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!!!


Grumpy, M.D. said...

Dying patients are never easy, but it sounds like he went willingly, and you did your best to help him transition comfortably to whatever is next.

That's a good thing, and good work.

Julie said...

I hope your new job goes well, we are seeing benefit cuts here. Sorry about your patient, that is always difficult.

Amanda said...

For some reason, when I have a pt that dies quickly like that it makes me so sad. Glad that you stood up for his wishes and respected that DNR!!

Carlene Noggle said...

I know how sad and stressful that must be to lose a patient that quickly...You know my daddy was doing the "picking" thing whenhe died..and also my grandmother..wonder why that is? I am glad that you are still goingt o the other hospital..the one you were at should have realized the good nurse that you are and compensated you for it.
Take care and God bless,
love ya,

mojitogirl said...

Loved reading your blog, reminds me of home (Daytona Beach and Halifax Hospital). Hope your new job goes well, I know how tough things got in my neck of the woods, hence my move down to the Keys. Best of luck to you!