Saturday, January 28, 2012

First Time

The other night was the first time I actually felt something emotionally for a patient. That might sound let me tell you more. 99.999999% of the time I can do my job without forming any emotional attachment whatsoever. Within a week, I have usually forgotten who I've even taken care of. That's not to say I don't connect with my patients. I do....I am very easy to talk to & get along with & I know my patients appreciate that. The blonde hair & blue eyes doesn't hurt either. I don't think I've ever had a patient ever complain about me to anyone. If they have, I never heard about it. Maybe it's because I know customer service & that is exactly what healthcare is turning into. We may not be able to save your life, but as long as the patient feels like we kissed their ass....that seems to be all that matters. Don't even get me started on patient satisfaction.

I got this patient as a new onset of 2nd degree heart block type 1....wenckebach. I don't see it very often, so I was somewhat worried & wondering how long before she slipped into 3rd degree heart block. She was an older lady, in her late 80's...lived at home alone. A jokester...she was asking for rum & coke as soon as she got to the room. She had a line for everything & while at times that can be annoying, she was cute. Her blood pressure was stable, her heart rate was ranging from 48 to 58. So far she was non-symptomatic, although she did have some dizziness earlier. I spoke with the on call cardio nurse practitioner & faxed her the EKG. She called back & told me to keep a close eye on this patient. Uhhhh, ok. Quit scaring me.

Off to sleep she goes & it isn't long for her heart rate to drop into the 30's. Eeekkk....I don't like it. So I do what I normally wouldn't do...I woke her up. She talked & talked & talked. I listen & listened & listened. I felt for her. She belongs in an assisted living facility, but she owns a home that will not sell. Therefore, she can't afford an assisted living facility. She also has no family around. So she relies on taxies & acquaintances to help her get to the doctors appts, the grocery store, to clean her house. It broke my heart. It made me think about how many of our elderly population is in the same boat. How many are living alone......feeling lonely & having to trust that these mere acquaintances aren't taking advantage of them? How many are being taken advantage of & possibly abused alone with it. She went on to tell me she had 13 brothers & sisters & the celebrations they had when they were younger. Just sad that their final days are spent so alone. I don't know if she had children, she never spoke of them & I figured it wasn't my place to ask. If she does though...I have to wonder how they can just abandon their mother like that. I could never do that. I finally exhausted the poor lady from all her talking & told her to get some sleep. I walked over to the monitor to check her heart rate & rhythm....wouldn't you know it...she converted back to a normal sinus rhythm!!!!!! Heart rate was in the 70's. That doesn't mean she couldn't slip back into the heart block....but it did mean I could breathe a little easier the rest of the shift.

I had a patient two days earlier....nearly 100 yrs old. She was easy to care for. Her son, however, was not. When I say that I would have preferred to jump off a bridge as opposed to listen to him talk....I am not kidding. This guy talked & talked & talked & talked. I was ready to bang my head against the wall as he never shut up...ever. If he wasn't talking to me, he was talking to his mother or the secretary or the patient in the next room or anyone that walked by the room. He never shut up. And he was one of those that thought he knew it all too. Around 9:30 pm he finally said he was gonna go home & get some sleep. Great! Bye!!!!!!!!!! Two hours later he was back & fully recharged to talk more. Ahhhhhhhhhhhhhhhhhhhhhh!!!!!!!!!!!!!!!!!!! Even as my shift was over & I was in the elevator to leave, he was holding open the elevator door to talk to me some more. I nicknamed him chatty Cathy. I also refused to take his mother back as a patient ever again. I just could not take anymore non-stop chatter.

On a bright note, I have stopped stressing about work. I figure all hospital administrations suck, so I may as well get used to it & make the best of it. I did a little research of my own on this HCAPHS/patient satisfaction stuff. And while my hospital tries to tell us they won't get any reimbursement from the govt if we aren't super high scoring on the turns out we are talking 1%. They will take a 1% cut if they are a low scoring hospital. I'm sure that is millions, but it's not what I was picturing....that the hospital would be getting no compensation. I think their goals are too hospital wants to score 85% or higher. Ummmm....who usually fills out surveys? Happy people? NO. Mad people? YES. Cause they want someone to know why they were unhappy. Drug addicts? YES. Because we will never be able to meet their pain requirements. Disgruntled family members? YES. Because they seem to think the hospital is a hotel & nothing we do is good enough. Oh well............I'm letting that stress go. Not gonna worry about it anymore.

Things with my guy......a mess. I think I've broken up with him like 5 times in the last 2 months. Funny thing is, he never believes me. He doesn't leave. He also doesn't get mad, which I guess is good for me. I, however, seem annoyed a lot. I'm not so sure it is all his fault. I am giving him credit for being patient & loving me even when it is the last thing I want or deserve.

And when I say I'm not so sure it is his fault...I am convinced I have started perimenopause. Yes, at 42.....I feel like I have hot flashes & moodiness. My period which use to last a max of 3 days is now dragged out over a week. I can cry for absolutely no reason. Like just last night I was watching something on tv & tears came to my eyes. It wasn't even anything sad or touching. In fact, I don't even remember what it was! And the cruel thing about all this......I know when it is happening. Like I know when I am acting irrational, that I truly am irrational. It isn't like I display this behavior & days later I realize I was wrong. I know in the moment that my behavior is not normal. I'm usually so calm & easy going....not much gets to me. The last few months....forget that! And no, it isn't mental illness either. I'm not doing anything inappropriate or detrimental. It's just the moodiness. And the hot flashes. Don't even get me started on the night sweats. I thought this stuff didn't start until at least 50. Sigh.

Ok, enough of this depressing stuff. This week I only work Sunday & Monday. On Wednesday I'm having lunch with my mom, aunt & sister-in-law. After that I'm planning to spend a few days in Orlando relaxing poolside. I hope the weather cooperates. I was going to bring my niece, but now I think I will just take a few days to myself...where I don't have to care for anyone but me. I hope that gets me out of this funk.

One thing that definitely lifted my mood was LUKE BRYAN. He was in concert this past Sunday with Jason Aldean. He is amazing! I felt so much better after the concert.

Have a good week!

Saturday, January 7, 2012

A Little Moody

Feels like forever since I last posted. Sorry about that. Time continues to fly by. I mean Christmas Eve was nearly 2 weeks ago....and now we are ending our first week of January. Goes by way too quick.

Last weekend at work...ugh, it was not one of my better times. I felt overwhelmed. Not by nursing, but by all of the non-nursing things we are expected to handle. I had a Baker Act (someone on a 72 hour psych hold) that was to be transferred to a psych facility when medically stable. Well, the MD signed the discharge...even though she wasn't medically stable. So the psych facility refuses to take her but tells me "I" need to get the order to cancel the transfer. Why? Why do "I" need to get that order? I have 9023480932 other things to do. Seems like it should have been something case management could handle, but nope. Repeated phone calls to the nurse practitioner on call who refuses to give that order & insists the order is "psych facility refuses patient." Uhhh, that's not an order. After spending nearly an hour of my time getting this "order", I gave up & deferred it to my charge nurse who had to get the nursing supervisor involved. The order never was written either...sigh.

The next night I still had this Baker Act & then got another Baker Act...this one was a crackhead. I'm not exaggerating. He smokes crack, doesn't take his much needed medication, comes to the hospital complaining of chest pain, weakness & acid reflux. He does this about twice a week...for the last 3 years straight. I'm not kidding. At some point, a hospital should be able to say "sorry buddy, no aren't allowed here for this same condition any more." Only I guess hospitals aren't allowed to do that. So I got the pleasure of dealing with this crackhead coming down off a high, his throat burning as though it were on fire & his attitude that I am there to SERVE him. Uhhhhhhh, check that attitude at the door. I have no sympathy for someone in his condition. He puts himself there. You don't want a bad case of acid reflux? Then don't smoke crack cause it breaks down the lining in your esophagus. And don't tell me you're nauseous as you finish off your 10th bowl of cereal in 4 hours, your four ice creams, your 15 fruit juices and ask me for a pepsi & chicken noodle soup inbetween complaining of nausea. I'm not buying it, nor do I feel bad for you. And I sympathize even less when you refuse to allow me or my staff to do anything...refused vital signs, refused heart monitor, refused lab draw. Time for you to go buddy. This is a hospital, not a hotel. Not to mention he got all up in my charge nurse's face for absolutely no reason. She was brave (maybe stupid), but I wasn't about to challenge someone coming down off a high with an unstable psych history who wasn't taking his meds. Nope, my life is too important to me.

And my third youngest patient was 87. I felt like I was caring for triplets. As soon as I'd get one settled and quiet, the other two would act up. It just reminded me as to how much I miss having techs on the floor. Life would be a better place if we'd get techs back.

Which leads me to question if this is the place I want to stay. I feel like I'm getting burnt out. I'm getting frustrated. Not so much by all the intense hands on patient care (which is tiring & my back aches), but by how micromanaged our hospital now is by administration. We are having a mandatory seminar on how to round on a patient. And if that's not enough, we have to get checked off also. Soooooooooo stupidddddddddddd!!!!! And now they are criticizing us if our patients use the call light more than once a shift.....because that makes them think that we are ignoring our patients if they actually have to use the call light. Isn't the call light there so they can call us when they need us?

And I don't think it reflects badly if they use the call light. I had one patient that wasn't steady on his feet. So I asked that he call me before getting up to use the bathroom. And each time, he sure enough remembered to call me. That is the purpose of the call light. Not for me to pop in every 10 minutes & ask if he has to go to the bathroom (as if I even have the time to do that). Or watch him while he's sleeping...just in case he should wake & need to use the bathroom. It is ridiculous. And the scripting....I should be an actress. It is like they are trying to turn us into Stepford Nurses & make us all generic & interchangeable. Ummmm, we're human!

Sorry, I'm kinda moody case you haven't I do have some thoughts of going back to the last hospital I was at...but I have hesitation about that because I do remember it sucked there (but at least we had techs) & they are connected to the same hospital I'm currently at. So if things are changing, it will probably trickle down eventually to the small hospital I left. I don't really want to change to another hospital chain as I have 8 years invested where I am. Soooooooooooo....I'm just thinking for now. Maybe I just need a nice tropical vacation. :)

I have started doing the Jillian Michaels workout dvd's for exercise & to release some of this stress. I am sore everywhere. I'll keep going though...on Sunday. Gotta give my body a little time to rest.

Still seeing the guy, but due to my moodiness, I'm kinda irritated with him too. I love him it shall pass.

Hope everyone had a Happy New Year!