Happy Thanksgiving 2009!

I am hoping everyone that reads my blog had a wonderful day today. I worked the first 8 hours of it, then slept & now I'm patiently awaiting 7:15 to arrive...because I just might get the night off. I'm on call & have to remain available until 7:15. If I don't hear anything, then I'm heading over to my parents house to surprise them. I still have to remain available until 11:15, but chances are it won't be a busy night at the hospital...unless some family feuds break out, but hopefully that isn't happening.

I'm kind of relieved to not have to go back. I had a patient last night...a man who I am told has basically given up on life. He's refusing to eat, refusing medications, refusing to be moved. He just wants to be left alone. So I go in the room & his daughter is there. She's very concerned, which I don't blame her...I would be too. I dread the day of having to watch my family or friends take a turn for the worse. His vital signs were stable, but he was sweaty...so I do an accucheck. It's 49. I give him some D50 IV since I knew he would refuse to eat or drink. That gets him up to 77 & it wouldn't be long before it started dropping again. I started his TPN & hoped that would kick in & sustain his blood sugar. During the day, the bag had run out early...so the dayshift nurse gave him insulin to cover his high blood sugar...but since he wasn't eating or drinking & the TPN wasn't running for hours...it was no wonder he was dropping. I don't blame the day nurse as I know they are very busy during the day & it probably slipped her mind when it came to giving insulin & nothing to eat or drink to follow behind it. I've done it myself when giving insulin at night & the patient just wants to go to sleep instead of having a snack. It happens.

So for a few hours, I was checking his blood sugar often. I didn't want it getting any lower. By 1 am, he was sustaining in the low 100's, which is perfect. All while this is going on, the daughter is saying he's had a change in status. He isn't responding. I told her it was probably a combination of having low blood sugar & being tired. I mean it was nearly 11 pm when she brought this up. She didn't like my answer, but I didn't know what she wanted me to do. I can't call a rapid response...the man was simply sleepy. I did talk to my charge nurse, who in turn went in & spoke to the daughter. It was agreed that we would monitor his vital signs every 2 hours. Luckily I wasn't so busy that this couldn't be achieved. He remained stable through the night & around 4 am, he was awake & talking to me & drinking grape juice.

I think to a degree, he simply didn't want to talk to his daughter. This happens quite a bit...the patient just wants the family to go home. I think it worries them watching their family worry about them. They rather just be alone or communicate only with their nurse. It's hard to watch this because it is very much appreciated & comforting to know there is a family very concerned about their loved one. So often we see the opposite...not a single visitor or phone call. Sometimes the only communication & touch they receive is from their nurse.

Last night I also got to meet my new orientee. She makes me feel old.....we both graduated from the same high school. Small world....lol. But I graduated the year after she was born!!!! OMG! She seems pretty cool, we hit it off & I think she'll be a good nurse. She was a tech on an oncology floor while in nursing school. I am hearing it's rather difficult out there now for new nurses to get hired. My hospital just hired 25 of them, but supposedly we're the only hospital hiring new grads at this time of the year. We won't be working together for another month, but I am looking forward to it. I'm glad I said yes to being a preceptor.

Ok, it's 7 pm...I don't want to jinx myself by packing to go to my parents house, but I want to leave as quickly as I can. So have a Happy Thanksgiving everyone & a great weekend!!!!

Moved Back...Yay!

I had another 5 days in a row off. It has been nice...relaxing...enjoyable. Goes by way too quickly though.

We got to finally move back to our regular floor last Tuesday. It is wonderful...like being home again. I had a patient that I had the previous week. Turns out she has Guillian-Barre disease & NO, she has not had any recent flu shots. She's a woman in her mid-80's that exercises every day & now she can barely move her legs. I feel so bad for her. No matter what we did, she could not get comfortable & she couldn't move herself. The disease is moving progressively fast for her. It makes me sad. To be of sound mind, but your body is failing your control. Not fair.

Not much really stands out from last week. Guess that's a good thing. I did find the time to go see New Moon on Saturday. I was expecting crazy crowds. My niece & I got there at 1:15...they had a show at 1:30, it wasn't crowded, no line to get in...perfect. The movie is decent, but I still say the whole storyline is kinda cheesy. At least my niece has come to her senses & is on Team Jacob. :)

Now my niece & I are reading Lovely Bones - since we saw the preview for the movie. Well, my niece is reading it anyways. I'm still muddling my way through True Blood.

Not much else really going on. Gosh, I seem so boring lately. Maybe something exciting will happen at work. I have to work Tues, Wed and Thurs nights this week...which means it will be the first year ever that I've had to work on Thanksgiving. I'm bummed I can't be with my family, but grateful I have all of Christmas off.

Ho Hum

Not too much going on at the moment. I've been off for 5 days and after I work the next 3 nights in a row, I'll be off for 5 days in a row again. Not a bad lifestyle, eh?

I'm going to be precepting a new grad next month. I have never precepted a new grad before...hopefully it will go well. Work wasn't too bad last week. I had a sad case...a drug addict...again. I don't know why it still surprises me when that happens. I guess I am more optimistic than pessimistic...even with all the unfortunate things going on in the world. This patient was in her late 20's...totally hooked on anything that would make her sleep. I don't get it. If you want to sleep...take Tylenol PM or Melatonin. Why get hooked on the narcotics? Probably a tolerance thing.

By the time I got her, they had discontinued the Dilaudid & was only giving her Percocet and Phenergan. They should have dc'd the Phenergan as she was totally using it for sleep only. I had no problem giving it to her because when it's nighttime & you have 4 other patients...you want your patients to remain calm & a sleeping patient is a good thing for us nightshift nurses. Still though, it's sad to see someone throwing their life away because of a drug addiction.

I also had this patient...in her late 60's...screaming her head off. As soon as I arrived on the floor, I thought "That's probably going to be my patient"...cause I'm lucky like that. :) Sure enough, it was. And if that wasn't lucky enough, she was also on bedrest & drinking Golytely. Yes....the one drug in medicine meant to make us smile when we say the name. Cause it does everything BUT make you "go lightly." It's a prep for a colonoscopy & it produces some strong results. So having a confused bedbound patient drinking Golytely is a nightmare.

Sometime during the night though, I got to make the deal of a lifetime. There was another patient that was having trouble with his nurse. So much so that he did not want her in his room anymore. He thought she was rude & he did not need a nurse like that. So they asked another nurse to trade a patient for that one. Ummm, that nurse couldn't do it...seems she already had a falling out with the patient. The next nurse said "No way!!!!!" So they came to me...begging. I first started to ask "What is wrong with that patient?" And then I suddenly stopped & asked "Can I trade my confused patient?" The reply was YES. Ok, done deal.

This irate patient was someone getting Oxycodone every 6 hours for back pain. He was an older man & I did believe he had genuine pain....not that it matters as I go with the belief that if it's ordered & the patient isn't showing any signs of drug toxicity or unstable vital signs...they get their medicine. This isn't the show "Intervention." We aren't here to cure someone with chronic pain or even drug addiction. It's supposed to be short-term nursing care...so if it's ordered...then give them their medicine. I went in & spoke to him, got him some food, got him his medicine & that was it.

The other nurse....the one that got the trade....well, let's just say she was not a happy camper. Oh well...don't be rude to your patients next time!

Speaking of rude, this same nurse can be quite vocal & not in a good way. I often overhear her say rude things to patients...to the point that I feel the need to report her. I don't usually do things like this as I know nursing can be stressful & it's probably just her way of releasing stress....but it's wrong. It's rude, insensitive & wrong. Problem is...I'm not sure how to go about it. Talking to her is out of the question as she is so self-centered she would never accept the idea that she is doing something wrong. It's always someone else's fault. So the next step is do I verbally say something to the charge nurse? the manager? write an anonymous letter? I don't know...but we work hard to achieve patient satisfaction & here she is ruining it all...repeatedly.

My youngest niece turned 13 this past week. Sigh. I miss the days of when she was 3 yrs old. It doesn't seem possible that she is just 5 yrs away from being an adult. Where does the time go?

Refreshed & Excited

We had a staff meeting today. It was good. I like the meetings there....very casual, interactive, funny. It was also refreshing. I guess maybe it's because we don't see our manager very often since we work nights, but she is a breath of fresh air. She seems to understand the hard work we put in & the common sense it takes to be a manager. She fights for us...gets us the equipment we need, listens to us gripe, tries to make things better.

She explained the one hour rounding to us in a way that totally made sense. Rather than it being yet another burden to put on nurses, we could see how it would be beneficial for both the patient and the nurse. Even waking the patient up for labs seemed understandable when she gave an explanation as to why this has been put into effect. We all want our patients to be happy, don't we?

We get to go back to our remodeled floor on Tuesday. Cannot wait!!!

How in the world is this legal???

I'm not sure if you all are aware of what our govt is up to when it comes to healthcare. I'm not talking about the $1 trillion dollar cost to cover 6 million people with a low cost health plan, I'm talking about patient satisfaction.

There used to be a time that we could say to our very demanding patients..."look, this isn't the Hilton, it's a hospital." Somehow, it's all changing though. Not that patient satisfaction wasn't important back then, but now...if the patient is on Medicare & isn't satisfied with their hospital stay.....the govt doesn't have to pay the hospital for that patient. How in the world is this legal???

And we wonder why hospitals are struggling to keep their doors open & shortstaff us on a daily basis...all over the country. Probably due to non-payment. Don't get me wrong...I'm all for patients being satisfied & I try my best to meet their needs...but there are usually 4 types of patients:

1) confused/dementia/out of their mind & probably wouldn't even remember being at the hospital or even recognizing that they were in a hospital

2) demanding patients who have something to complain about no matter what you do

3) patients that seem genuine & happy, don't ask for anything or if they do...it's immediately taken care of....only to complain a day or two later that none of their needs are being met

4) drug seekers who are never happy with what you do unless they are getting their latest fix

So, as you see, it's nearly impossible to achieve high patient satisfaction scores. This doesn't stop hospitals from trying though. Instead of hiring extra staff...such as patient care techs or more nurses so we have a better nurse to patient ration...they have decided that nurses can also do customer satisfaction type work.

Just when I think "what else can they possibly come up with to add to our workload"...they come up with more non-nursing things. The latest...one hour rounding. Sounds nice in theory, doesn't it? We are supposed to stop in at each patient room every hour & ask "Are you having any pain? Do you need to go potty? Do you want to change your position in bed? Do you have any other needs that I can help you with?" Again, sounds nice in theory. But every freaking hour? Just when do they expect patients to get some rest?

Ok, fair enough, I can handle it. What else can they throw at us? Hahahaha...why do I even ask? Now they want us to go in a 1/2 hour before the lab techs come around....they want us to wake up our patients to alert them that the lab will be drawing blood in approx 30 min. This is to be done any time between 2 am & 4 am. The lab will give us a 30 min notice. Somehow this will make the patients less frightened when the lab tech actually enters the room. As if it is the lab tech they are frightened about...no, it's the needles!

And if this isn't enough...in order to keep them awake for that 30 min period before lab gets there, we should bring them fresh water, empty the garbage & volunteer to help them to the bathroom. Are you kidding me? Seriously. Is there anyone that wants to be woken up at 2 am with a 30 min notice that lab is on their way? Do you want me bringing you fresh water at 2 am? Emptying the garbage can? I know if I were the patient I would be saying something like "GET OUT OF MY ROOM NOW!!!!!!!!" or "LET ME SLEEP!!!!!!!"

Ok, so seriously....what more can they add? Ha......more. We also have to ask when we do our initial assessment..."What is the most important thing we can accomplish for you tonight?" They look at me like I am insane or a bit off the wall.

And if that wasn't enough....the superuser post I had a week or so ago. I'm a superuser to show doctors how to put in their orders. Is this really part of nursing? Can't they hire ancillary staff to be available to the doctors rather than pull nurses away from the patients? Or how about the unit secretaries...you know...the ones that usually put in the orders. Wouldn't that make more sense since now they won't have as many orders to put in?

Sigh...I am afraid to ask "What else can they add?" Cause I'm sure there is a whole list of non-nursing ideas that they have.

I'm all for patients being satisfied with their hospital stay. I'm also realistic enough to know that by opening this door & allowing the patient to dictate what they consider "satisfaction"...it will be nearly impossible to achieve. We're not a high class hotel or a shopping mall, we're a healthcare facility. Let us get back to focusing on health.

It's wishful thinking though...sigh.