Some updates!

Ahhhh....so much going on...

ME

*have lost 17.9 lbs in the last month with the help of Weight Watchers

*am very proud of myself for losing that weight considering I've had a sprained ankle for the last month & haven't been able to do much cardio

*have lost a total of 34 lbs if you count what I lost before starting WW

*my ankle on a good day is 90% better, on other days it's around 70%.....right now it's having a 90% day :)

*my knee is just about healed...which is a quick reminder of how amazing the human body is & the healing process

*working weekends only has been soooooo refreshing; I no longer feel overworked or overtired....just as the hard work is beginning to wear me down, my 2 day shift is over & I have 5 days for ME

*Christmas shopping will be a breeze this year....my family decided to do a grab bag name thingy, so technically I only have to buy for one person...and he's a millionaire, what do you get a millionaire? Haven't decided yet...lol. Of course I'm still gonna buy for my youngest niece & nephew since they are just kids. It is really nice not to be running around trying to figure out what to buy 10 to 15 other people.

*That also means I can buy myself stuff...like a new tv...which is yet to be determined. More details later.

WORK

*had a patient who was nearly 100 yrs old....Baker Acted because she tried to commit suicide. She has breathing problems & was tired of the struggle...so she took some sleeping pills. It's just a reminder that this country should have some humane way for people to leave Earth when they reach a certain age & are of sound mind to decide so. To make them wait until they are suffering....I just don't get it. Animals are treated better when it comes to stuff like this. And to be Baker Acted when you're nearly a century old...seriously??? Ridiculous!

*had another patient that started crying when she found out I wouldn't be back the next night. I've never had anyone react like that. Crying.......tears & tears. It's kinda nice to know we do impact some people's lives.

*our manager got promoted...so we are manager-less; I'm hoping whoever they do hire in the future doesn't impact our unit negatively; we have managed to go from being the floor no one ever wanted to work on...to now a waiting list & we did that in one year; I don't want to lose that.

*one of my favorite nurses ever is retiring at the end of this month; happy for her, sad for me :(

That's all for now...have a great weekend!!!

Still hobbling

I'm still hobbling around. The ankle is better & I can walk...but it gets swollen & at times it aches a little bit. I worked the weekend & did ok......even walked 2 1/2 miles after work Monday morning! I came home, went to sleep, woke up & ankle felt perfectly fine. I walk 30 feet to my mailbox & suddenly my ankle is aching. Grrr! And last night I tried out that new Kinect thing for Xbox360. Guess it's probably too soon to be jumping & moving side to side...cause my ankle was hurting afterwards. This morning I woke up & it was ok. I wish it would just all go away. It's been 10 days already...when will this swelling stop? I realize no one really knows, but I'm just venting a little. I want to get back to working out & walking without feeling like I'm overdoing it.

Work was ok. I got floated to a med/tele floor on Saturday. Not really sure why someone would order med/tele as opposed to PCU. They both require a heart monitor, but the med/tele floor only does vitals once a shift as opposed to PCU doing them every 4 hours. Oh well, I wasn't complaining. I was busy though & realized they have it far worse than I do. They get 5 patients WITHOUT a tech. That is insane to me. How do they expect us to deliver quality healthcare, yet not supply us with the ability to provide that? Seriously. I'm sure if the patient to nurse ratio was decreased, there would be far less hospital related deaths.

I won't go into that rant. Sunday I was back on my floor & all was fine until about 4:30 in the morning when our fabulous ER (not) gave me a patient with a diagnosis of bronchitis. Turns out his real admitting diagnosis should have been A-fib with RVR. Let me mention...new onset of A-fib too. His heart rate when he got to me was 163. Nice. I called & got a cardizem drip and after all his admission stuff was done, I wrote up the ER for delay of care. He came in 4 hours earlier & all of his EKG strips showed the A-fib & although his HR was not extremely high while in the ED...you could see it was increasing. Started out at 92 & the last strip they showed read 119. How do they not address something like that? Bronchitis at this point was the least of his worries!

Sighhhhhh.......

Sprained Ankle

I have finally started doing something healthy with my life....working out & eating better. I've been walking & walking & walking...and it's paid off. I've lost 7 lbs. I walk every single morning (who am I???). Yesterday I got up & walked when it was just 40 degrees outside. And wouldn't you know it...just as I'm about 2 blocks from my car, I stepped on some debris on the trail & sprained my ankle...as well as scraped up my knee. *%#)#$(!!!!

I don't think it's an extreme sprain as I am able to hobble around. There is no bruising that I can see. Some swelling of course...but I have been following the RICE treatment pretty much....rest, ice, compression & elevation. Since it happened yesterday morning, I had to call in to work because no way could I walk like a nurse needs to walk during her shift. I tried to picture myself in a wheelchair, but don't think my patients would have liked that...not to mention the rooms are so small, I doubt I could even get near my patients while in a wheelchair. I hate calling in though...even when it's 100% legit. I have to rest though. I called in again for tonight...because if I want to get better, I have got to rest it. Hopefully I don't get in any trouble...since I just went to the weekend option & we're only allowed 3 weekends off a year. Oh well, we'll see...but seriously, no way can I walk around for 13 hours.

I am walking to the bathroom & to the kitchen...it hurts, but I know it's good to move it if I can. I woke up this morning & it was all stiff & swollen, but I put some more ice on it & it's a little better. I'm planning to get more rest this week...as long as it takes. Luckily, I have nothing planned & I went grocery shopping last week...so I can last awhile indoors.

I'm frustrated though. I want to get back to walking. I want this pain & swelling gone. I guess in a way it's showing me how I take walking for granted. It was feeling so good walking every morning. I want to get back to that.

It's been about 20 years since I've sprained my ankle...so I ask those of you who are reading this....how long does it take to heal?

Work has been going ok. I am really liking just working 2 days a week. It gives me time to focus on me. I find it easier to get back to a normal sleep schedule. It's nice to be awake during the daylight hours!

I have to go study now. We have a nursing skills lab & this year they are insisting it be hands on & we have to teach them. Ugh. It's one thing to know what you are doing, it's another to have to verbalize it step by step.

Hope everyone is having a better weekend than I!!!!

You Got to Know When to Hold Em...

Know when to fold them, know when to walk away, know when to run......from patient's who are under a Marchmen Act. That song was running through my head last Wednesday night when I was just starting to take report, they handed me a piece of paper with a few details scribbled on it & said "your new admit is on their way up." Uhhh, say what???

Next thing I know, the charge nurse is taking all "dangerous objects" out of the room...like the plastic bags for the garbage & laundry, the blood pressure cuff & 02 sat from the dynamap on the wall, etc. Ummm....he's not suicidal, he's just an alcoholic who the cops brought in because he passed out at a bus stop. She seemed to think it was the same as a Baker Act...which is a person that is a danger to themselves &/or others. Basically a person who was trying to commit suicide.....whether they were really trying or just doing it for attention, we don't exactly know - but all dangerous objects have to leave the room. A Marchmen Act is just someone that is intoxicated & this act is put into place so that they are not allowed to walk out AMA...which most alcoholics would do if given the opportunity.

Anyways, luckily he's asleep (AKA knocked out with Ativan) when he arrives at the floor. The charge now wants me to put paper scrubs on him instead of the hospital gown. Again, this is ridiculous. He is not suicidal. And why can't we just get paper gowns instead of pants & a shirt? Have you ever tried to put a shirt & pants on someone that could get aggravated? Me either, because I wasn't about to start moving him all around in an attempt to put paper clothes on. I told the sitter let's just let him sleep & when he wakes up later, we'll attempt it then.

I took care of my other two patients as quickly as possible, because I just had a feeling this one would be some trouble when he woke up. It was then that I had the bright idea to volunteer to go home at 11, if they needed someone to go home. Best idea I've ever had. And luckily they did indeed need someone to go. He woke up around 10:30 asking for some food & then told me he'd be leaving after he ate. Ummm, no, you can't leave tonight. He wasn't agitated, but I could see that it could go that way. I got him some food, gave report & got out of there as quickly as possible. I just have a hard time dealing with someone that does not want to be at the hospital.

Not because I have a problem with the patient, but because I think they have the right to decide if they want to stay or not. We aren't a prison, we aren't a psych hospital....we are a regular hospital. If he wants help, he knows where to go. Why the cops just didn't take them to their station & let him sleep it off, I don't really know. Maybe they were overcrowded. Still though, it doesn't require a hospital stay to sober up. Meanwhile, we drug them up with Ativan so they are asleep most of the time until they are discharged. That is not a reason to be admitted.

I came home that night, picked up one of my best friend's & we headed to Denny's. It was a blast!

I started my weekend option Sunday night. I got floated to ICU again. Ahhhh!!!!! But this time it was a piece of cake.

I started walking again too. Now that I'm on the same schedule as one of my co-worker/good friend...we are determined to lose some weight. So every morning we're gonna walk.

I have nothing else planned for the rest of the week & it feels great!

Oh Honey Please

That's what I heard over & over my last two shifts at work from my patient....oh honey please....oh honey please....oh honey please. Sometimes it feels weird telling someone much older than me what they can or cannot do. Like this patient for instance....she was 90 yrs old, very unsteady on her feet & what did she want to do...get out of bed & go for a walk. It took two nurses just to help her to the bedside commode that was like 2 inches from her bed, so I knew there was no way I'd be able to take her for a walk. It didn't stop her from asking though...at least a 100 times.

She kept telling me her mother was waiting for her & that her grandmother would be mad if she didn't show up. New nurses might try to reorient 90 yr olds that talk like this. Me, however, I do not. I jump into their world & remind her that her mother & grandmother are fine...that they understand she needs to stay in bed & rest. I'm not about to tell her she's 90 & her mother & grandmother are not around. For all I know...their spirits could be in the room or the hallway or somewhere & she hears them perfectly fine. It's not uncommon to see someone speaking to someone that isn't there. Just because we can't see them, doesn't mean they don't exist, right?

I also did what I was taught a few years ago when you have a confused patient that is constantly trying to climb out of bed. You make the room a little more on the cooler side because then they are more apt to want to stay in bed & under the covers. I used to think that was so cruel when I was a new nurse. Now I totally get it. And it works a lot of the time.

I read an old post of mine from my first year in nursing. It cracked me up to see how naive I was. Now I'm old & jaded....kidding!!!!! But I do have experience on my side. It's weird now to be the experienced nurse on the floor with all the newbies. They all come to me with questions & amazingly, a lot of time I have the answers. It's still weird to me though because I don't feel like the "go to" person. I wonder if I ever will.

I have a co-worker who also happens to be a very good friend of mine. She tends to have a black cloud that follows her...meaning if there is a confused, combative patient...she usually ends up with them. She worked last Sunday & was telling me about this patient that was in restraints & got out of them & was threatening to kick her butt (to put it nicely) & she had to call security for help. Turns out I got him as a patient the next night. However, this patient couldn't have been any nicer. In fact, I had to take his restraints off twice to change his gown & bedding & he willingly let me put them back on. He thanked me for being so wonderful. I crack up because this is usually how it will go with my friend & I. If we are working the same night, she'll tell me about her outrageous patient...I'll walk in the room & the patient will have a nice, non-temperamental conversation with me. My friend stands there in awe. Thus, my nickname is "The Patient Whisperer." She wasn't a believer at first, but now she is...lol.

This is my last free weekend off. I have my brother & his kids over. We went to the mall to do a little shopping last night. I kept asking them "What do you want to do for fun?" One said "Red Lobster", the other said "Zaxby's." Ummm, that's your idea of fun? So as we were sitting down to dinner at Red Lobster, I brought the subject up again. I was throwing ideas out such as Halloween Horror Nights at Universal Studios, a movie, an Orlando Magic basketball game, a haunted house. It all got shot down. Apparently, their idea of fun is much different than mine.

Baylorrrrr Babyyyyyy

Yeah yeah....I'm going Baylor. That basically means instead of working 12 nights a month, I'll be working 8 nights...and get paid the same. The catch is that those 8 nights will always be Saturday & Sunday nights. Doesn't bother me...I'll have 5 days/nights off to do whatever I want. I don't do anything on the weekends that can't be done during the week AND I'll still have Friday nights & Saturday days if need be.

Needless to say...I am a happy camper. And I'll get to work right alongside one of my best nurse friends. Yaysers!!!

This week at work was nail-biting. They floated me to ICU. Ughhhhhh! I will never be an ICU nurse because the stress drives me insane. I am a PCU nurse...which means I am trained to notice when a patient's health has taken a turn for the worse. I notice it, I initiate getting something to help the patient &/OR getting the distressed patient to ICU....so they are in better hands & I no longer have to deal with the stress of a having a patient in distress. It's a win/win. However, when I am the "ICU nurse".....I feel like a newbie. I am stressed the entire shift & absolutely hate it.

I am not trained to work there, but for some reason, it's perfectly ok to float us non-ICU trained nurses to ICU when they are short. I had one patient who had been cardioverted from A-fib with RVR to a junctional rhythm with a heart rate of 30 beats per minute. Scary to me.

And my other patients...admitted with pneumonia BUT also has lung cancer that has mets to other places AND his family refuses to tell him he has any cancer whatsoever. I don't get how this is legal. The patient, while he is in his 80's, was alert & oriented. Isn't it HIS right to know what is going on with HIS body? His son is a pulmonologist & doesn't want his father giving up on life if he were to know he had cancer. What? How is this legal?

Fastforward to my shift with him & this patient was struggling to breathe. Respirations of 40 per min, 100% heated high flow as well as a non-rebreather mask. He would have mini-panic attacks (because he couldn't breathe) & his 02 sat would decrease to 78%. I'd have to calm him down, remind him to breathe through his nose & try to slow down his breathing. This went on all night. I hated it because I know he was suffering. His doctor son was in earlier in the shift & I confirmed the code status of his father = FULL CODE. Insane. He has lung cancer that has mets to other locations & he can barely breathe. It's time to start thinking about comfort care. This isn't a case of pneumonia that we can treat with antibiotics & send on his way.

By the time I left, he was barely keeping an 02 sat of 92% & he was so exhausted from labored breathing that he could hardly open his eyes. I kept asking those around me isn't there anything we can do for him? They told me no...not until he is unable to maintain 92%. I went home with him on my mind & when I came back to work that night, I saw that they had put him on a ventilator. Absolutely insane. I don't get how a pulmonologist could do this to his father. He is trained to know better. I doubt they'll be able to get him off the vent successfully. Needless to say, I hope I don't float back to ICU for a long, long time.

The rest of my week was fine. I actually got to leave a little early on my last shift. Yay....it's rare, but I love when I can leave early. One thing that made me smile at work was taking care of an 89 yr old patient. I went to wash my hands in the sink in her room & she had her curling iron, makeup & other hair accessories surrounding the sink. 89 yrs old and still doing her hair & makeup while in the hospital...lol. Adorable. I love taking care of little old ladies. I don't know why...they are just more enjoyable than anyone else. Of course it helps when they are alert & oriented!

I saw The Social Network & Devil this weekend. I found The Social Network interesting. Especially since it did not have any input from the guy that actually invented Facebook...rather it was the viewpoint of everyone that was suing him because they felt it was their idea. Lame. So even though they tried to portray him as some bad dude, the audience & I still seemed to be 100% on the side of the Facebook CEO. Hard to believe that FB is worth $25 billion. Devil was good.....if you like suspenseful type movies...which I do. Not gory, but plenty of suspense.

Peanut Butter reminds me of YOU

I went into work Sunday night. It was a veryyyy busy night for me. I was ready to ask for an orientation since I had been precepting all year. I forgot how exhausting it can be to take care of patients by myself. Whew!

Anyways, I started out the night with 2 patients. Within 30 min of shift change, I got a new admission. I got her name, looked up the info. Figured I'd have to transfuse some blood. Not a big deal, but can be time consuming with the hourly vital signs. As soon as the patient comes off the elevator with transport, she's saying "I know you!!!!!" I look at her, read her name again...I have no clue who she is. But you can't say that, so instead I try to play along. She starts naming the city I live in, what my favorite pizza is & mentions how she thinks my blue eyes are beautiful. Ok, she does know me...lol. Kidding. But putting all those things together brought it all back. I knew exactly who she was. I had her has a patient about a year ago. It's amazing how you can leave an impression on someone. I mean, I can barely remember what I did a few days ago...much less what some stranger may have crossed my path a year ago.

So I get her settled into bed. Her daughters are with her. She is trying to shoo them out the door by saying she needs to spend some time with me. Inside I am cracking up. This patient is in her late 70's. I have no idea why she is fascinated with me. While her daughters realize I am just a kind person, they are a little peeved their mother is kicking them out. I think at the same time though, they felt ok leaving her there....since she was so happy to see me.

She then brings up how I always brought her peanut butter & graham crackers last time she was there. And then she says "Every time I see peanut butter, it reminds me of you." Lol...cracks me up every time. Who says this to people? So now of course when I see peanut butter, it reminds me of her saying that I remind her of peanut butter. And it probably always will remind me of that.

Her hemoglobin was a little on the low side, nothing critical, but they ordered 2 units of RBC's. She also was feeling a little shaky. I got the blood transfused during the shift & came back the next night to find they were prepping her for a colonoscopy & EGD the next day...to see if there was an active bleed. Luckily, there was no active bleed...but at the same time, no explanation as to why her hemoglobin dropped. That's the part of medicine I don't like...not knowing why something out of the ordinary happens.

I had another patient that came in with a hemoglobin of 5.0. That is critical. Transfused a total of 4 units...but unable to find any active bleed. Huh? And I have this patient in my care for a total of 30 min & his mother is asking me why is he in this condition. Ummmm, I just got out of report. I'm lucky I know his name at this point. She needs to speak with the doctors because I had no info to give her. I felt awful because she was ready to burst into tears with no answers.

I have reached a point where I definitely know I'm getting old. When I think of the above patient, the first thought that pops into my head is "This kid..."....only he's not a kid. He's about 10 yrs younger than me....but as I'm giving report, I hear myself saying "This kid....". Have I reached the point of calling everyone younger than me a kid??? Oh boy. I'm old!!!

Anyways, back to my first patient. We frequently "round" (check in) on our patients. So I stopped by & asked if there was anything I could do for her or get for her. She says "What I've been asking you for all along...your address & phone number." Ummm, I can't give out personal info & at the same time, I'm trying not to even think about why she would want that info. Especially when she asked for my phone number but followed it up with "I'm not going to call you." Huh? Since she asked about 6 times for the information, I gave her one of the hospital business cards with their address & ph number on it. I explained to her that it's against hospital policy to give out personal info. She was fine with it & she loved the business card. Even put it away in a safe place. I'm hoping she's not planning on sending me a year's supply of peanut butter or anything. :)

It's been a strange week. My orientee is on her own for the first time this week & her patient wrote her a 2 page love letter. It was a little on the creepy side, but I'm sure he meant well. We had another patient write a 4 page letter complaining about a doctor. It's just one of those weeks.

Scary moment

This doesn't have to do with nursing, but I had a very scary moment around 3:30 this morning. My precious dog Shay ran away. I had let her out & when I went to call her back in, she was nowhere to be found. I called out for her over & over for 10 min. Nothing.

I grabbed a flashlight & some shoes & headed down this eery dirt road next to my house. I refer to it as the Texas Chainsaw Massacre type road. There are a couple of houses back there & one of them has dogs. I hoped she had maybe wandered over there. While I'm walking, I call my brother. No answer. I call one of my good friends. No answer. Ugh...I'm on my own at 3:30 in the morning to try to find my princess. I call her name repeatedly & get no response. As I got closer to the houses, I worried that one of the homeowner's might come out with a gun & shoot me...because I'm sure I'm the only person that has ever wandered down that scary looking road in the middle of the night.

So I walk back to my house with plans to drive around. I have no idea where to drive around as I live on the main road & other than the dirt road, there aren't many other roads to look on. There are plenty of woods though. I get home & walk in the door & see that Shay has returned. I was sooooooooo grateful. I have no idea where she was, but was glad she was smart enough to know how to come back.

In other news...I bought an iPad!!! I love it. I don't love the price, but I love the item. It is really handy & I'm definitely getting my money's worth.

Work has been ok. It was my orientee's last week & she was sick two of the three days. So I was back on my own. It wasn't bad. I had one quirky patient...when I went into his room, it had to be about 95 degrees. I asked "Why do you want it so hot in here?" He replied "I'm doing laundry." I look over at the air conditioner/heater & he has his socks & underwear sitting on top. Ok, gross. I'm sure that is a fire hazard too, but I got his vital signs & got out of there. I felt like I was in a sauna.

I also had a patient in his late 20's that was just diagnosed with cardiomyopathy. His ejection fraction was approx 32%. That is really poor for someone of that age. His doctor also informed him that he could drop dead at any time with this diagnosis. Then the doctor leaves and my patient is crying. Only he doesn't want me to see that he is crying...so he puts the bedspread over his head. Can you picture this? It was as bizarre as it sounds.

It was a wake up call for me though. I definitely don't treat my body the way I should.....rarely ever exercise or eat right. I'm joining the YMCA tomorrow & will make exercise a priority. The heart needs to be worked out in order to remain strong. I know this. I will do this. The eating...well, that won't be as easy to implement, but I plan to work towards eating better. Baby steps.

Urgent need

A co-worker of mine gets an urgent call from one of her patient's the other night. "Hurry, come quick to my room, hurryyyyyyyyy!!!!!!!!!!" So she races down the hall to see what is wrong with the patient. The patient replies "I need you to get me my purse, there is some face cream I want to buy on this infomercial." Seriously??? That is the urgent need? Ahhhh...#$#$^%!&&#@.

It is getting so beyond ridiculous what nursing in a hospital setting is turning into. No longer are we "nursing" people back to health...we are too busy portraying ourselves as customer service reps who will do whatever, whenever & however it takes so that the hospital can get a good rating when they send out the survey after the patient's visit.

It's not the hospital's fault. It's the govt. They send out surveys to everyone that stays in the hospital except those living in a nursing home, frequent flyers, alcoholics or Baker Acts/drug overdoses. If a hospital doesn't score high, then the govt (Medicare/Medicaid) doesn't have to pay the hospital. Doesn't matter if the healthcare was amazing & the patient is healed & healthy now...it all depends on the hospital survey rating. So in turn, our focus is more on making the patient happy than healthy. Ugh!

I'm telling you...it's just a matter of time before hospitals are including spa like services....manicures, pedicures, hairstyling...just to increase patient satisfaction scores. This is what "healthcare" is turning into.

What a joke!

Uneventful

Not too much going on lately. It's been a couple of uneventful weeks (my favorite type of weeks!). I don't know if it's cause of my age or just the line of work I am in, but I am so forgetful. Like just to try to remember what type of patients I had in the last week or two...I draw a blank. Maybe it's what nurses do....forget the past so we can focus on the present. I don't know. Lately it's to the point that I can barely even remember patient's names & I only have 3 or 4 patients a night! I refer to them by room numbers...which I'm sure HIPAA is happy about, but it stinks when you go in a patient's room & can't remember their name. Now I see why so many nurses call their patients honey or dear. I have yet to do that...I just don't refer to strangers with pet names. Now if it's my niece or my dog...I call them a zillion different cute things, but strangers...nope, just not my thing.

I have 3 weeks left with my orientee. I'm hoping there will be a new hire so I can have another trainee, but so far I've heard nothing. It's been a long time since I've had to take patients on my own. Oh well, it's not like I'm not capable of it. Of course I'm hoping it opens up the possibility of being called off. They seem to skip me since I have an orientee. Then again, it also puts me on the float list. I dread being floated. It's like taking a fish out of water....it's so not my comfort zone. Especially when they float me to ICU. So far I've been able to avoid that, but I'm sure I won't always be able to pull that off. ICU is just not for me.

In other news...I went to my first IMAX movie last night. I saw Inception & I have to say...IMAX is amazing. Definitely worth the extra money just for the comfortable seats. Inception was a bit confusing though.

Not too much else is really going on. I've been slowly redecorating my house. I have so many things I want to buy....new refrigerator, new tv's, new couch, new car...but nothing is absolutely necessary & I want no bills. So I shall save my money & hopefully by December I'll be able to get some the things I'm wanting. One good thing...my mortgage is paid off. Woo hoo...I am officially debt free. :)

I hope everyone is having a wonderful Labor Day weekend. I've just been taking it easy. Time seems to fly by faster than ever. I don't get it. Even the days where I have absolutely nothing planned & don't even leave the house...the time flies by. I guess it's all part of getting older.

Well Amanda

You wanted to know what happened with the patient...the doc came in, ordered Benadryl & 2 hours she woke up perfectly fine. Makes absolutely no sense to me as that was not an allergic reaction I was witnessing. 2 days later she drove herself home. Weird!!!!!

I've got some more peculiar situations, but I have one more shift tonight. So I've got to get to bed & I'll catch up this weekend.

Like Nothing I'd Ever Seen Before

Last Tues night/early Wed morning a patient was admitted...she was in her late 30's...she had a panic attack. She wasn't my patient, but my orientee jumped in to help because this pt's nurse was helping another nurse's pt who was in bad shape. We put the heart monitor on & took vitals...she seemed totally alert & oriented & normal. Since insurance companies don't really like people being admitted with a diagnosis of panic attack, she was admitted with chest pain. Plus she had an abnormal EKG. Regardless, I figured she'd be discharged by the time we got back the next night as most walkie-talkie chest painers usually are.

Well, we end up getting her as our patient on Wednesday night & I was like "Why is she still here?" The report I got was crappy......day nurse was like "I don't know why she's still here." Doesn't give us much info at all. Not only turns out they had a stress test scheduled for her the next morning, but when we went to assess her at 1930...she is sitting in bed shaking, looking scared to death, but not saying a word....even when we'd speak to her. Weird!! I asked her "What's wrong?" No response. Day nurse had given her a Xanax at 1900 (never told us she did or why she did!!!!) We took her vitals & left to discuss this weirdness.

We came back 10 min later to her vomiting all over the floor. Ok, doubt the Xanax ever really got in her system, so we call the psych MD (yep, psych was on the case) & he orders THORAZINE........old psych med, not really recommended these days, much less IV. So we give that to her & she falls asleep. I think ok...she'll sleep the rest of the night, no problem. Still bugs me though that her behavior was so beyond anything I'd ever seen before.

Nope, 2 hours later she's awake, still silent, but now her arms are all flexed & she's staring at the wall. She can say her name & year, etc when urged to do so, but otherwise silent. Her one arm is all twisted & her legs are doing funky things. She vomited a few more times that night...just green bile as she hadn't had much to eat or drink in the last 5 days. Ok, weird, but she falls asleep again.

I had no idea what to do for her. Us nurses like to fix things & this was not fixable. I even had four very experienced nurses assess her. Like myself...they had never seen anything like that. I said how would I even describe that over the phone to the MD? The charge nurse told me not to call...the pt wasn't in distress & this was something they would have to see with their own eyes. Ok, no prob. Last thing I wanted was to give her something that would just make her sleep during the day when the MD's rounded. They definitely had to see this peculiar behavior with their own eyes.

Now it's 6 am (yay = almost time for me to go home) & she has had no urine output the entire shift....so we call her primary doc at 0645 (didn't want to wake him up with this news, so waited until the last minute...figuring he'd order fluids & we could hang them before we left). He tells my orientee (hey ,she needs to get used to calling md's) there is nothing more he can do for this pt, it's all a psych issue & he will not be ordering anything for her. Ummmm...what?? She has no urine output in over 12 hours. We can't give her fluids? Nope, nothing. Did I mention that the psych doctor had signed off? What a mess!

Two minutes later the stress lab is calling for report on her. I told them "ummm, I doubt she will be able to have a stress test today." They said they would still come & get her & if she refused...then she wouldn't have it done. I just don't think they were comprehending just how bizarre this patient was. Oh well, soon enough they would see.

So before we left, we repositioned her in bed as she now had the pillow over her head & her legs sticking out on the side of the bed...not exactly the way I like to leave my patients. She was all sweaty & still not speaking. Gave report to the lucky day nurse & wished her luck. She had seen this patient yesterday as her partner was the pt's nurse. I told her I'll be asking her next week what the doctors had to say regarding the pt's condition...because it was so not normal.

All I can think is that according to her history...she ran out of Celexa & just stopped taking it. I know you aren't supposed to do that with antidepressants........so maybe that was causing the reaction we got. I don't know. Maybe the Thorazine just made it worse...with all those twisted arms and weird body positions. It was just very bizarre!!!!!!!!!

I'm curious to see how it all turned out.

I spent another weekend in Orlando. I pricelined it again (I need help!). I got Embassy Suites for $53 a night. Usually it's $123. Good deal, but lousy hotel. I usually like Embassy Suites, but this one was kinda trashy...which somehow got rated a 3.5 stars on Priceline. I have no idea how! It was cloudy & all rainy the entire weekend, so no sun for me. I did see The Other Guys...I found it amusing. Will Ferrell & Marky Mark are funny. If you don't like them, you probably won't like the movie.

Commit me now!

Yes, that's right...commit me now. Dare I say it...I am actually looking forward to going back to work later tonight! What is wrong with me??? Lol...seriously, this is so not me. Usually I am the one counting the days down until I am off again (which I am already doing for this week). I've been on vacation for nearly 2 weeks & it feels like it's been 6 months. You don't really need to commit me...because around 10:30 earlier tonight, my hospital called asking if I wanted to work 11 to 7 and me being the reliable person I am...didn't answer the phone. :)

Everyone else is doing them, so I will too...bullet time!

**Why is it that when I go to a restaurant & they ask what I would like to drink & I say "Dr. Pepper"....I get a reply of "We don't have Dr. Pepper, but we do have root beer." Ummm, I don't know about the rest of you...but in my experience, root beer isn't anything like Dr. Pepper.

**I just got done eating some pumpkin seeds & every time I do this, afterwards I am left wondering why I even bothered. They are too salty, too much work goes into getting them out of the shell & in the back of my mind...I see a future diagnosis of diverticulosis because I don't always get all of the shell off & end up eating it. Sigh.

**I am way more easy-going than I ever thought possible. My niece & I played this brain-wave game at Wonder Works...where it somehow measured the stress in your mind & would show it on a screen measured thru your brain wave activity. We watched people ahead of us & their activity was all over the place. Then we sat down & practically nothing. Like the lowest line possible on the monitor showed up for both of us. We thought maybe it wasn't working right, but they brought some other people in & bam...it was all over the place again. So either we are both very easy-going or we're brain-dead. Hey...maybe both!

**I am anticipating the next time I can plan a vacation strictly for the chance to bid on priceline again...lol.

**I saw the movie Salt tonight - was way better than I expected, however I had no expectations at all...so figure that one out!

**I stayed up until 6 am yesterday rearranging & reorganizing room...because I can!!! (and just maybe it needed to be done)

**I watched a new show called Last Chance Highway...and started crying profusely...tears of happiness. It's an 8 episode show about a lady that goes to dog pounds & saves dogs. It shows how she picks them out, how she takes them into her home & how she gets them adopted. The crying began when the saved dogs met their future families. What can I say...I have a weak spot for doggies. Google it if interested.

**I had a lady come up to me in a parking lot asking for money. Hmmm...that sounds like she was robbing me...she definitely wasn't doing that. She was just asking for a handout. I felt bad, but at the same time I just wondered how legit she was. I've got no problem donating to shelters or causes or co-workers, etc....but I don't like strangers approaching me in parking lots.

**My last entry will be a reminder to those in the dating pool.....DO NOT get drunk on a first date & gross out the people sitting at the next table over. I took my niece & nephew to Applebee's for dinner after the movie. We had the pleasure of sitting next to this scary looking couple of characters on their first date. I swear they had 6 drinks each & had yet to order dinner. He was really loud, but suddenly it went quiet so I made the mistake of glancing their way only to find them making out at the table. Uhhh....gross!!!!! I'm trying to eat here. Needless to say, we skipped dessert & got out of there as quickly as possible.

OMG

How is it possible that it is August 1st right now & the only thing I posted in the last month was a few sentences about going on vacation? OMG...I am really slacking.

I wish I could blame it on overworking or having such an exciting, busy life that I haven't had time to post...but umm, no, that's not it. In fact, I've been off of work for nearly 2 weeks now. I go back Monday night. I guess I've just gotten super lazy. Sorry.

My latest orientee just took her NCLEX board exam & passed. Yay! So that means she'll still be on orientation until the end of September....again Yay! I'm getting really used to teaching new nurses. I hope I'm doing a good job. My first orientee is doing wonderfully for a new nurse. My second one seems to have conflict everywhere, that even I don't understand. And my latest one...it's like having a puppy. New nurses are so eager to learn, so eager to do stuff. I looked back on one of the sayings I read back when I was a new nurse. It basically compared experienced nurses to new nurses & it cracks me up cause it's 100% true.

Anyways...let's see...I can't really say much about work. Nothing outstanding really comes to mind. My oldest niece has decided to go to nursing school though. She was in college to become a dental hygienist, but after 2 yrs of working towards it....I guess she found it boring. I don't think she has any idea what she's getting into with nursing, but boring would not be one of the words I used to describe it!

My vacation was wonderful. I went to the exciting city of Orlando. Yep....about a 30 min drive from my house...lol. For those that don't know....the south is experiencing an unbearable heat wave. It started in June & just does not seem to be letting up. At 7 pm this evening it was 92 degrees out. And it feels like I'm stepping into a sauna whenever I go outside. I should just sit out there...I swear I could lose 5 lbs just from being outside for about 20 min.

Anyways, I searched & searched & searched every hotel room from Daytona to Fort Lauderdale...looking for something nice, but not too pricey because I needed 2 rooms....my brother & his kids were tagging along & while I don't mind sharing a room with my niece...no way was I going to have my brother & nephew in the room with us. So for a good 2 weeks I looked at nearly every hotel room online. I'm sure I set some type of world record!

The day BEFORE we were set to begin the vacation, I started to panic as I still had yet to make a decision on where to stay. I somehow stumbled across a message board regarding Priceline.com. I am soooooooooo glad I did. It showed me the hotels that are "usually" chosen when you bid. I decided to take a chance. I figured anything rated 4 stars (highest ranking) would be a decent place to stay & secretly hoped for the Hyatt Grand Cypress. The usual rate is around $200 or higher. Hotels.com was offering it for $159. Nope...I wanted a better deal. Soooooo I took a chance & tried priceline. My first attempt at $62 was rejected....grrrr. So I upped it a little & put in $80 & it was accepted!!!!!!!!!! How awesome is that??? It wasn't a bargain...it was a steal!!!!!!!! I reserved it for 2 nights.

Next I attempted to bid on a hotel near Wet n Wild water park...figuring my brother & his children could walk over there while I do a little R&R at the pool. Low & behold, I got my favorite hotel (the one I usually always stay at while in Orlando) for $30 a night. Usually it's $75 & that is with a Florida resident discount. Usually the rooms are like $125. Needless to say...I love priceline. I will attempt more future vacations using it.

We pretty much took it easy. One day of shopping. A night of Wonder Works and the Fun Spot Amusement place. Nothing big....but I am happy as long as I have some sun & a pool.

Hope everyone is doing well. Congratulations to my friend Amanda...she delivered a healthy, beautiful baby girl a few days ago!!

Countdown is on...

The countdown is on...for vacation. I work the next 4 nights in a row & then off for like 10 days. Not sure where I'm going yet, but it will include sun, tropical drinks & a pool.

Out with the Old...

It's a new week...feeling soooo much better than last week. Nothing like having 5 days off to make one forget what they deal with at work. I didn't do much of anything. I did attempt to clean my closet. Well, the closet is looking great, but my bedroom has everything all over the floor that I don't want to put back into the closet. So the bedroom is a disaster, but the closet looks mahveloussss...lol.

I go back to work tonight. It's my orientee's final week before she's on her own. I feel a little bad for her. She tried to match her schedule to mine for next month & they gave her only like 3 days out of 9 that I am working. She's afraid to be without me, but she'll be fine. I felt the same way when I was coming off orientation. I'm also starting tonight with a new orientee. So out with the old, in with the new.

I like having orientee's, but the first week or two is kinda rough. So much to show them & they have so much to learn. I have been lucky - the orientees I've had so far have been pretty quick learners. I'm hoping this one is the same. We'll see.

Hope everyone had a great weekend & stay cool in this hot, hot weather (it's over 100 degrees here in FL...ugh).

What in the World?

What a strange shift it was last night. I don't know what is going on this week, but we seem to have every alcoholic around walking into the ED drunk & wanting a room. As if it's a hotel or a shelter. And they admit them...every time. I certainly didn't go into nursing to babysit drunks. And I'm not talking about drunks who have decided they've had enough of drinking and want to stop. No, all they want is to leave as quickly as they came in so they can resume their lifestyle. Only we can't let them leave because now 3 days later, they are detoxing, confused & not a whole lot of fun to be around.

One of mine almost escaped this morning. I'm not kidding when I say his hand was on the door of the stairway to leave the building. Whew. Close one. And wouldn't you know it's when I wasn't the last one in his room when the bed alarm went off every 15 min. Whoever it was, they forgot to reset the bed alarm...thus the reason he was nearly able to get away. Luckily he was pleasantly confused & walked back to his room with a little bit of coaxing. All while dripping blood up & down the hallways because he pulled out his IV. Did I mention all of this went down around 6:40 am...right as the change of shift was starting to happen.

The one good thing about that.........makes me very eager to go home. And so very thankful my work week is over until next Monday. I have no ill will towards these unfortunate individuals. I try to understand what led them to where they are today & they all have a troubling past.

What I am a bit resentful towards is that this isn't nursing. And it's not so much this incident...in fact it's hardly got anything to do with it other than for a few seconds I think about what if he did leave & no one had noticed? What kind of liability does that put on me? Ugh, don't want to think about it too much. Too scary.

It seems more & more that the hospital as well as the Joint Commission or maybe the hospital is changing simply because of the Joint Commission & all of their changes/requirements/b.s as well as Medicare. Whatever it is, it's not nursing. It's not what I was doing 5 years ago as a nurse. Certainly I can't be the only one that has seen how much other work has been dumped in our laps.

Rarely do we have the time to really be a nurse to our patients. We are expected to be everything....friend, family member, secretary, maid, social worker, counselor, assistant, concierge, detox professional, pharmacists, sleep apnea reps....it goes on & on. How did all of that somehow get lumped into what a nurse is?

Or maybe it's just the dynamics of my unit now that we have no techs and we are basically the only ones the patient interacts with other than the doctors popping in for 30 to 60 seconds & disappearing again. I don't know. Maybe it was just a crazy week & it's got me thinking too much.

Hopefully next week will be a better week.

Close Call

Word of advice to my fellow nurses...please, please, please think before giving hypertensive medications. For some reason, the dayshift nurse felt it appropriate to give Atenolol and Lisinopril to a patient with a BP of approx 92/45. NOT A GOOD IDEA! I had him by the time the meds kicked in with a BP of 62/38. Being an experienced nurse, I knew that a bolus was necessary & got the intervention started quickly.....I don't even want to imagine what the alternative might have been.

Work is going pretty well. I just celebrated my 1 yr anniv at this hospital I switched over to. It went by quickly. I also get a raise this month...sweet.

It has been outrageously hot & humid this month. We're talking like 99 degrees, but with the heat index...more like 105. Ugh. Too hot for me.

Sometimes They Shouldn't Be Saved

We had a code blue about 10 days ago. Don't know why, but a normal alert & oriented person's heart just stopped beating. No real warnings. The code was called. I was handed the book to record the minute by minute details of what happened during the code. I had never done that before, but I learned quickly. My advice...get a blank piece of paper & just start writing stuff down...by the minute. Then after all is said & done, transfer it to the official code paperwork.

Anyways, the patient was asystole....epinephrine and atropine were pushed. CPR continued...we got a pulse, then it went to v-tach and then to v-fib. What do we do with v-fib.......defib. We ended up shocking him 4 times. Just as they were calling for us to stop the code, a normal sinus rhythm popped up on the screen. Sounds like a miracle...but the code had lasted 20 minutes & it's too long without oxygen to the brain. He survived...he's on a vent...but plans to extubate & send him with hospice since he is virtually brain dead.

It's sad...both for the medical staff and the family. We think we were helping, but after all is said & done, we should have let him go a few minutes sooner during that code. I feel for the family...it's a tough decision for them, but they are making the right one.

My orientee is doing well. She's taking the full patient load on her own & I am trying to back off & let her come to me if she needs advice. She has 12 shifts left on orientation, so she needs to learn to be independent. I think this week I will challenge her...when she comes to me to ask a question, I'll ask her what she thinks. It's the best way to learn. She seems to have a good head on her shoulders.

We got fitted for our navy colored scrubs. No one is happy about all looking the same, but there's nothing we can do about it. I'm glad it's not white or some other goofy color. I feel like they are making us generic by all looking the same. Oh well, seems like many hospitals are doing this also. If that's my biggest pet peeve with the hospital, it's not so bad.

I spent last weekend with my three bff's at a hotel in Orlando. One of my friends turned 40, so we spent the day poolside and the night at Citywalk. Stayed the night at the hotel & went shopping the next day. It was a blast!!!

And speaking of bff's......today is Maria's b-day. Happy Birthday, Maria!!! :))

Grey's Anatomy finale

Did you see it? If not, stop reading this & go to abc.com and watch it. It was nervewracking & suspenseful. The best I've ever seen on tv ever! I had to remind myself to breathe. Some scenes are graphic/violent, so don't watch if you don't think you can handle it.

For those of you who did see it....what did you think?

Here's a link to the show...it's in 2 parts...

http://abc.go.com/watch/greys-anatomy/93515/261783/sanctuary-(finale-part-1)

http://abc.go.com/watch/greys-anatomy/93515/261805/death-and-all-his-friends-(finale-part-2)

I Made a Nurse Cry

Yep, I made a nurse cry last night.....because it was her 60th birthday & I managed to surprise her with a mini-party! :)

Work is going well. Had my yearly eval the other day. Yep, it's just about a year since I switched hospitals & for once, it was an awesome eval. My old hospital would never quite give you the credit you deserved because their motto was "you should always be striving to do better." Ummm, ok, I can strive to do better while still doing great & that's exactly what this eval was about. Or more like "don't change anything, we love what you're doing." It's nice to be appreciated. I was also told I am the designated preceptor for the night shift for new hires. Nice! And we have raises coming in June. Woo hoo!

It's kind of amazing. When I first got hired at this hospital a year ago, my floor was like the most unwanted floor for anyone to want to work on. Now 12 months later....there is an actual waiting list of nurses who want to work on my floor only. Needless to say, not only have I had an awesome year, so has my unit. We are where everyone wants to be. I don't think it's only because our pt ratio is 3 to 1, but also the attitude the floor exudes. Teamwork has increased 100%. It's now a fun, friendly floor. I like to think that those of us that transferred from my old hospital were a large part of the reason...because that is how we prefer to work...as a team. And that attitude is contagious. So all is good. I'm happy with my career at this point.

I do need to get focused on achieving my bachelor's degree in nursing. This hospital will pay for it 100%, so why not? The thought of having to do schoolwork though = ugh. Maybe later in the year. I don't want to think about it right now.

I'm going to Disney's Animal Kingdom in the morning...so I've got to get some sleep. Have a good weekend everyone!

Incredible!!!!!

Yes, my fascination with Tim McGraw continues. I saw him in concert yet again this past Thursday night in Jacksonville. He is just incredible. He sang for nearly 2 hours and at one point the lead singer from Lynyrd Skynyrd was there & they were singing "Sweet Home Alabama" together. It was amazing. I could never tire of watching Tim.

I think I was sitting in the row of "men with tiny bladders who drink too much alcohol." I had an aisle seat & must have had to get up at least 80 times to let these guys by. It was ridiculous, but they are lucky I was in a good mood.

Lady Antebellum opened for Tim. They are awesome & I'm sure this will be the last time they ever open for anyone. They are well on their way to being a great band.

I'm already checking out the other cities Tim will be in this summer.....might just have to take a road trip. Yes, he was that good!! :))