, help me, help me." I ask "Are you cold?" No. "Are you in pain?" No. "Are you having trouble breathing?" No. Help me, help me, help me. At this point he's looking quite pale to me so I call in the charge nurse. He's as baffled as I am. So we decide to check his blood pressure. We couldn't get one. We tried to do it manually. Still couldn't get one. I go to check the monitor to see what his heart rate/rhythm looks ok. I call respiratory to come assess him. He comes in & says "Yes, something is going on with this patient because he didn't look/act this way earlier." Now a few other nurses have come in & we're all staring at my patient. He's breathing rapidly now & not saying anything. I go to call the doctor to tell him about the change in status. The patient is a full DNR meaning he wants absolutely no measures taken to save his life.

At that point, another nurse says "Would you like me to call the family?" Yesssss....thank you. I get the doctor on the phone & he starts ordering "ICU transfer, start him on dopamine, saline bolus, chest xray, ABG's" this point the nursing supervisor is standing by me hearing all this & repeatedly announcing "He's a full DNR." It was annoying me so much that I finally said "Then here, you talk to the doctor." I don't think he liked that, but since he had a different opinion of what type of treatment this patient should get...he should talk to the doctor directly. They decide not to transfer the patient...just give him a saline bolus & see what happens. 9 minutes later my patient died.

It was so quick. I couldn't believe it. Never did I think he would die on my shift even though the doctor at shift change was saying "I can't believe he made it through surgery." I then realized that my patient wasn't asking me or my staff for help.....he was talking to others. Kinda weird, but I totally believe that when it's your time to go....others show up to assist the transition from life to death. I've seen it too many times to not realize there is something more going on than what we are physically able to see.

I'll say it again...the staff on that floor was amazing. They helped me every step of the way & made sure I was ok. I was a little could I not be? I find comfort in knowing he didn't suffer, wasn't in pain...but sad for the family that lost their father that morning. Needless to say, I came home & slept the entire day.

Now back to resigning...I guess it's kinda rocked the unit a little bit. The director of nursing requested meetings with those of us leaving. And to top it off...who shows up at the hospital Tuesday morning.....JCAHO...aka The Joint Commission of do a week long inspection. I had to laugh. Of all weeks for them to show up. I was happy though as I was not scheduled at all. Not that we see them at night, but it was nice not to have to deal with the drama/stress of the inspections.

I haven't met with the director of nursing yet, but the other two that have said the meetings went well. Basically it was focused on why are you leaving & what can we do to make you stay. She says she had no clue that the nurses were unhappy. I find that very hard to believe as we are not shy to voice our opinions. She also offered match what the other hospital is offering in order to get them to stay. It's a nice effort, but a little too late. And really....match the offer? Why not go a little beyond? Not that it matters, I think we are all pretty much set to go try out this new hospital. I know there are others filling out applications & doing interviews, but I'm not sure anyone else is leaving. We'll see. It will also be interesting to see if they actually make any changes towards nursing or if it's just all talk.

On Thursday I went in for my physical and also into human resources to get all the information for orientation. My official start date is June 15th. It will be here before I know it. I mean May has flown by!

Thursday night I went out to dinner at The Cheesecake Factory with my two very best friends. They've been with me since high we go way back. It was a great night...lots of laughter, a few tears (Julie)...but a very good night. Need to have more of those.

Yesterday I went into my other hospital for a yearly evaluation. I didn't really know how she could evaluate me as I'm rarely there, but at least it was done & she said I would be getting a raise...they just hadn't heard from administration what the raises would be this year. She asked if everything was going ok at my usual hospital & I informed her I was leaving. She wanted me to come over full-time to this hospital...but there is no way. It's too similar to my other hospital...very small & nowhere to really grow.

Last night I went out with a friend & saw Night at the Museum 2. It was very Ben Stiller usually is. Very crowded! Today I'm going out with another friend to see "Ghosts of Girlfriends Past" & out to dinner. Busy, busy, busy. My DVR is so full it's starting to delete shows & I still need to catch up on True Blood before season 2 starts. Ahhhhhhhh...and my work schedule this week.....Sun, Mon, Weds, Thurs and Friday night. AHhhhhhhhh! I'm hoping to get cancelled a few nights, but if not, the paycheck will be nice.

The diet/Weight Watchers has kinda been on hold. I'm doing ok...maintaining, but haven't had any time to really exercise & with all this rain...the walking is pretty much non-existent. We were able to walk about 4 miles on Tuesday night...I needed it after what I dealt with earlier that day...but since then it's been raining. I'm hoping when I switch to the other hospital...that we'll have a normal routine schedule & be able to get back to walking on our days off & be able to get back to the WW meetings.

I hope everyone has a wonderful Memorial Day weekend!!!

Friday, May 22, 2009

Oh what a week it's been

I can't go into too much detail at the moment....because I don't really have the's been a crazy week! Resigning, working, friends = drama, shocking, sad, mental therapy, fun, laughing. So many ups & just one week! It reminds me of why I prefer a calm easy-going life.

Anyways...I will be back soon...hopefully tonight to update you all on the latest & greatest things going on with me. For now....just be glad you're not living somewhere that it's been pouring down rain the last 5 or 6 days straight...aka Florida.

Saturday, May 16, 2009

Meant to be

To think just two weeks ago I was upset by having my hours cut...well, good news...I have a new job! job at a new hospital with a higher wage and a higher night differential and free tuition for my bachelor's degree and an offer that after a year, I am welcome to transition into their critical care program if that's the direction I want to go. It's all good...except the drive...although the drive adds on about 15 minutes to what I'm used to right now (I hate driving), one of my co-workers that lives right near my house also got hired at the same hospital on the same unit & we were both told that we would be able to work the same nights since they know we're driving a little bit of a distance and would like to carpool. So that works out too. I think it was all meant to be.

I worked three nights this past week & each night I sat right next to a radio which repeatedly broadcasted about a nursing job fair. I had already known about the job fair in advance & had thought about attending. After hearing that commercial play over & over about every 25 min on the radio, I had no doubt I would at least check things out. Apparently some of my co-workers had the same idea as I ran into 3 others at the job fair just minutes after it started.

Things fell right into place from the moment I got it was all meant to be. I'm sure this hospital has some downfalls, but right now...I am excited for this opportunity. I typed up my resignation letter & hand-delivered it to my nurse manager. She was shocked and called me about an hour later to inquire as to what was going on & to let me know if I ever wanted to come give her a call. That was pretty nice. Two other nurses on my unit also resigned that same day. They are also going to the hospital I will be at. By shift change it seemed as if word spread quickly & a few others are contemplating leaving. Guess that overstaffing problem might be resolved sooner than later.

I gave a 4 week notice. I only had to give 2 weeks, but I told them I'd finish out this schedule that starts on Sunday...just to be fair (I imagine I'll be the first one called off anytime we're overstaffed between now & the end of the schedule...oh well). The new hospital was fine with that my start date is June 15th. I am nervous, but excited...did I mention the unit I'm on has 42 "private" rooms?? doesn't take much to make me

I'm excited...never thought it would fall into place this quickly, but very thankful it has & the new opportunities I will be given. I had wanted to get my bachelor's degree, but the cost is what stopped me. This hospital is going for magnet status & as a result...they are encouraging their nurses to get Bachelor & Master degrees & they pay it all directly. None of this out of pocket expense & we'll pay you back stuff. Plus it's all online classes. Sweet!

Needless to say, I slept very well last night. I'm only scheduled one night this week...Sunday I should be able to avoid the drama as more people discover a few of us are leaving.

Thanks to everyone for their wonderful comments...I really do appreciate everything you say.

Tuesday, May 5, 2009

The Time is Now

Looks like the time has come to seriously start looking to work somewhere else. Reason hours have been cut in half because we are overstaffed. How many hospitals can complain about that...being OVERstaffed with nurses? Ugh, it was a poor management decision made about 8 months ago to force all per diem nurses to go full or part-time and to hire more nurses for our busy season rather than hire agency or travelers. Now that it's starting to slow down...we have way too many nurses & not enough patients.

Luckily, the other hospital still has a need for nurses and I was able to pick up enough shifts that there won't be much of a difference in my paycheck...thank goodness! But I think I've had way too many signs lately to move on & find something else. I'm not sure what exactly I'm looking for, but hoping the answer(s) will come. I know I've made the most important one so far & that is knowing I will be moving on. Just have to secure something else before doing so. Lots of things to think tired of thinking about it. Trying not to stress out about it. Change is good, right? Right??????? :)

I got called off tonight....this is after being sent home last week. Frustrating! But I didn't mind because I am pretty tired & am happy to be home at the moment.

Not much to say about my's been an easy week...or should I say easy 2 nights. I'm going out Wednesday night and Thursday night with friends....gotta have a little fun to decrease the thoughts going on in my head. I'm thankful nursing is a secure job & finding something new won't be too difficult (at least I hope not). I'll keep ya updated...wish me luck!