Saturday, July 18, 2009

Putting Out Fires

Isn't that what nursing is all about....putting out fires? Gone are the days of getting to know your patients, calming their fears, giving massages, etc. Instead it has been replaced with hours of non-stop charting and tasks aka fires.

I should have come into work Monday night with my own team of firefighters....but nurses have to brave this stuff all on our own. Now I had most of these patients the night I thought coming back the next wouldn't be so bad. That's the problem...thinking. I sat down for report & was immediately told by the day nurse..."I hope your patients don't die, you have 3 that could die at anytime." What?????? Who says stuff like this?

Patient #1 had a hemoglobin of 5.9. Really not good considering the day before it was 9.3. So she was needing 3 units of blood, yet it was now 7 pm & she had yet to receive even 1 unit. Grrr!

Patient #2 had runs of V-tach. I had a feeling it was a result of his potassium being low even though we were continuously replacing it.

Patient #3 had just been diagnosed with a pulmonary embolism (blood clot in his lungs) & had yet to be started on Heparin. We had the order, but at 7 pm, it still was not hung. Grrr!!

Patient #4 had to be transferred to our big hospital because he was needing 3 heart stents a.s.a.p.

And Patient #5...a new admission they were handing me during report. Nice, huh?

I managed to hande it all, put out the fires & everyone survived without any problems...but the day nurse called in sick the next morning. Guess he was worried he'd be walking back into a disaster zone.

Tuesday night was ok....much better than Monday night. I'm working Mon, Tues & Fri this coming week. I usually like to work 3 in a row & be done with it, but I am interested in seeing if maybe it's better to split up the days as I was worn out by the end of that third shift this past week. I've been off since Wednesday & am still tired!

It's pouring down rain...which I like cause it's tooooooo hot in Florida lately. Or should I say too humid. Either way, it's too icky to be outside. Time to catch up on some tv.

I think later tonight I'm going to go visit my old hospital...just to say hi. Hard to believe I've already been at the new job for a month!

Have a good weekend everyone!

Thursday, July 16, 2009

Quick Update...Swine Flu

The nurse with swine flu passed away last Saturday. So sad...shocking. You just never know what God has planned.

I had a very busy/rough week. I'll update more later.

Sunday, July 12, 2009

Swine Flu = scary

I'm sure you've all heard of the Swine Flu. I didn't really think much of it because I think they are blowing it out of proportion. However, we did have a recent death at the hospital I work at. That isn't as shocking as now the nurse that took care of that fighting for her life as she came down with the Swine Flu within 48 hours of taking care of that patient. It's been a couple of weeks now that she's been on a ventilator & they aren't sure what is going to happen with her. They were thinking the end was near as both of her lungs collapsed...but she's somehow managing to hang on.

I don't know the nurse, but I can see how it affects the rest of the staff that do know her. It scares me to see just how quickly life can change. One minute you're taking care of someone sick & next thing you're the sick one.

I had a patient the other night that tested positive for the regular flu. They were working him up for the Swine as a result...I had to take many precautions...gown, gloves, N-95 mask AND goggles. Let me tell you...I'm sure I looked adorable (NOT!). The poor am I supposed to reassure him that he'll be ok while I look like I'm deathly afraid of even touching him? And wouldn't you know it...he was the needy type of patient that would call every 10 minutes...which meant every 10 minutes I was putting on all that gear...over & over & over. Lots of fun...let me tell you!

I had to take a PCU test on Friday....that sucker was hard. I looked at the bottom of the test & it said PCU/ICU test. Why am I being asked ICU questions? I also had to take a test on rhythm strips. Not just normal type rhythms like sinus rhythm, sinus brady, etc. had dual pacemakers, junctional, idiopathic, etc. I have no idea how I did. I kept wanting to write "I am not a cardiologist."

I also found out that when we have a code doctor shows up. We are on our own with the rest of our staff. That seems so odd to me. My other hospital was so small...the ER doc could get there in under 60 seconds usually. I just can't picture nurses running the entire code. Guess one day I'll find out...hopefully not for a very long time.

It's back to work tonight, Mon & Tues nights. We have some lift class on Weds morning....then off until the following Monday. I'm looking forward to more than a few days off.

Have a good week everyone!

Monday, July 6, 2009

So Ready to be off of Orientation!

Did everyone have a wonderful 4th of July? I spent it at my brother's house/party. It left me wondering...what is it about men & fireworks? He had thousands of dollars worth of fireworks that took 90 minutes to set off....and it wasn't like one at a time. It was these huge boxes of fireworks that they were lighting 3 at a time. It was fun to watch, but it left me wondering...why are men so willing to spend tons of money on fireworks? I never see women rushing out to buy fireworks. I don't know what is spending ridiculous amounts of money on fireworks or us women that stand there watching them go off. Hmmm...maybe that's why men do it...for women's admiration. Who knows?

Anyways, it was a good time. Hard to believe the year is half over. Where did it go??? Before we know it...Thanksgiving & Christmas will be here. I wouldn't mind it cooling off a bit. I nearly passed out at the party just from standing in the sun talking. Seriously! It was that 97 degrees. I went to sit down & was feeling awful & silently telling myself "please don't pass out, please don't pass out." I went inside & put some cold water on my face, drank down a bottle of Vitamin water & hoped for the best. Luckily, the icky feeling went away quickly.

Last week at work was fine. I am so ready to be off of orientation & on my own. I want independence. It's funny how we all have different ways of doing the same job. I noticed there are some nurses that are all about the charting....they don't let a single thing slip by them when it comes to the chart or the computer. However, it seems like the thing they are least concerned with is the actual patient. It's so odd to me that they can be so fixated on the charting aspect, but suck at actual patient care. And when I mean suck....their idea of an assessment is to introduce themselves to the patient & that's it! They don't touch them, they don't listen to their lungs...they don't even ask the patient how they are doing. It's so bizarre to me.

I, on the other hand, focus more on the patient than the paperwork. The charting can wait until later...when the patient is sleeping or when my assessments are done & everyone is A-ok. For instance, my preceptor & I had a patient the other night...yes, we shared our patients because apparently she's only been a nurse since October & didn't feel comfortable letting me take care of any patients on my own. I didn't mind...whatever suits her best. So we have this patient in his late 80's who just had a lap chole (gallbladder surgery). His blood pressure at 8 pm is something like 93/48. A little low, but considering they gave him Oxycontin for pain...I would expect it to be low. The nurse says to me "His blood pressure is low because he's in pain." Ummm, I don't think so. Usually it's the reverse....BP goes up when one is in pain. He had also received 8 mg of Bumex (diuretic) during the day because he had congestive heart failure. 8 mg is a big dose. So I figured between the pain medicine & the makes sense his BP is a little on the low side.

The nurse keeps taking his blood pressure over & over until she finally gets a reading of 103/52. She's relieved now. I just stood there looking at her. She tells me his next dose of Bumex is due at 11. I said "We're not going to give it, are we?" She thought I was insane & reminded me of how high his BNP (lab test that shows one is in congestive heart failure). It was over 2,000 which is high, but his blood pressure is don't give diuretics to someone with a low BP. I felt bad for him because he was complaining of pain from the surgery, but all we could offer him was Tylenol because anything else could lower his BP.

Now it's 10:30...she's going to have lunch & I tell her I'm going to recheck his blood pressure. The first reading I get is 79/38. Uh oh. So I recheck it on the other arm. 80/41. Not good. I go into the breakroom to tell her & the advice I get....give him something to drink & put his feet up. Are you serious? This is a post-op patient. For all I know, he could be bleeding internally. About 15 min later she ventures into the room & his BP is still low. So she gets the charge nurse & they stand there discussing him & debating about whether to give the dose of Bumex. I didn't say a word, but trust me...if they had pulled that dose to give, I would have spoken up loud & clear.

She then announces she's going to call the doctor...that the patient probably needs IV fluids. So she says she's going to call the primary doctor. I inquired as to why not call the cardiologist...that is the doctor that ordered the diuretic and the blood pressure is freaking low. She says they don't call the consulting doctors...just the primary. What? Isn't that the purpose of having specialists on the case? She calls twice & gets no call back. Are you going to try to call the cardiologist now? No. She calls a rapid response instead. Weird. I would have called that the first time I got the really low BP, not an hour later, but ok. Maybe they just do things differently here.

He shows up...yes, it's a one man rapid responder. He comes to the same conclusion that I had an hour ago. That the patient needs fluids and no more Bumex. She calls the primary one more time & he finally calls back....all she gets to say is the patient's blood pressure before the doctor cuts her off, orders fluids & hangs up. See, this is why I don't like dealing with primary doctors for important stuff. They aren't the best at handling critical situations.

While she's starting the fluids, I look back over his medication record & see that the day nurse had not only given him Oxycontin, Bumex 8 mg IV...she also gave him Isosorbide (blood pressure lowering medication)...which is all fine & dandy...except his BP when she gave all this stuff was 102/49. Ugh...that's why his BP is so low now. We're just going to have to hope the fluids work & wait until his medications wear off. Thankfully he remained stable the rest of the night & was still responding appropriately to us & his 02 sat was good...even though his lips were blue. The nurse would keep telling him to wet his lips so the blueness would go away. Sigh.

I'm back tonight for 3 in a row. I have to take some competency test on Friday. You'd think they'd have you take the test before hiring someone, wouldn't you? We have 2 hours to take it...I hope it's not that long of a test. She's like "bring your calipers & a calculator." Ugh!

Have a great week!!!