Friday, October 30, 2009

It Happens in Threes

This past week was a strange one at work. And also a sad one. Tuesday night started out extremely rough. My orientee & I had 4 patients. 4 patients that were total cares. I was so thankful to have an experienced nurse as an orientee. I could not imagine how stressed I would have been had those 4 patients been all mine with no help. Wow...ok, don't want to imagine that scenario anymore.

The orientee took 3 of them as her own, I took 1 & would take the future admission. We worked as a team though...both helping each patient & each other. My patient was in some extreme pain in his lower extremities. He was all swollen. I thought for sure it was going to be DVT's (blood clots) in his legs...but the ultrasound ruled that out. He was getting 4 mg of Morphine every 4 hours. It's a decent dose...with Lortab inbetween. I felt bad that I couldn't take the pain away completely. I don't think anything we had could do that short of putting him into a coma.

We made it through that shift & for some odd orientee & I went to the day charge nurse & volunteered to be floated that night....if they needed someone to do that. She looked shocked that someone was volunteering, but we assured her it would be no problem. Partly because we didn't want that group of patients back & partly because it's easier to float to somewhere new when you have a partner to go with you.

Our wish was granted...we came back the next night & we were floated to another PCU floor. Before we left my usual floor, the day nurse of one of our patients informed us that he died that afternoon. We were shocked as he had been very alert & active all night long. She said physical therapy took him for a walk, then he came back, said he was tired, laid down & never woke up. He was a DNR, but still. Although ideally that is the way I want to go. No pain, no discomfort...just sleeping when your heart decides to stop.

So we leave my floor & go to the other floor. It was a piece of cake. We only had 4 patients the entire night & they were all pleasant people. With 2 of us being there, we could attend to their every need within seconds. This really should be how nursing should be done if the hospitals/Medicare really care about patient satisfaction. I'll save that topic for another day.

We're sitting there charting when we hear "Code Blue, room such & such." Gasp...that was my patient from the night before that was having the pain in his legs. O.M.G. He's coding. Part of me is wanting to know what happened & the other part is thanking God & the stars above for floating me tonight. I'm not a new nurse, but I still panic during stressful situations such as when my patients heart stops working. I didn't want to call up there as I knew they were all busy. I also didn't want to be an onlooker either. A little while later an oncology doctor we knew came to our floor & told us he was at the code & the patient did not make it. Wow....that makes 2 of our patients from the night before gone. This has never happened in my nursing career. Even though I wasn't present when either of them passed, I still felt weird inside.

My orientee then reminds me "You know this death stuff always happens in threes." Ugh, that's's usually true. So we waited & hoped none of our patients coded. At shift change, we hear a code blue called for my usual floor...again. My orientee turned & looked at me & said "see!!!!" However, that code was cancelled within a couple of minutes, so it wasn't a true code.

We came back Thursday night & did not get to float this time. We were a little on edge, but we did have an entirely new group of patients. My 2 were wonderful....walkie talkies....didn't need much. Her 2 were so so, but not bad. My orientee then got a call from her usual floor telling her that the patient that fell on our floor last week just passed away within the last hour. She had been my orientee's patient last week the night she fell. There was our third.

I am weirded out...if that makes any sense. I don't believe the fall caused her death or speeded up her death. She was in congestive heart failure and she had an aortic valve that needed to be replaced....for the second time since it wasn't working properly. Because of her poor health (prior to this hospitalization), there wasn't a cardiologist in the area that would agree to do this procedure. She was in respiratory failure when she was admitted & it steadily got worse. I feel bad for her husband. He is such a sweet man. I'm sad for all of these patients lose someone that you love....there are no proper words to describe the grief.

I'm sure there will be a lawsuit in regards to the fall even though she was alert & oriented. We've already been advised to write down what happened & keep it somewhere safe...because it could be 2 or 3 years before anyone asks us anything. This is the part of health care that I don't like. You give your all & you can still be sued even if it's not your fault.

Friday, October 23, 2009

How Awesome is This?

I am a superuser. What does that mean? I'm not exactly sure at this point, but I have been appointed superuser along with 3 charge nurses. I feel honored as I'm the only floor nurse chosen. Again though, I'm not sure exactly what my duties are. Hopefully one day they'll explain it to

What is awesome though....doctors putting in their own orders!!! No more written orders. Nope, if they want blood work done in the AM, they will be entering the orders on the computer themselves. And if they mess up, well...then it's all on them. No more blaming the secretaries or nurses for their mistakes. Is this not awesome?

The downside to that is no more guessing games as to what is written. That can be fun as some doctors can not write...they scribble. Even their name....half the time we can't figure out who the doctor is that even ordered stuff. So we pass the chart around from nurse to nurse with "Can you guess who this doctor is? Can you guess what they wrote?" It's like a medical version of Jeopardy. I will miss that.

It's starting in the ER right now. I guess they figure if the ER doctors can do it, then any doctor can do it. I absolutely cannot wait. The redlining of charts will be virtually nil, except for telephone orders. I am loving this! Whoever came up with this idea....I love them!!!!!!!!!!!!!!!!!!!!!!!!!!

Saturday, October 17, 2009

Worst Patient Ever

Ahhh, I am so glad this week of work is over. It was a true test of patience for me...I think I passed. Let me start by saying that I am soooooooo sick of drug addicts. I try to sympathize, I try to see their viewpoint, I try to be understanding......cause that's just me. They, however, don't give a damn about anyone other than themselves....which in return causes me to start to wonder why do I even bother trying to care for them?

It makes me wonder...does the drug addiction make them that selfish or are they naturally selfish & that leads them to be drug addicts? We'll never really know, but I am sick of them & soooo wish that the hospitals could turn these people away. Instead, the doctors cave into their drug addiction & prescribe Morphine and Dilaudid....which creates the path of as soon as they are discharged, they come right back with yet another fake ailment in order to get their drug fix. It's so irritating & then they have the nerve to complain that the hospital is what is making them sick...all the germs floating around. Then go home & stay home!

I had my worst patient ever....he was young, in his 30' with chest pain.....because of cocaine. Ugh. It should not be allowed. If you choose to do cocaine, then you should be taking it at your own risk & not wasting the taxpayer's dollars to get more drugs. By the time I got him as a patient, he had already been there a week. Ridiculous. Don't prescribe him pain meds & I'm sure he would have been out of there in a day. Regardless, the doctors did not give him his drug of choice (Dilaudid). But they did allow him Morphine...not what he wanted, but he was quickly gaining an addiction to that. Every 4 hours.

When I first met him, his room must have been 100 degrees. No lie. It was hot in there. He was so disrespectful & he had just met me. I tried to calm him.....asked him what he needed right then, tried to meet his expectations....but all I got was "this place is contaminated, you're the reason I'm sick, none of you know what you are doing." Yeah, buddy......I'm sure you live in a sterile environment & are the picture of health outside of here. It's like he really wanted to piss off anyone that he came into contact with. It wasn't at that point that he annoyed me though. I've dealt with plenty of jerks before and I'll deal with them in the future too. It's just part of nursing. Sometimes you run into selfish jerks that think you are there to cater to them & only them.

He was the type that no matter what you said, he had to argue & even though his argument was ridiculous...he insisted he was right. You could say the sky was blue & he'd disagree. Around midnight I found him complaining to my charge nurse. Not because of me...but because he couldn't stand the smell of sickness that he felt was coming in from the halls and that this place was making him more sick. Meanwhile, his room is still 100 degrees & he is naked at this point. Naked. Totally alert & oriented, but naked. Ugh, disgusting pervert. So the charge tells him that keeping his room that hot isn't going to help him get better, that a cooler room might allow him to breathe a little better. He has the nerve to say he doesn't want to get cold. She replied "Then put some clothes on!" I swear, he could have a starring role in Dumb & Dumber.

Moving's now around 2 & his pain medicine is due. I push it in the IV, then flush, then start an antibiotic running. Everything is problems. About a half hour later he is complaining that something is wrong with the IV. I go (and bring another nurse with me to witness cause I knew he was a liar) and check the IV. We kink the IV line to see if we can get blood return in his IV & it's there....which means the IV is in the vein & in the right spot. He is so clueless that he doesn't realize what we are doing, so we explain it. He then starts tugging on the IV & says it's all messed up & infiltrated. Yeah, ok.

My witness asks him "does he want a new IV?" I had already warned her in advance of this guy. He replies "Yes." She puts in a new IV & it's at that moment that he claims the other IV was no good & he needs more pain medicine because it didn't go in the right place. As if I'm going to fall for that!!!! I'm blonde, but not that blonde. I tell him there is no way that I am giving him anymore pain medicine before 6. He's saying some very disrespectful things, myself & the other nurse choose to ignore him rather than put him in his much as we would have liked. He then insists on talking to the charge nurse again. As if her answer would have been any different than mine. I'm sooooooo glad I brought the other nurse in as a witness. The charge already knows him well & is as equally annoyed as we are. She lets him know that there will be no pain med given before 6.

He continues to ask for one at a time. I need some juice. Brought him juice. I need some ice. Brought him ice. I need a new gown. Brought him a new gown. I need something to eat. That's it......I'm done. I'll see you at 6.

I go in at 6 to bring him the pain medication & he's moving his hand all around so I cannot get to his IV. So I stop & look at him cause at this point...he pretty stupid to be playing this game since he is the one that wants the pain med. I would have no problem throwing it away & calling it a day. He then starts yelling "Why are you so nervous? Why can't you get the medicine in my IV?" Ugh, this is not nursing. And for any of you in nursing school that think "I never want to go into psych nursing" me, the psych patients will come to you!

I tell my charge nurse that I do not want this patient back the next night or ever. I make sure the day charge is aware also. What happens.....I come back that night & have him again. I was sooo irritated. I don't get mad often, but I was mad. No one was around for me to complain or get it switched, so I figured I'd just deal with it. For some reason, God must want me to spend another 12 hours taking care of this drug addict.

I go in to assess him & find that he is acting totally different. He is actually being nice & talking normal & his room isn't 100 degrees. I am ready to go into shock. He's still a little off the wall, but being friendly. I actually say to him "I like seeing this side of you." And I listen to him talk for like 15 minutes. I wanted him to see that I want him to feel better. I'm not there to make things worse. For a few more hours, things go very smoothly. I think to, a caring heart really can do wonders.

Well, about 4 hours later he's back to his selfish ways & now he's calling random numbers in the hospital asking for pain medication stronger than what we have prescribed for him. The charge nurse (a different one than the night before) goes into his room & tells him if he doesn't stop calling random numbers, she will take his phone away & he has 3 options at this point.....comply with his current plan of treatment, sign out against medical advice or fire his doctor - but he has to find another doctor to take his case. The doctors will not allow you Dilaudid, so stop asking for it. She said it like it was & then walked out.

I never heard another word out of him. I went in & gave him his other scheduled IV medications & I believe he thought one of those was his pain meds as he never called for pain meds again that morning & when I left...he was sleeping. I was very thankful not to be going back that night.

Frustrating, annoying, exhausting, disappointing. Luckily, my other patients were very thankful for all that I did for them & they were nice to me. I wasn't going to let one lousy person bring me down. I even had a patient that tested positive for H1N1. While I didn't want to go into his room & be exposed to it...the times that I did, he was super nice. And he was getting better. Now I definitely know I have been exposed to H1N1. I'm hoping I don't get it.

Florida finally is getting some cool weather this weekend. Yay! I go back to work Monday soon. But after I get off work on Thursday morning...I have 5 days off. I think I'm just going to hang out at, relax, maybe attempt to get organized. It's a never-ending process.

Have a good weekend everyone. Stay warm, northerners!

Monday, October 12, 2009

Go Big or Go Home!

We had another townhall meeting this week. I decided to go yesterday since I am working Tues, Wed & Thurs this week & didn't want to go after working 12 hours. It's hard enough adjusting to losing an hour of sleep (due to the drive), but add in a loss of another hour = Jen not a happy camper. So I went yesterday & loved it. I'm not just pretending either.

As with any work meetings...I dread going. I'm used to them being boring and the administration not really caring what we felt/thought & usually we'd be told of what we're not doing right & what we need to improve on. Basically they were doom & gloom. This hospital is different. It is more like a pep rally. It is simply amazing. Seriously. Amazing. A work meeting. Who would have ever thought they could be fun?

I was looking forward to this meeting because we just went through the employee satisfaction survey & although I was unable to give my input (you have to be there for at least 3 months to take the survey), I was interested in seeing the results. This meeting was a Hollywood Academy Award carpet, pictures, food, administration dressed up in tux & long gowns, paparazzi. It was pretty impressive! Not only were they taking pics, they printed them during the meeting & were handing them to us after the meeting was over. Who knew administration could be this quick & efficient?

The results were amazing too....we are a hospital within a large chain of hospitals. I think one of the largest chains in the United States. That being said...we rank #1 in employee satisfaction within our chain. Number one!!! On top of that, our hospital is in the 83rd percentile in the entire U.S. And my department ranks in the top 25% in the country. Say what?????

We have not had a patient fall in 58 days...and we don't even use bed alarms! This is a hospital with more than 350 beds. At my old hospital...we were lucky to go a week without a fall & the hospital is less than half the size. And we had bed alarms - not that they always worked.

Anyways, it feels really good to be working somewhere that I can be proud of. Somewhere that the departments can work together rather than against one another. Somewhere that the administration pays tribute to all that we do. It's the little things that mean so much....yeah, the candy, chocolate & cheesecake help....but just having our administrators recognizing & acknowledging our hardwork is the best. Especially after leaving a hospital that views nurses at the bottom of the barrel.

I am so glad I made the decision to change hospitals. Nursing is still a very tough, demanding & tiring job...and always will be. However, it's nice to be free of the chaos & drama from the higher ups. It's nice to be able to call pharmacy & not get the run around or have to wait hours for a medication. It's nice to get report from ER & things be in order. It's nice to call lab & not get excuses. It's nice to call doctors & not get an attitude or hung up on. It's nice to have a new unit that we all have pretty much blended right into. It's been a nice adjustment.

It's nice to work at a hospital you can be proud of.

Thursday, October 8, 2009

What Do You Mean???

Told you I would survive. My cold is nearly gone. I have a cough, but it's not bad. I had no problem working 3 nights in a row. To think back to a week, what a difference! I'm not 100%, but getting there. I even went ahead & got the regular flu shot this year. I am refusing the swine flu shot though. There just isn't enough testing for me to feel confident that 1) it will even work and 2) that it won't cause more problems because no one has a clue because it hasn't been tested enough. As far as my illness last week...I don't think it was the swine flu. I never had a fever & it felt more like the usual congestion of a cold. Oh well, I'll never know.

Work has been pretty simple this week. The patients weren't bad. I mean they are very sick and half the ones we discharge don't seem to be any better than when they came in. I think it's the general population of where this hospital is. So many are nursing home patients that they give a few IV antibiotics & send them back until the nursing home wants a break & sends them back to us. And others....they are there for weeks. I have no real idea what we are doing for them other than wasting money on keeping them in the hospital day after day. For those that think one will be turned away simply because they have no insurance...that is so not true. At least not in Florida.

It's overkill with the testing here. I had one older gentleman that came in with a fever of 100.0. They did nothing to treat the temperature & it went away within a couple of hours & stayed away. However, they admitted him with the diagnosis of "Fever rule out Meningitis." What? Because of a one time fever of 100.0??? They attempted to do a lumbar puncture THREE times & could not get it. So then they decide to order an MRI of his spine. This patient is unable to answer the questions on the MRI form because he has dementia & we have no next of kin to call. Sooooo they do a series of x-rays to try to determine whether he has any metal in his body that would prevent him from having an MRI. All this for a guy that showed up with no other symptom than a fever 100.0 one time. Needless to say, he had no meningitis...but it took thousands of dollars just to be sure. Ridiculous!

I get this call last night from a doctor I have never spoken to (nor would like to speak to again). He runs through a list of orders...blah, blah, repeat it back to me. I like that...he's efficient even though you can tell he's being cocky at the same time. Like he's waiting for me to mess up. He orders an MRI of the thoracic spine & lumbar spine for a patient of mine that has to be done asap. I call the patient's daughter to make her aware since she is the power of attorney as her mother has alzheimer's. She tells me her mother will need something to sedate her in order to get the MRI done.

So I call the doctor's service....only to find out he's not on call. Ummm, I just talked to him 5 minutes ago. "Sorry, he's not on call." Ok, then who is on call & have him call me back. They give me a one word answer as to who's on call & they page him. This P.A. (physician's assistant) calls me back. I don't generally like talking to them, because it doesn't seem that they know what they are doing. Anyways...I explain to him what is going on...that Dr. so & so ordered for an MRI & the patient needs sedation. He replies with something like "My partner ordered that?" Ummmm...since when are MD's partners with PA's? Anyways, I say yes & the patient's daughter requests she get some type of medication for sedation in order to have this MRI done.

I think I'm speaking clear english that makes sense. It's not uncommon for a patient to be claustrophobic or uncomfortable having to lie still during an MRI that takes over an hour. His reply..."Is she medical?" What????? Medical?????? What are you talking about? He says "Is she medical services?" Huh??? What do you mean medical services & what does this have to do with sedation? I mean he did just call my floor at the he really asking if she's a patient that's been admitted? I don't understand! He finally gives up or I finally give him the answer he's looking for...I'm not sure which, but he moves on to ask "What kind of sedation do you want?" WTF? MRI sedation! What do you mean what do I want? I want my patient sedated so that she can get this MRI done. Am I not speaking clearly? He replies "Conscious sedation or regular sedation?" Say what????

My co-worker/friend is sitting next to me & is amused at my conversation as she is only hearing one side of it & I'm giving her a look like I'm talking to a nutcase & that I need her to step in & interpret even though both the P.A. & I speak very clear english. So he asks again if I want conscious sedation. In my mind, the only times I think of conscious sedation are during certain ICU procedures and to be cardioverted during SVT. It requires anesthesia administered by a professional........I have never heard of that type of sedation done for an MRI. I was looking for an Ativan, maybe Xanax, Valium.....something to make the patient sleepy/relaxed but not unconscious.

Now the P.A. is getting really annoyed with me as we simply don't understand one another & he is trying to talk me into calling the primary doctor for this. I couldn't understand why he wanted me to call the primary who didn't order this test nor had any clue it was even happening. I just wanted to speak to the doctor that ordered this MRI & get some sedation. Is that too much to ask?

Long story short...he orders Valium which I also imagine he was hurrying off the phone so he could take some himself since he seemed so rattled at my questions. The patient went down for the MRI, but complained one time she felt a little short of the MRI tech stopped the exam, called me....I went down to assess her, but couldn't find the MRI tech anywhere. So my charge nurse calls the nursing supervisor who basically handles it like a rapid response & brings the patient back = incomplete test.

I go to assess my patient upon her arrival back to the floor & ask her "How was the test?" Her reply...."What test?" I asked her if she was short of breath. She had no clue what I was talking about. Sigh. My charge nurse wanted me to call the doctor to let him know the test wasn't completed. 2 am I'm supposed to call?????? I knew I'd end up getting that P.A. again. No way. What are they going to do? Attempt to medicate her more when she complained she was short of breath? I don't think so. I called him at 6:30 this morning & guess no call back. The answering service kept paging only guess was that he was waiting until shift change was complete as I'm sure he had no desire to speak to me again. :)

I'm sleepy. Heading to bed. I have 5 days off...yay!!!

Friday, October 2, 2009

I Will Survive

I could kick myself right now because 2 weeks ago I said to my friend/co-worker..."I never get sick." Then I go on vacation for a week & have been sick ever since. Ahhhhhhhhhhh....why can't karma work this fast in other situations?

I was feeling achy on Sunday...thinking it was my sunburn. Tuesday I had a sore throat, head congestion, was hot...but no fever. I called in sick to work. I didn't want to as I haven't been there very long, but there is no way I could have taken care of anyone besides myself that night & even that was rough. I sucked it up & went in Wed. night & lucked out that we were overstaffed & I could leave at 11 without any penalty against me. I thought I was better last night...went into work & before I knew it...I was in the middle of a non-stop coughing fit which led to my eyes getting all watery & my body was sweaty yet clammy & the headache began. It just goes on & on. We weren't overstaffed, so if I wanted to leave - it was basically like calling in sick - even though I was at work.

I hope I don't get in trouble for it. I mean I'm really sick. Oh well, whatever is meant to be will happen.

I just want to get rid of this sickness. I don't even have any reason to go to the doctor.....I have a cough, but no temp & anything coming out of my nose is a clear color. So I doubt antibiotics are necessary. I'm off until Monday night & praying this is all gone by then. Meanwhile I'm contemplating buying stock in Nyquil.

My patients this week were pretty simple...which made me regret going home. I think a couple of them wanted to take care of me. And last night was like one of my most embarrassing moments ever....a family member called me on the phone to ask about his mom. During our conversation, my throat got very dry & I was coughing & barely breathing. He's saying "It sounds like you need to be in the hospital." Yet, he keeps asking questions. And not normal questions like "how is my mom doing?" No...he asks me how long does it take for someone that retains long does it take for the extra CO2 to get out of her bloodstream? Huh??? I was nearly ready to pass out with his endless questions & my lack of oxygen. I couldn't even say throat was that dry. It was so awkward.

Meanwhile I'm coughing so hard that I expect blood or one of my lungs to appear at any moment & one of my co-workers says "It sounds like you need some water." And she just keeps going about her business. This same co-worker asks me later "Why are you going home?" Are you serious? As if non-stop coughing & an inability to breathe is my norm. Another co-worker says "I think you have a pre-existing condition." What????? Who are these people? I'm sick!

And I don't get it....I'm sick, my nose is stuffed up, I'm coughing non-stop & yet when they need a witness for their insulin - they hand me their toughbooks to put in my information. I am touching their computers with the hands that I have been coughing into & they don't care. If it had been the opposite, I would have been sanitizing my computer immediately or finding someone that wasn't so ill that they had to go home. But that's just me.

Another thing...I may be 40 yrs old, but I am half-tempted to drive out to my parents house so that they can take care of me. Yeah, I'm that sick. However, they are 45 min away & I am more comfortable in my own home & I don't want them catching instead they drove to me & went to the grocery store to get me some survival items. I love you, Mom & Dad!!! They are the best.

I am heading back to bed & hoping/praying/dreaming that I am back to normal health by the am.