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.