The Misadventures of a Nurse....well, sort of...

First Time

2012-01-28T15:58:00.002-05:00

The other night was the first time I actually felt something emotionally for a patient. That might sound weird....so 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 admission....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 surveys....it 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 high....my 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!

A Little Moody

2012-01-07T00:22:00.002-05:00

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 more...you 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 night....my 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 today...in case you haven't noticed...lol. 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 though...so it shall pass.

Hope everyone had a Happy New Year!

Not that great of a week

2011-12-09T23:31:00.003-05:00

I worked three in a row this week & it wasn't too bad....except for early Monday morning. I had a pt in her early 90's with gallstones. Her daughter was staying in the room with her. Pesky daughter, but she meant well & I think she saw that her mother & I sorta bonded. Daughter comes out at 2:45 am to say she is leaving & her brother will be here soon for the rest of the shift. Says her mother sounds like she has some liquid in her throat, but otherwise no changes. Around 3 am, I decide to take vital signs. I like to get vital signs out of the way as soon as possible...I am so NOT a procrastinator at work (unlike the rest of my life).

I start with her first. I put the blood pressure cuff on & start it. Then I put the 02 sat on. I see her heart rate is 91. Pretty normal. The blood pressure comes back at 75/35. I think "uhhhh, that can't be right." The 02 sat reads 80%. Hmmm, no, that can't be right either. Heart rate is still saying 90. So I retake the blood pressure & attempt to wake this little lady up. I get nothing. By now I realize this isn't going to have a happy ending. I call my charge...she's on break. So I drag two other nurses in to confirm what I'm witnessing. They agree...she's actively dying. I call the daughter to tell her to turn around. That her mother isn't responding to me. I call the monitor tech to let him know to watch. As I'm on the phone with him....in less than 10 seconds her heart rate went from 90 to 44 to asystole. She was a DNR...thankfully. I would not want to have cracked her ribs trying to save her. The three of us (nurses) are at the end of the bed just watching her. I started the vitals at 3 am. Time of death is 3:06 am.

Just as I turn to walk out of the room, the son walks up. Ugh, this is the part I hate. Breaking devastating news to family members. He's all smiles as he hasn't realized what just happened. I tell him she just passed away. Ugh, heartbreak. He, of course, is in shock. This is the part of nursing that I hate. Well, that & trachs. The daughter arrived...shocked, but at the same time it makes me wonder as the patient was in hospice care before coming to the hospital for a check on the abdominal pain. So it shouldn't have been totally unexpected....still though, losing a parent...no matter what age is devastating I'm sure. They didn't stay long.

I go on to take my other patients vital signs because this is nursing & you don't get breaks....even when your patient dies. You are expected to just keep going. Not more than 10 minutes later do I have the charge handing me a paper on a new admission. Seriously??? She replies "you're down to 2 patients." Now this I totally disagree on. It isn't like my 3rd patient just disappears because she died. I still have to do charting on her. I still have to get her ready for the morgue. Can I at least get this stuff done before you bring me someone new? So annoying sometimes. Luckily, my new admission was a wonderful woman who was not in any distress & just wanted to go to sleep.

My other patients this week were pretty good. One had this forceful cough that scared the heck out of me. I thought he'd be the one coding as he looked like he was about to die every time he had a coughing fit. I got some cough medicine ordered & gave it to him. It was no help. Did I mention he was on a 50% venti mask at the time & he would rip it off every time he started to cough. And his 02 sat would drop to 75%. Ugh. I called the doctor after a few hours of this coughing cycle & she tells me "there is no miracle cure for coughs." Really????? There is nothing out there that can help someone stop coughing? Fine, whatever. I bring respiratory in on this & we decide that since he rips the venti mask off anyways, let's switch him to a high flow nasal canula at 10 liters. Wouldn't you know it...that solved the coughing problem. It isn't to say he stopped coughing completely, but I can definitely say it was the venti mask irritating his throat into these coughing spells. I'd never seen that happen before.

I'm off until Tuesday now & it has been a rough week outside of work. The "guy".....well, it's not going so well. Not going to go into details, but I don't see it lasting. I'm beginning to think there is no Mr. Right out there for me. Oh well. Things could be worse.

And I learned this week that someone I went to high school with was strangled to death in her home. She is a recently divorced mother of 5. They have yet to name the ex-husband a suspect....but I would bet everything I have that he did it. It's not cause she had a restraining order on him that makes me think that. Or the fact that she had a security camera installed in her house because she felt he was coming in when she wasn't there. It's not the fact that in October, she got a judgment against him....he owes something like $65,000 to her. It's not the fact that he has been telling the police she has been using online dating web sites to meet men & how "dangerous" it is to meet online people. You know what seals it for me...the ex states he got a text message from her on the day she was killed asking him to pick up the kids from school. The police state they aren't sure if she texted that or the killer did. Now come on!!! What random person who is in the midst of killing someone is going to stop, text the ex to get the kids & continue to kill? Or why would she text that? She wasn't even in communication with him. I have no doubt he is the one that killed her & texted that after the fact as he picked up all 5 kids and kept them at his house while her body lay in her house for over 48 hours before being found. Disgusting. I can only hope they have enough evidence to prosecute him.

I am trying so hard to get into the Christmas spirit. Seems like December is flying by. Oh well, I am ready for a new year. Hoping 2012 isn't as crazy as 2011 has been.

Wow, feels like ages

2011-11-28T02:29:00.002-05:00

Wow, feels like ages since I posted, but it's only been what...3 or 4 days? There isn't much to post regarding work....except for the fact that I hate those surveys the government requires when someone goes home. Because our administration gets the results & then tries to make us believe we are the worst hospital in the world...which I know is not true. They are so confusing too. One minute they are telling us that we are in the top 15 percentile of all hospitals in the nation and the next minute we are in the lowest 1 percentile. How is that possible? I've given up trying to figure out their strategies to motivate us & I will continue to do what I do....just be me & treat my patients as though they were a close family member. That's all I can do....really. I refuse to get caught up in that stress trap that keeps popping up.

Thanksgiving was wonderful. I can't believe how quickly it goes by. The only thing I bought this weekend was a new dryer...cause mine stopped working on Saturday. So that was my present to myself...lovely. It's amazing though...how an appliance can somehow make you a little happier. Maybe it's the newness of it or just out with the old. I want to wash things just so I can see how fast this thing can dry them. Silly, I know. Don't try to understand me.

I ventured out today & saw Breaking Dawn. Sigh. I'm sorry....but I felt like it was so lame. I guess my imagination is better than what they are producing in the movies. I try to like Edward, I really do....but it is impossible. He is too wussy for me. Anyways...I have totally forgotten what was written in the 4th novel & plan to reread it sometime between now & next November....when the final Twilight movie is released. Because I totally forgot what happens next & want to know.

I watched in horror as my Florida Gators lost yet another game...this time to FSU....ugh. Can't get worse than that in football.

My back is about 90% better. I am not even on Advil anymore & it feels pretty darn good. The ears are better too. I finally was able to unblock the left side. Every now & then it clogs back up, but it doesn't stay that way. The new thing now though is if I put my head back or when I lay down...everything starts spinning. Personally I enjoy it. It is sort of like being on a rollercoaster or a ride that makes you dizzy. I'm not too concerned about it as it only lasts maybe 10 seconds. I figure it has something to do with my ears & that as soon as that problem resolves, hopefully the dizziness will too.

That's been my exciting weekend. I go back to work Tuesday night. Maybe I'll have a story or two to tell. :)

Happy Thanksgiving!

2011-11-24T00:07:00.003-05:00

Happy Thanksgiving everyone!

I have much to be thankful for...but these few things I am not...

*this never-ending cold, I have had it for 3 months now & just when I think nasal congestion is the worst thing ever......it drains from my nose into my middle ear. Now I am convinced that is the worst thing ever. My hearing is all muffled & I can feel the fluid moving. I have tried everything...antibiotics, all the allergy meds, Advil, Flonase, neti pot, etc. My latest try is Mucinex D along with the neti pot, Flonase & Afrin. Only this time with the Flonase & Afrin, I have to put my head down & tilt the bottles in hopes that they reach the Eustachian tubes. Because I am convinced that if I can open those up, all the fluid will come out. And it worked on my right ear, my left is being a bit stubborn. I'm not giving up hope yet.

*my very sore back, I was taking a shower this past Saturday morning & silly me, I leaned down a little to dry off my shins/calves & I instantly felt pain. I know this pain & in my head I was saying nooooooooo, noooooooo, nooooooo! This resulted in me having to call in sick for 2 days from work. I could barely move, even with muscle relaxers. I am feeling better today, but it is still sore. Guess the universe is trying to convince me that there are worse things than ear congestion.

*my tooth, or should I say what is left of my tooth. I was eating some of that laffy taffy candy stuff & lucky me...it pulled out part of my tooth. And my dental insurance doesn't kick in until Jan 1. And it is a holiday weekend. Sigh. Yet the universe trying to show me there are worse things than ear congestion & a sore back. Luckily, I have no pain associated with this tooth loss. At least not yet. I think I may have had a root canal with this tooth, but I honestly can't remember. I sure hope so...cause I don't want tooth pain. It is a long way until Monday.

Ok, universe...you can stop trying to show me there are worse things than what I am currently experiencing. I'm convinced.

Quick update on the guy....well, 2 weeks ago I thought everything was ending. Again, it is my own issues that led me to this conclusion. I see it so clearly. Luckily, I don't scare him off when I run in the other direction. He was needing reassurance & I thought he was wanting out. We tried to just be friends.....that lasted approx. one day. So moving forward, everything is good & back to normal. It's tough though....not living near one another. In a way it is good too, cause we kinda have to take things slower. It can be frustrating too though. Oh well, time to be thankful & for that I am. Just like I am amused he is so crazy about me. I mean it is neat to see how just me being me can make someone else happy. He wrote this to me the other day...

In everyone's life, at some time, our inner fire goes out. It is then burst into flame by an

encounter with another human being. We should all be thankful for those people who rekindle

the inner spirit.

Sweet, isn't it? Ok, enough of that.

Work is still a pain. They are constantly thinking up ways to torture us. At least it seems that way. We have a new manager...again. I have come to learn that nurse managers don't last very long. I have no desire to ever be one or to even be a charge nurse. I just want to take care of my patients & go home. That's all.

Yay for Tony Stewart........2011 Nascar Champion. Yessssssss!

Happy Thanksgiving everyone! Hope you have a safe & wonderful holiday.

I Survived!

2011-11-02T01:31:00.002-04:00

I worked 4 night shifts in a row & have survived to tell you about it! I cannot remember the last time I worked that many hours in 4 days. Truthfully, it wasn't bad. I know I was spared from having any real disasters. Either that or I'm getting good at fixing a disaster before it happens. Who knows?

I had a woman that came in with a fever & 2 weeks later she lays in a bed without any ability to really move or speak. Somewhere along the line she had had a stroke. Next up on the menu was to insert a feeding tube. Sad.

I had a male that up until a month ago was a pretty heavy drinker. Then one day he just stopped & according to his wife...says he began acting strange. Hmmm, perhaps that is why she put up with him drinking...she didn't like his normal behavior. He was ok for me....thoroughly confused. Who is the President........his reply....Woodrow Wilson. Say what? I have never had anyone respond with that answer ever. I had been warned this patient could get combative & that he was one strong dude, so watch out. The first night I had him...piece of cake. Second night...he was a bit more alert which meant he then had a desire to try to stand up. Why do they do this? Our computers were down, so I grabbed my ipad & sat in a recliner next to his bed, reminding him to stay in bed. I was lucky enough to be able to do this for 4 hours. My other patients were sleeping...as good patients should be.

After reminding him to stay in bed for the 3940283043 time & him starting to get restless...I decide it is time for Ativan. Once he felt me flush his IV, the drama started. He latched onto my arm as though I was attempting to cut his other arm off. I hadn't even had the chance to hook up the Ativan, much less push it. I could have taken the easy route & called someone in to help...but nah, I knew I could handle this. So being the talented nurse I am, with one hand I hold his free hand that is trying to attack me & with my other hand, I attach the syringe & push away....all while distracting him with my congested voice (yes, I still have this damn cold 10 weeks later). It worked, within minutes he was relaxing. I was now free to roam around the cabin....just kiddingggggggg.

My third patient was a new admission & very easy to care for. The next night I got the same patients back plus one. Easy night. Monday night...not so much. I was told I was getting a direct admit at shift change. Ugh, hate direct admits any time of the shift, but especially at shift change. Obviously the doctor feels they are so sick they should bypass the ED & go right to the floor, but that means I know really nothing about them as they have had no workup done & the doctor's order reads "Call me when pt arrives to floor." Which means time calling him, him calling back, him placing orders, me having to write orders, me having to clarify with pharmacy the meds, me having to make sure the pt is comfortable, meds are corrects, etc. IT IS TIME CONSUMING & the beginning of the shift is the worst time as I have no extra time.

I didn't stress about it & I am very lucky my patient was not in any distress. She did have CHF & Pneumonia & a drunk daughter outside drinking in the parking lot (lovely).....but the patient was stable & wasn't demanding. My other patients were great too....well, the one basically in a coma & the other one knocked out with Ativan......plus one more that only wanted to read his bible. I realize I really lucked out.

We had a town hall meeting where our CEO basically told us we are the best staff ever & we are #1 against all other Adventist based hospitals as far as employee engagement. I don't know how he does it...because the entire nursing staff is highly stressed & short-staffed, but a few words from the CEO & suddenly we feel wonderful. Brainwashing I tell ya!

I'm off now until Monday night. I'm spending a couple of days with my man. Ahhhh....yep, I haven't run in the other direction yet. Friday I have a nursing skills fair thing. Saturday is a class reunion & Sunday will be my day to do nothingggggggggggg.

Hope everyone is doing well. Have a good week!

It's funny

2011-10-25T00:10:00.005-04:00

It's funny how things aren't always as wonderful as you pictured they would be. Like having 10 days off. Don't get me wrong...I loveeeeeeeeeee not being at work. Especially this week as I heard AHCA is in the house (hospital) doing inspections. Not that they are there at night, but the day staff is usually frantically stressed out & I like not having to deal with that. I don't go back to work until Friday night........and Saturday night......and Sunday night....and Monday night. What have I gotten myself into? 4 shifts in a row at that place is like working 4 months straight. Sigh. Let's not think about that until Friday.

Where was I? Oh yeah....when I scheduled myself to have 10 days off.....I pictured myself....relaxing, spending time with friends & family, getting my house organized, spending a couple days at the beach, feeling rested & relaxed before I had to return to the crazy place I call work. My first day off was last Tuesday. I didn't really accomplish anything between Tuesday & Friday....except sleep. I slept so well....ahhhh. And I caught up on my tv shows. I did spend the weekend with my brother, niece & nephew. That was fun...relaxing...nice. By Sunday afternoon, I couldn't wait to have my house to myself again. My fav football player, Tim Tebow, was starting for the Denver Broncos. I couldn't watch. I'm really not that interested in pro football. I had the tv on & I could hear it, but I wasn't watching it. I knew they were losing. I checked out facebook & saw all the people dissing Tebow. That he's overhyped. That he has no talent as a quarterback.

It was at this point that I barked back at the haters & decided to watch the last part of the game. I knew they were losing 15-0 & virtually had no shot at winning....but something drew me in to watch. And guess what...not only did they tie it up...Tebow went on to win the game. A M A Z I N G ! ! ! Of course I immediately went back on facebook & posted "Uhhh, you were saying????..."

It isn't that he is a talented athlete. He works hard....harder than probably any other athlete out there. But I think what works for him is his ability to motivate. Heck, he had the Miami fans cheering AGAINST Miami....lol. I don't think his calling is football, but if that's how he can reach people right now...then that is his purpose for now. He's definitely a leader. Remember the name!

Ok, so that was all good & I finally got the one thing I had been craving for the last 2 weeks or so = Pumpkin Pie Pop Tarts. Mmmmm...they are yummy. Almost as good as the Pumpkin Pie Blizzard at Dairy Queen.

I am getting together with my friends tomorrow night. And more than likely I'll go away somewhere on Wed & Thurs. So most of my to-do list is done. Well, except the organizing part. I'm good at procrastinating that.

But right now I sit here hating the dating life. Not that things are going bad. They are still really good....like better than I thought possible good, but not too good to be true good, if that makes sense. What I hate is all the old emotions it brings up from past relationships....disappointment, lack of trust, mind games, unsure of myself. He doesn't bring that out in me...he's been the opposite of all that. So I know it's my issues & I don't know if they are being brought to the surface because my "walls" are coming down or if I'm looking to keep them in place. I'm actually looking forward to going back to work to get my mind on something else...because I'm finding too much time for myself = too much time to think about things I don't need to be thinking about. And it doesn't help that PMS showed up on Friday & seems to still be here. Sigh. Breathe Jen Breathe. I'll be ok. Venting is over.

Highlight of last week........seeing Sugarland in concert!!!!!!! They are so awesome. Highlight after seeing Sugarland in concert.....finding out Luke Bryan is coming to Orlando on Jan 22. Yay!!!!!!!!! He's opening for Jason Aldean....not really a fan of him, but I'll be going to see Luke. And I also found out Lady Antebellum will be in concert in May. Not sure if I'll go see them....it's in Jacksonville, so I'll need to have some extra money for a hotel. We'll see how much I work the next few months & decide from there.

Work was great last week. I had 3 really good patients, two nights in a row. However, other patients on the unit would not stop screaming. It felt like a psych ward or possibly the labor & delivery room. Nothing was wrong with them. They were just screamers. You get people like that sometimes. I seriously don't know how employees at nursing homes do it. Maybe they are hard of hearing? I have a nursing skills fair the beginning of Nov & I think we have a big meeting next week to review our employee satisfaction scores. So exciting...NOT. We have lost 2 more night nurses & what does our manager do...hire new grads. Which means they won't be ready to be on their own for 12 weeks. Great! Oh well, that should mean I can work more...which is what I need to do.....for my emotional needs & my bank account needs. :)

p.s. Operation Workout is on hold....I know, I know...it will do me good emotionally. I'm trying to get motivated. Where is Tim Tebow when I need him???

Nightmare Continues

2011-10-09T02:49:00.002-04:00

Yep...same old stuff at work. We have Jcaho & Ahca doing inspections....well, they are due to randomly show up & inspect. So all the administration is on edge, because if we don't pass inspection...we don't get reimbursed by medicare. Such a crock. Needless to say, so much time is spent on paperwork now that I get very little time for actual patient care. Is this what healthcare is coming to? All paperwork to cover our butts & very little nurse-to-patient interaction. I'm trying to just roll with it & hoping that once the inspections are complete, life will return to normal. Time will tell.

I got back from my Caribbean cruise last Saturday. I'm a little depressed. I miss the life of luxury where all you think about is what to eat or drink. Nothing else. Sigh. Meanwhile, I'm already planning my next cruise. I believe it will be in December.

I still have my cold. Yep, this sucker isn't going away. It's been like 7 weeks now that it has dragged on. Right before the cruise, all the congestion from my throat area moved up into my sinuses. That has been a lot of fun, let me tell you. Nothing like not being able to breathe while you sleep & non-stop coughing! I have tried nearly everything to no avail. I got a prescription for Flonase today. Everyone keeps telling me it is great for stuffy noses. So far I don't notice any change, but they tell me it takes a few days. Meanwhile, my doctor wants me to drink whiskey. Seriously? Yep, seriously. I can't do it. The thought of it makes me nauseous.

It has been raining here pretty much non-stop for the last 48 hours. I'm tired of it. Someone turn it off. I work tomorrow night & am praying I don't have to drive in it.

I'm still working part-time. Two days is more than enough for me to be at work. Especially with this sickness that won't leave my side. I do need to get focused though. Like if I'm not going to work as much, I should at least be working out at home & getting my act together. All I seem to do is come home & sleep or watch tv. I'm yawning now...but making myself stay up so I can sleep during the day before work. Ahhh, the life of a nightshift nurse. Exciting, huh??? :)

I did have a fun date last weekend. We watched the Florida Gators lose miserably, but we still managed to have fun. I don't know what the future holds, but it is nice to have a connection with someone. Ahhh, jb. :)))

I work Sun & Mon...then off until the following Sunday. I vow to clean my house really good & start exercising....starting Tuesday...lol.

Hope everyone has a great week!!!!!!!

Shoot em up = bullets

2011-09-18T02:36:00.002-04:00

**Work has been outrageously insane. I don't even know what happened. Two years ago I started at this hospital & it was paradise. Even a year ago it was still paradise. Now...it is hell. It's like the administration is coming out of the woodwork with new rules & regulations & 99.99999999% of it is absolutely ridiculous. Just when I think I have heard it all & say to myself...what more can they possibly add to our jobs? And then they add something even more ridiculous. I'm telling you, it won't be long before they have us cleaning the rooms & giving manicures....sigh.

**I guess I could be worse off. I could be like one of my patients this week. A drug addict. Late 20's...hooked for years. Doesn't appear like your typical druggie, but she's been to our ER alone over 100 times in the past couple of years. May as well multiply that by 3 as there are other hospitals nearby that she rotates ER visits. What I don't get is why the doctors review past visits & think...hmmmm...maybe she is faking her symptoms just to get Dilaudid. And hmmmm...maybe giving Dilaudid to someone that is pregnant isn't the smartest idea. Her latest antic was to crush up Ambien, mix it with water or something...and inject it into her bicep. Yep... intramuscular. Not really sure how you can get a high off that as I've never seen anyone do that before. I guess she's exhausted her veins as it is nearly impossible to even get an IV in her. Anyways...she has injected her arm multiple times & you know what happens. It gets an abscess & infected & she needs to be hospitalized for IV antibiotics & she begs for Dilaudid & gets her way. It is such a waste of time & money. Then she'll complain of a headache....a normal doctor would prescribe Tylenol. Her doctor....MRI of the brain, MRA of the neck & brain. Thousands of dollars in tests wasted.

**Another sad story...a perfectly rational person that is homeless & has nowhere to go & no money for food.......comes to our ER complaining of chest pain & tells the ER doctor he wants to jump in front of a bus. Before you go...awwwwww...mind you.....he was just looking for a place to stay for 3 days knowing full well the MD couldn't let him be discharged. So he was Baker Acted for being a threat to himself. While I have a lot of sympathy for people who have nowhere to go, I do not think a hospital is the place to be. I understand it, but again...numerous tests being done all because he wants a place to sleep & some free meals.

**I had a patient fall this week. I kick myself, but I shouldn't...because I knew this was going to happen. I must have gone to his room 100 times during my shift. I was telling him so often what would happen if he attempted to get up on his own & he'd brush me off. He was alert & oriented & used to getting up whenever he wanted at home. I can't keep him tied to the bed. All I could do is keep re-educating him the risks of getting up without anyone around for assistance. He assured me he would not get up. He was sitting in the recliner chair. I had just gone to his room..."you need anything?" NOPE. "You want to go back to bed?" NOPE. "Here's your call light, push it if you need anything...DO NOT GET UP." OK, NO PROBLEM." Within 120 seconds of me walking from his room to the nurse's station, I hear that dreaded noise of someone falling to the ground. I wanted to scream in frustration cause I knew who it was. Luckily he was fine, no injuries whatsoever. After that I told him he didn't have a choice...he was staying in bed where I could have a bed alarm on so I'd be alerted when he was attempting to get up. I do not like falls!

**One more shift to go (tonight) until my 2 week vacation begins. I CANNOT WAIT! Well, I will probably go into work early Weds morning to get the Nursing Skills fair done, but that doesn't really count as there is no patient care involved.

My cruise leaves on Saturday.......to the Caribbean....hopefully there will be no tropical storms or hurricanes floating around down there.

**Operation Workout begins when I get back from the cruise = Oct 1. No more excuses for me. I'm tired of being this size. You would think with the 930840248 miles I walk per night when at work, that I'd lose something, but nope. I have never sweated more at work than I do now. I don't know if it's hot flashes or just a workout for me...but something needs to be done. Exercise is key.

Have a great week everyone!

Almost All Better

2011-09-15T06:24:00.002-04:00

Hey all...I'm almost all better. Whatever that virus was, it knocked me out for like 10 days. Every night I was having fevers and after a few days I had a terrible cough. I thought I was going to collapse my lungs. I ended up seeing my doctor & although he really didn't want to give me an antibiotic, he did because of the recurring fever. I also got some cough medicine....the good stuff. Much more effective than over the counter.

The antibiotics did knock out the fever. The cough, however, is still lingering & it's nearly a month later. My voice is 95% back to normal. There are still some days where I wake up really warm or like right now...feel warm...but I'm beginning to think those are more like hot flashes than some illness. I ended up missing 4 days of work. I've never called in that many times. I had too though...I can't go to work with a fever. I did end up getting a verbal warning.....because of their stupid can't call out more than once in a two month period............regardless of whether you truly are sick or in a car accident or having an organ transplant. It is a stupid rule.

Work has been hell. The patients are sooooooo complex & soooooooo ill. Top that off with us being extremely understaffed & unappreciated...well, needless to say, my unit is a mess right now. Even our manager is bailing on us to go to another floor. Nice. And the hospital also decided that all those foreign nurses they recruited & gave work visas to over the last couple years...well, they won't be sponsoring them any more...so back to their foreign countries they go. Which means we will be even more understaffed. I want to scream.

It has really forced me to reconsider going back to my old hospital. Sure the raises suck & there are no bonuses, but at least we were properly staffed & the patients weren't so complex.....and they have patient care techs. I'll make a decision after my cruise.

Yesssss...that's right...it's nearly cruise time. I work tonight, Friday night & Sunday night...then I have 2 weeks of vacation. My cruise leaves on Sat Sept 24 & I will be gone for a week. I need an escape.

Back to the patients....there was one that really stood out the other night. He wasn't my patient, but it is the first time I really felt fearful of getting attacked. He was in for syncope & collapse....but had a history of schizophrenia & it was in full effect. It was downright scary. He yelled at us (the nurses) for 5 hours straight. Yelled! Our charge nurse was a whole lot of help.....she told us to stay away from him. Keep an eye on him...but stay away, we don't get paid enough to risk being attacked. Gee, thanks. Do you think we could get security or some male brought to the floor just in case this patient goes off the deep end? Nope.

I asked the nurse if she had any type of anti-anxiety drugs or anti-psychotic drugs she could give him. She told me he refused his meds. Ummm, great, but he's an agitated patient that is out of his mind right now....he doesn't get a choice in the matter. She managed to give him some Ativan IV & within 2 minutes, he was sleeping like a baby. Thank goodness, otherwise I would have been the one needing the medicine. All of his yelling & bullying towards us made me want to bang my head against the wall. I'm not even being funny. And it truly scares me that he lives at home alone & is probably like this quite often. So much for thinking I'd never go into psych nursing. They will come to you. I did not like it at all.

At my other hospital, when we had patients get out of control...we'd call a code grey (asking for extra manpower) & a bunch of men would show up & usually that would be enough to intimidate whoever was out of control & put them back into reality. If not, then they would be physically moved to a bed & restrained & getting anti-anxiety meds. Never would they have allowed the nurses to have to put up with such verbal abuse with the risk of physical violence. Never. It's discouraging to say the least...the way my current hospital handles it.

Hope everyone is having a great week!!!

Summer Flu???

2011-08-22T20:40:00.002-04:00

I have been dealing with some type of illness the last 4 days. I had been off for nearly 2 weeks. Took a trip to Atlanta and another trip to Daytona. I was all ready to go back to work last Saturday. Then Friday I was exhausted. Slept a lot. Woke up in the evening with a fever. Ugh...I never get sick!

I started taking Advil. I knew I couldn't call in sick to work. I already called in on time in July and you aren't allowed to call in more than once in a 2 month period without getting in trouble. Stupid rule! So I went in to work Saturday night. Big mistake. As soon as I got there, I could feel my temp starting to rise. I was flushed & tired...and hadn't even done anything yet. Luckily they had enough nurses there so I was able to go right home. Didn't even have to take report or anything. I don't care if I get in trouble for calling in sick. I am sick & no way can I work nor should I be around other sick people.

So I came home...my temp is normally 97, but now it was 100. I figured it's low-grade...let my body fight whatever infection it is trying to fight without intervening. Another big mistake. Within a couple of hours it was up to 103. Way high for me. So I resumed the Advil, put some ice packs under my arms & in the groin area (since that's what I do for my patients at work) & it took awhile to come down, but eventually it was back to 97 by morning. Weird thing is...I really don't have any other symptoms than a cough. My nose, head & lungs are clear. Stomach is fine, no UTI. My throat is just a tad scratchy but nothing to complain about. Even with the high fever, I felt ok.

So now it's Sunday morning...I called in sick to work. No way was I going in after what I dealt with Saturday night. I retake my temp & it's 96.4. Even better! Till the evening. Back up to 101 with Contac cold medicine & fever reducer. So I start back with Advil & went to sleep. I woke up all sweaty, but too exhausted to do anything & slept some more. Monday morning, my temp is back to 97...yay. Jump in the shower & then back to bed. Took a nap from 1 to 4 & woke up with another temp. Started Advil again.

I don't know what this is & I wish it would just go away. Luckily I don't have to go back to work until Thursday, but I'd like to get back to normal before then. I'm debating about whether to see a doctor or allow them to start me on a broad spectrum antibiotic. I'm all for my body fighting its own battles...but not when I see no results. And did I mention...I never get sick. I don't know anyone that is sick or has heard of being sick. So I don't know what this is.

And on top of that...it has made me all weepy. Like I rented Soul Surfer Saturday night & could not stop crying. You would have thought that was my kid in the movie. Then Sunday night I watched this special on Amazing Animal videos...omg, a polar bear was attacking a woman & I got all emotional. And they showed that Christian the Lion clip at the very end. Forget about it....cry me a river. I've seen that video 93040932 times...but it gets me every time. And this morning...someone on FB posted a pic of one of the fallen Navy Seals funeral & his dog lying by his casket. Niagara falls for me...could not stop crying. It's just a picture!

Hope everyone is having a better week than I am!!

Third Degree Heart Block

2011-07-27T01:13:00.002-04:00

I am still thoroughly enjoying my part time schedule. I'm there just long enough to get a decent paycheck, but short enough that when a night goes bad...I'm so glad I don't have to come back.

I had 3 patients last week. One with a mystery as to why he was so weak & suddenly anemic, one alcohol withdrawal and one who has chronic anemia, but again, they have no idea why. They sounded terrible on paper. I should know by now not to assume they will be as terrible as they sound...because usually the train wrecks on paper are awesome patients, while the ones that sound too good to be true...end up being a pain in the ass. So I should know by now not to think the worst. I just pictured having to give blood to two of them while dealing with an out of control alcoholic as the third patient. Luckily, NONE of that happened.

Pt #1...mystery man. I made an extra effort to connect with him. I could tell he was frustrated being in the hospital for a couple of weeks and not getting any real answers. We could tell him everything it wasn't, but unfortunately...no one had figured out what was causing his problems. So I really took my time to comfort him. He slept like 10 hours out of my 12 hour shift...so it wasn't bad.

Pt #2...the alcoholic. He looked a mess, but for some reason, he & I bonded. He didn't give me any trouble, I didn't give him any judgment. Whatever he needed, I got it for him...if it was ordered. One thing I wouldn't get was nausea medicine. I cannot allow myself to call an MD for nausea medicine when a patient says "I'm feeling nausous, I need medicine....oh, and can you get me a turkey sandwich, a pepsi & some ice cream too." Uhhhh, no...pick one or the other. Nausea medicine or food. Which is more important to you? He always chose food.

Pt #3...although his hemoglobin was enough to make you panic....in the 5 and 6 range, he actually never asked for a single thing and the only time he would call was if his IV machine was beeping. During his time at the hospital, they had already transfused something like 15 units of blood. His count would go up for a day & then drop back critically low. NO.IDEA.WHY.

I also got an admission around 4:30 in the morning, but one of my friends did nearly the entire admission. She rocks! The patient had an active GI bleed. Eeeekkkk...don't like those because the smell is horrible. And you never get used to it.

So my first night was good. You know what that means. My second night would have to be bad.

I come back & get my first 3 patients, but didn't have to deal with GI bleed. Well, other than continuously spraying the hall every hour because that odor was creeping its way into the nurse's station. My patients were all doing well. You know you've bonded with a patient when they say "Heyyyyyy girlfriendddddddddddd" as you enter the room. That would be pt #2.

Everything was going great until about 4 am when I'm told I'll be getting an admission. Ok, fine. I start getting report from ED and the nurse tells me the patient's blood pressure is labile. Ummmm, can you explain a little more in depth...as I'm clicking on the vital signs tab on the computer. She says "It goes up & down." I look...he came in it was 130/65, now two hours later it's 75/22. Uhhhhhhhhhhhh....................hold up. I call the nursing supervisor & she says she'll check it out. I tell the ED nurse what's going on & she says "I understand what you're saying, but you do know that blood pressure & stability are NOT related. Really? What nursing school did you go to?

The nursing supervisor checks him out, says he's fine...talking, joking, bp currently 110/60. Ok, fine, whatever. Bring him here...fully expecting I'd have to do a rapid response should his bp drop. I take my other patients vitals. Everyone is great...stable. My new patient arrives, no less than 2 min later I get a call from the monitor tech...."uhhh, your patient is sustaining a heart rate of 30." So I rush over to that room. It's pt #1. Thirty min earlier he had been normal sinus rhythm with a heart rate of 80. Now he was 30. Luckily he's talking to me & his blood pressure hasn't changed. Whew..did not want a code blue.

I tell my charge nurse what is going on....5 of us go back in his room & are staring at him...lol. This is the tricky part....you have to tell your patient why you are there, but you don't want to scare him either. I leave to call the cardiologist. Someone else reminded me to call rapid response. I call the rapid response nurse & get the reply "He sounds fine." Uhhh, you can tell all that over the phone??? So he comes up, looks at the rhythm strip & runs to the room. He tells us the patient is in 3rd degree complete heart block. Eeekkk...this can be fatal. In my 7 years as a nurse, I have never seen someone go from normal sinus rhythm right into complete heart block.

I'm still waiting for the cardiologist to call back, so we order an EKG and I call the primary to get an order for ICU. She calls me back quickly, I get the order....easy peasy. Finally the cardiologist calls back & after I read him the EKG strip. He thanks me for telling him & hangs up. WTF? I wasn't telling him the morning weather report.

Anyways, we quickly got my patient to ICU. The nurse down there asked him what was going on as a gauge to see how much he knew. His reply..."one minute I was sleeping and the next thing I knew...5 beautiful nurses were standing over me asking if I was alright." Awwwwww....sweet! I really hope he's ok.

Needless to say, I got back to my floor at 6:30 am...I checked on my admission who was now sound asleep & I passed him onto the day nurse. I had a staff meeting at 7:30, so no way would I have been able to do the admission. And he was sleeping, it could wait. Wow, what a morning. So glad I then had like 9 days off. :)

Weird thing is....within 48 hours...two more patients on my floor went into complete heart block. This never happens!!!!!!!!!!

Some good things...

*We got a cost of living raise....yesssssssssss

*I pretty much spent that raise staying at a resort for 2 days & drinking frozen drinks by the pool....yessssssssss

*I went from having no guys lately to two asking me out....yessssssssss

*I got a new dishwasher....yessssssssss

*Found out my friend that just went thru a double mastectomy for breast cancer is now cancer free....yesssssssssssss!!!!

Hope everyone is having a good week!!! :)))

What The F???

2011-07-12T21:26:00.006-04:00

Not guilty??? Seriously??? What kind of people are those jurors? Never mind, don't answer. Believe me, I already know & I can sum it up in one word = MORONS!!!!!! The more they talk, the more they annoy me. They did not even take her behavior after the death or her numerous lies to everyone into consideration. They were more focused on trying to figure out if her father was involved & how she died. Helloooo, McFlyyyyyy....if someone is acting very suspicious, never reports her child missing for 31 days & everything she says is a lie...even to law enforcement & the child's remains are found in a garbage bag in a swamp a block or two from the house...and the face has duct tape all over it, then you should consider that that liar is hiding something. I give up. Just reinforces that common sense isn't so common. And if another one states "Not guilty doesn't mean Innocent"...I am going to throw something at my tv.

I've spent the last 7 weeks watching this drama on tv & the last nearly 3 years hearing about this case day after day because it's local. She gets out this Sunday & I can only hope that she disappears forever. She has what's coming in due time & by a higher power. At least I got the pleasure of learning who Jeff Ashton & Yuri Melich were. :)))

Work...it is exhausting me lately. It truly feels like I work in a psychiatric hospital. We have patients screaming, patients yelling, patients detoxing, patients acting bizarre...and it's not even a full moon. I called in sick tonight. I was feeling nauseous & feverish, but I'm doing better now. I need to get some sleep. I was puppysitting the last few days & not getting nearly the amount of sleep I need.

Hope everyone has a good week!

Things

2011-06-27T06:02:00.003-04:00

Things I hate about nursing:

*Patient's families....no, not all of them. Just the annoying ones. The ones who think they know it all or think they are staying in the penthouse suite of some fancy hotel & that you're their personal servant. You know the type. 9 times out of 10, they are worse than the patient.....and funny how when they leave, the patient feels much better.

I'm not dissing family members as a whole. If my family member were in the hospital, I'd want to know what was going on. I would not, however, let the staff know I was a nurse nor would I try to boss them around. I have yet to spend the night in a hospital unless it was for myself & that was one night back in August of 1996 when I had my gallbladder removed. I'm just not a fan of sleeping at hospitals. I can see if your kid is hospitalized, but beyond that...I'm not sure why people spend the night with their family members. Regardless, no biggie. Just don't climb in the bed with them. This is a hospital, not a hotel! And don't get mad when we ask you to get out of the bed because you are in the way.

Also, do not get mad at the nurse when your family member dies. Case in point...my patient...the other night. An eighty something year old, veryyyy sick. Organs failing. Pt two days earlier stating she knows she's going to die. Doctor discusses with family that they need to decide on hospice...do you want her to go home & have hospice to the house or do you want her admitted to a hospice facility? Family couldn't make a decision. "We need to think about it." Ok, but that isn't going to delay the fact that your family member is actively dying. They leave at 8 pm that night. She had labored breathing since I got there at 7....well, she had it for the last week or so, this was no different. No worries. I get her hooked up to TPN (nutrition through a central line). Take her vitals...they were fine. Only thing I didn't like is that she wasn't waking up, but day shift had given her Ativan due to a panic attack a couple hours earlier. So I figure she's in a nice comfortable sleep.

Check on her again at 9:20 when respiratory is there giving her a breathing treatment. Heart rate was the same as when I took her vitals 40 min earlier. Still not really waking up, but breathing rate the same. I come back about 15 min later...don't really know why at the time, but it's obvious afterwards that God was sending me there. I look at my patient & see that she no longer has labored breathing. I think for a quick second "wow, that breathing treatment really helped." As quickly as I thought it, that thought went away only to be replaced with reality...my patient is not breathing AT ALL. Ummm, not good. I know she is a full DNR, so I'm not panicking. I calmly tell my charge nurse I can't get my patient to wake up.....I don't like drawing a crowd. No one but my charge is interested, so she follows me to the room & declares what I had been thinking....she's not waking up cause she's not breathing.

At this point I find it odd that the monitor tech hasn't called me...because surely if she's not breathing, she can't have much of a heart rate. So I call him & ask how her rhythm looks. He was like "Oh Sh*t, I'm sorry, I didn't notice...she's in the 20's." That's ok...luckily I was on top of it. There is nothing to do when it is a DNR...except wait. Oh & call the MD & the family. I dread calling families over the phone in situations like this. I hate being the one with the awful news, plus I worry that they'll get in an accident while driving to the hospital. I page the MD & then call the family. I don't want to tell them that she's pretty much gone, but I do want to stress that they need to get to the hospital. What do I say? What do I say??? I tell them that her breathing pattern has changed (it's the truth!) & that I don't expect her to make it through this change. They get my point & rush on over.

One of my co-workers met with them & was in the room with them when I walked in. I overhear one of them saying "the nurse should have known she was going to die earlier & then we would have stayed." Ummm...what? We're nurses, not psychics. While I may have had a feeling she wasn't doing well & made a comment an hour earlier to a co-worker that I hope she makes it through my shift...I had no idea that she would be gone in less than 5 minutes. I tried to explain that we did not see any changes in her, that it happened very quickly. Then I quieted down because I realized they don't want an answer...they just want someone to blame. This family member had skipped seeing their mother that day & had planned to see her the next day. I can only imagine the guilt she was feeling...so I just stood there & listened to her complain about how disappointed she was with the hospital care because we should have known she was about to die. We left them to grieve & I never went back in again. My charge nurse handled it, because I couldn't. It's the one thing I don't like about nursing....dealing with heartache & grief. It would pull me too close to that emotional line I try to stay away from.

*Another thing I hate...navy blue scrubs. Well, I don't hate the color...I hate the fact that we all have to wear the exact same uniform AND we have to pay for it ourselves. How is that legal? They require it, yet we have to pay for it. I miss having some variety & pretty colors.

Things I love about nursing:

*Those wonderful shifts that tend to follow miserable shifts...

I was dreading coming in the next night. I wasn't emotional, I just didn't want another sad night or exhausting night. Guess the universe understood, because I got 3 very easy patients the next night. Patients that liked to sleep & were not needy for anything. I had so much free time on my hands that I got to (you're gonna love this, Amanda!) watch 3 hours of Prison Break on my cell phone....love Netflix! And I got to read. Not continuously of course...still did my one hour rounding & gave one of my patients a bath...but that was about it. No drama, no one expecting me to be a psychic.

*Another thing I love about nursing....CPOE. It's where the doctor's put their orders in the computer instead of writing them out. We just started it a week or so ago & I love it! Veryyyy little redlining the charts. And very little responsibility on the nurse. If the doctor doesn't order something correctly...it's on him/her. All the responsibility falls on the MD...where it belongs. It's the future at all hospitals & I fully support it. Change is hard, but this is a good change.

Other things I hate:

*Casey Anthony & Jose Baez. This trial is making me crazy. Just when I think the prosecution has proved their case....the family members get on the witness stand & lie & cry & screw with everyone's head. I'm sorry, I love my family members...but if one of them kills a child......I'm not lying for them. Makes me sick. And then court on Saturday gets dismissed for a reason they won't disclose. Talk about patience being tested!!!!! I am counting the minutes to 8:30 this morning so I can see if court resumes or if there is a mistrial or if one of her lawyer's are quitting. Drives me crazy I tell you.

Other things I love:

*Jeff Ashton...one of the prosecutors. He's just awesome. Nuff said.

*89 days to my cruise in September...yeahhhh!

*My family & friends.

*Luke Bryan (y'all should know this by now!)

Hope everyone has a fantastic week!

Refreshed

2011-06-12T23:29:00.005-04:00

Katy Perry concert was ahhhh-mazzzzingggg. She is really good. I guess I'm comparing her a lot to the Gaga concert & well....Katy kicks butt. Only because she doesn't seem to be a freak (except when it comes to marrying one) & it was a concert, not a performance like Gaga. I'm done with concerts now until October....Sugarland. And of course whenever Luke Bryan publishes his concert lineup....ahhhh...patiently waiting... ahhhhh.

Can't really say much about work. I haven't been there since last Tuesday morning. Having 8 days off is sweeeeeeet. I feel refreshed...at least as far as work goes. I know I was close to feeling burnt out & angry with things I don't need to be concerned about. So to be able to take a step back & regroup...it's been nice. I'm glad my unit gives me that flexibility. I'm going to continue to do this light schedule at least until October. Cause I have a cruise in September & nothing's getting in my way of that!

We celebrated my parent's 51st wedding anniversary last night at the best steak & lobster restaurant in Orlando. A good time was had by all. I ordered a margarita & I swear they showed up with a fish bowl size glass. Whoa! As my facebook status reads....3 giant margaritas later...mmmm hmmm. I was feeling no pain. And I had lobster tail...from Australia. It is the best. They are gigantic. Yummm! I've been recuperating today. Hoping for some good weather tomorrow & Tuesday so I can work on this tan...but it's supposed to rain. So who knows what I'll be doing. I'm sure I'll find something. :)

What Makes Me Happy

2011-06-09T00:32:00.005-04:00

This is how I get thru tough times at work...replaying his face & music in my head. :)

He's the next big star of country music! He's an awesome performer. He just rocked the CMT Music Awards...check him out...

http://blog.zap2it.com/frominsidethebox/2011/06/luke-brian-rocks-country-girl-shake-it-for-me-for-2011-cmt-music-awards.html

p.s. his name is Luke Bryan....future country music entertainer of the year...mark my words

Silly ER nurse!

2011-06-07T21:46:00.004-04:00

Sunday Night at work was wonderful. I started with 3 walkie talkie patients....which NEVER happens. So I was in my glory. I knew I was open to get a 4th patient since I had such easy patients. No problem. I've got plenty of time to admit someone and my new admit was also an easy patient. So I just knew Monday night would not go as well. Never is it possible to have 2 great nights in a row.

Monday night I got 3 of my patients back. Great, I think. The charge nurse gives me an admission while at the same time one of my patients is getting discharge orders. Wonderful! @@. I take report from the ER nurse. It had to be one of the worst reports ever given. I'm hoping he's a new nurse, otherwise....he doesn't belong in nursing. The patient's name sounded very familiar to me, yet I couldn't place her face. I'm told she overdosed on morphine tablets....but didn't mean to. She took 10 times the dose she was supposed to. Ummm, that doesn't sound like an accident to me. Apparently she was just trying to get rid of the pain. At least that's what she told them when she was still conscious. Fastforward approx 2 hours later and I'm told they gave her 2 doses of Narcan & she's still unresponsive, but has lots of secretions that they are suctioning. Ummm, ok??? He goes on to tell me she has normal saline running at 100 ml/hr through a #24 IV in her thumb. And that they bolused her with 1,000 ml's. I asked how was her urine output. He sounded surprised & answered honestly....he didn't know. I asked does she have a foley cath or a diaper on...since she's unresponsive & obviously not getting up to pee. The ER nurse doesn't know. He's reading through the orders when I ask if she has any oxygen on. He replies 2 to 4 liters. Ummmm, which is it? He isn't sure. And he proceeds to tell me he cannot get an O2 sat on her. Then how do you know this drug overdosed unresponsive patient is getting enough oxygen? He doesn't know.

Now I'm starting to wonder if our ER has any doctors...because this is making no sense. I ask what her rhythm is. He says sinus tachy at about 120 or so. No one is concerned about that rate. Guess they're just happy she has a heartbeat. He proceeds to tell me she is a Baker Act & requires a sitter. I thought this was a little silly as she was unresponsive, but she obviously was a threat to herself, but ok. Only there is no sitter available. WTF? This is a joke, right? I hang up with ER cause now anything I ask, I get the generic response of "I just got this patient.". I go to my charge nurse & tell her I do not think this obviously unstable, critical patient belongs on PCU. Since no sitter is available, she calls the supervisor & refuses to accept the patient. Later I hear that she is in ICU, still unresponsive, on a Narcan drip with a blood pressure in the 80's and a temp of 103 and on the verge of being intubated. I want to know who the heck made the decision that she belonged on a PCU unit. Ridiculous!!

I did end up getting an admission. Luckily, it was after I discharged my other patient...who by the way was so happy to go home, that she surprised me by giving me a hug and a kiss on the cheek. I don't usually like strangers getting that close to me....unless we're talking about someome like say Tim McGraw or Luke Bryan. :). It was sweet though, so I didn't flip out.

I'm off now for 8 days...yay! Celebrating my mom's birthday tomorrow, then the Katy Perry concert on Thursday & a nice lobster dinner on Saturday night! Yum!

Cold Blooded Murder

2011-05-28T00:57:00.003-04:00

Never did I think something like this would happen. Not that it couldn't happen, because it can & has...at other places, but not here...not so close to home. I'm in shock.

Yesterday I got to work & was told there was just a shooting at our sister hospital...someone got shot in the parking garage. I didn't know what to think. Like why of all places...a hospital parking garage? I was able to get in touch with someone that was working there that night & she informed me that it was a surgeon that had been shot. The news was reporting that both the shooter and the victim were in critical condition.

It wasn't long before I found out the shooter died. Silently I thought...GOOD. What kind of person murders a surgeon in cold blood? Not just any type of surgeon, but a transplant surgeon. Those type of surgeons perform nothing short of miracles. Their glory isn't in the money they make, but in the lives they save.

Our hospital is well known for having a dream team of a transplant team. It's a small team, but a great one. Last year...the 4 surgeons & the rest of their team transplanted 3 livers and 5 kidneys. They also harvested 2 hearts, 4 livers, 4 sets of kidneys & a pancreas in ONE weekend. They are awesome people. Yeah, it's not much compared to the big hospitals in this country, but for Florida...it was recordsetting & it shows their commitment to doing what they love...helping people get a new chance at life.

Back to Thursday night...a disgruntled patient...hunted down one of the surgeons & shot him in the hospital parking lot. It happened with other people around. We know for certain the surgeon was the target, because thankfully, the shooter didn't shoot anyone else....besides himself a few minutes later.

They both died.

Things aren't supposed to happen like this. Anyone involved in health care knows we are in a vulnerable profession. We try our best to help people who are feeling their worst. Sometimes we end up having to care for people that are not mentally stable. We all know the risks...mostly in the form of abuse...physically &/or emotionally. It's a given. Not everyone is going to like you. We don't expect to be murdered because of our job.

We were talking about it last night at work....at any given time, anyone can walk into our hospital & just start shooting. I guess that can happen anywhere (and does). I can only hope that this does not become more common. I'm not going to say we should have better security because of what happened. I doubt any amount of security could have changed what happened Thursday evening. If someone really wants to hurt you, chances are more on their side of it happening than ours.

Still though, it's not right.

RIP Dr. N.

Yeee Hawww

2011-05-17T04:01:00.002-04:00

The time has come that I give in to being a "country" girl. I was born just outside of Chicago, but raised here in Florida (most of my life). I never listened to country...like ever. For me, Florida, was in the south...but not a redneck, southern accent, beer drinking type place like all the other southern states...lol. No one has a "Florida" accent. Probably cause 95% of us are from somewhere else. Unlike Georgia, where you can barely understand anything they say or North Carolina or Tennessee...the ones who have the real southern accents.

Sure I like (ok, loveeeeeee) Tim McGraw & Garth Brooks. I enjoy Toby Keith, Kenny Chesney & Martina McBride. But it was not until May 1st of this year when I heard Luke Bryan sing for the first time, that I decided I am partly country.....if that's possible. Now I'm not gonna start wearing jeans & boots or start drinking whiskey...but I am going to enjoy listening to his music. I'll be honest...I'm not sure if it's the music or his looks....ok, yeah, right...it's his looks...who am I kidding. He's adorable. His music/accent takes a little getting used to...because to a degree he does have that Georgia Gomer Pyle type accent. More than his looks though, the man can work a crowd!!!!!!!!! Like from 0 to 60 in no time flat.

What I'm talking about (if you're still reading this)...is the Emotional Traffic/Tim McGraw concert. The Band Perry opened for him....ehhh, they have a long way to go. They have one really good hit song, but they are amateurs compared to the other opening act.....Luke Bryan. I had heard his name, but never his music or him in person. He livened that crowd right up. I don't even know why he's opening for people...he could definitely sell out concerts on his own. I guess it takes time, because last year it was Lady Antebellum who I saw opening for Tim & now look at them. :)

Dare I say it.......Luke was better than Tim. GASP! And you know how much I loveeeeeeee Tim McGraw. Don't get me wrong, the concert was great...something was lacking though. Seemed like Tim didn't have a lot of energy. He needs to do whatever Luke does, cause that guy has tons of energy.

Ok, enough of the concert review...back to work type stuff. Hmmm...this part-time status is great! My bank account isn't too happy, but mentally I like it. I feel like I hardly ever work. On top of that....my niece & nephew finally got to go home. So I have my house back...my privacy....my freedom! Oh, how I have missed it. I worked last Wed & Thurs...have been off since Friday morning & I have not left the house once....except to get the mail & newspapers. My sleep schedule is all messed up...I'm not sure I'll ever figure out how to successfully go from a night schedule to a day schedule. Regardless, it doesn't matter.......I can sleep when I want. I can be awake all night long & it doesn't matterrrrrr....cause I don't have anywhere to be & nothing to do but rest & relax. It's heaven on earth, I'm telling you!

Work is still crazy. I have never seen a hospital so full all the time. I don't know where these people come from. It's not like we're the only hospital in the vicinity. There has to be at least 7 or 8 hospitals within 30 miles of one another. Yet we are filled to the capacity night after night, day after day. I don't know if it's that we truly are busy or that they are just admitting people that normally wouldn't be admitted. If they are, they aren't on my floor...cause on my floor, the patients seem really sick.

I had a pretty good group of patients this past week. One man is a sad story though.....in his 60's, broke his hip, had surgery, discharged to rehab only to end up with a septic infection. Now he's been in the hospital for over a month I think...just laying there. Can't pass the swallow eval, family is hesitant to agree to a feeding tube. Sad. One minute everything is fine, the next you fall & your life changes forever.

Speaking of falls...lately we've had a bunch of them. They keep asking us what we can do to decrease it. I have no idea. We do now more than ever....round every hour, bed alarms, clearly communicating to every patient to call us for assistance. Short of sitting next to their bed all night or restraining them to the bed...I don't know what else we can do.

I had another patient who came in with a hemoglobin in the low 6's. That is really bad. We gave him 4 units of blood, but have yet to determine where he is bleeding. His stool was negative. He had no signs or symptoms. What the heck? Where does the blood go? The lovely doctor on his case wanted us...the nurses...to do a digital disimpaction. Ummmmm...yes, it's as gross as it sounds. United, the nursing staff refused & put it back on the doctor that if he wants that done, he can do it himself. My fingers are not going there. There are some lines I must draw. Luckily, the patient was able to go on his own.

I had a few other patients, but nothing really stands out. It's nice to be working on weekdays & seeing some of my other nursing friends who I hadn't worked with in awhile. Hope everyone has a great week!!!

Updates updates updates

2011-04-29T10:29:00.003-04:00

Ahhh, such a wonderful way to start a morning...watching a fairytale come true. Yep, that's right...I've been up since 5:30 am watching the Royal Wedding. Nooooo, I didn't set my alarm. I just happened to wake up & figured I'd turn it on. I'm glad I did. It was beautiful. The groom looked handsome, the bride looked stunning & there's no doubt they love one another. Ahhh, William & Kate. Of course now I feel old because I can still remember watching Charles & Diana get married & seeing them introduce William as a newborn. Enough of that!!!

Updates!

*There are still some GRUMPY older people that will never be pleased. Luckily, I haven't had to deal with any of them lately. I worked 3 in a row last weekend & I had the same patients all 3 nights. This rarely ever happens. And they were great patients for the most part. One didn't want anything from me ever. The second one ate nearly everything we had to eat on the nightshift...all three nights. And the third one...couldn't eat anything. Poor thing was only like 60 lbs and even unable to absorb the tube feeding we were trying to give her. I really think social services should be called to investigate. It is not normal to be that weight & the family denies any problems. You could see every bone in her body. It was not pretty. I felt like she could break a bone with any movement. She didn't even have the strength to lift her head. It was like taking care of a baby. :(

*The HCAPHS (govt) surveys are still a pain in the butt & probably always will be. Grrrr!

*My eval rocked! And we get a 2% raise. It's not much, but it's something. Of course my eval only lasted maybe 10 min, the other 50 min was a discussion about HCAPHS surveys. Ugh!

*I no longer love my 2 day work weekends, so I switched to part-time status with the requirement only being 2 days a week, but I can pick up additional shifts. My reasoning being...I need a break & I'm not going to get that with full-time status right now. I think at the beginning of next year, I will switch back to full-time (I'll reevaluate that later in the year), but summer is nearly here & I want to be able to take some vacation time without anyone being able to say no. Weekend status wouldn't allow me that freedom & sometimes I want weekends off....so that's the reason I got rid of that status. What I don't want is to become burnt out on bedside nursing & that is easy to do if you feel like you don't have enough time off. I don't want to be one of those nurses that hates my job, but can't do anything else because the pay is decent in nursing. So although I'll be making less $$$, mentally I'll be better off.....for now. :)

*I'm still waiting on the doctors to put in their own orders. June is when they say it will start happening. I can't wait to see it!!!

*The jury is still out on how I feel about my new manager. Talking to her during the eval was helpful & I see her approach, but at the same time...it's still odd that she won't come out of her office to talk to us. I would never want her job in a million years & in my 7 years of nursing, I have yet to see a manager last more than 2 years in that position. It's not easy. So I'll try not to judge & hope that she has our best interest at heart.

*We just had a nursing survey & I'm sure the hospital won't be happy with our results. Maybe it will wake administration up. Still looking forward to the employee satisfaction survey in August.

*I still have my niece & nephew. Supposedly the boyfriend will be moving out this weekend & the kids can go home on Monday. I'm not holding my breath nor getting my hopes up. I do want my freedom & privacy back...but still in doubt this will actually happen. The kids don't even want to go back. Soon it will be summer & I'm sure they'll be over here again. One day I will get my place back to myself. (fingers crossed)

*The Lady Gaga concert......amazingggggggg....yet weirdddddddd. It will be shown on HBO in May from Madison Square Garden...so if you have HBO, check it out. You'll see what I mean. I used to think she just did this bizarre stuff to get attention.....but now I think she truly is bizarre & this is totally normal stuff for her. I'm not sure what her message was during the concert. There was some type of message, because she talked A LOT, but I have no idea what her point was. It was a great performance though...over 2 hours of HER. That being said, I don't think I'll ever go to another concert of hers again. Once was enough.

Ok, those were my updates from the last post. Now on to current stuff...

*Prayers for all of those affected by the tornadoes these last few days. So heartbreaking.

*I'm feeling sad that today will be the final space shuttle launch. I grew up in Florida & launches are a normal way of life. The thought of never watching another one or never hearing any more sonic booms...makes me sad. I can only hope the next President brings it back. Way too much is invested to just slash space shuttles from existence.

*I'm heading out to my parents house in a little while. They are right on the east coast & I've never been there to watch a shuttle launch. It's also a nice little get away for me.

*Tim McGraw concert is on Sunday....and it's his birthday! Can't wait!!!!!

Have a great weekend everyone!

Bullets!

2011-04-03T15:54:00.002-04:00

Nooooo...not the bang bang kind. This kind:

*There really are some grumpy older people & NOTHING you do will make things better.

*Co-workers rock! The govt is getting ridiculous with their demands for "customer satisfaction" & in turn...that makes hospital administration get ridiculous with the way we now interact with patients. Sometimes I feel like an actress with all the lines I'm supposed to recite.

*Evals are this month. Will there be raises or won't there???

*I had a patient last night that I thought I was going to have to use the Heimlich maneuver. However, he was choking on water...so that wouldn't help me. Actually he was aspirating the liquid into his lungs. As soon as I figured that out....after yelling at him to cough....I told him no more drinks for him. He wasn't happy...but helloooo, you're choking on it.

*I love my 2 day work weekends. It goes by so quickly. I don't think I'll ever be able to go back to 3 days a week.

*Soon the doctors will be putting in their own orders instead of writing them. I cannot wait to see how this goes, although I'll miss the guessing what this scribble mark means type games I play with my co-workers.

*Our new manager....she's been there since the beginning of January....has yet to come out of her office & speak to us. If we want to talk to her, we have to go into her office or email her. I thought maybe she was shy at first, but now I see this is just the way she operates. It's the most bizarre thing I've seen when it comes to someone in a management position. I think I've said "hi" to her twice since she started. I guarantee you, she doesn't know my name. I don't know what she's afraid of, but the more she stays hidden away, the more the staff resents her.

*And lately nearly everyone is getting written up for anything. So far I've managed to avoid that, but hearing my co-workers "infractions" irritates me. Especially when it's the newer nurses. Instead of condemning them, use it as a way to teach them. Now they are afraid to mention anything they think might be wrong because they are in fear of getting punished. Such an unhealthy work environment.

*I cannot wait for the employee satisfaction surveys in August. It's still far away, but from what I'm hearing...people are going to be giving zeros. It's sad really....because last year we were the most satisfied working staff in all of the hospitals "chain"...which is at least 35 (or more) hospitals. It makes me wonder if administration is even aware of how unhappy the staff is. If not, there will be a wake up call in August...that's for sure.

*Ok, enough whining about work. Let's now whine about my home life. My ex-sis-in-law has been involved with a loser for the last 9 years or so. Loser clashes with my niece...because she has never been afraid to verbalize her hatred for him. As time went on, his behavior got worse....erratic, frustrated, bossy, etc. I hated that my niece had to live with such a monster. Fast forward to 6 weeks ago....loser tells everyone he's going on a trip to China...just to get away. Uh huh, yeah right. Turns out he was hooking up with some chick in China. Everyone here found out about it because he blabbed to his friends before he left. So my ex-sis-in-law declares she is dumping him & kicking him out of their house. Sounds like a dream come true...especially for my niece. Well, not only is he a loser, he wrote in an email he wishes my niece would die. Nice, right? When I saw that email...I refused to let her go back to her home while he is still living there. Because if he was an a-hole when he lived there, he's going to be ten times worse as he's getting kicked out.

*I have had her & my nephew at my house since March 7. Loser is still living with the ex-sis-in-law. She keeps saying he's moving out...but he's still there. Who knows if or when he'll ever leave. I find it truly disgusting that she is choosing this freak of nature over her own children. And you know how many times she's seen them since they've been at my house....ONCE. What kind of mother is that? She lives like 5 miles away & has seen them ONCE.

*It's been a sacrifice for me giving up my life as I know it....privacy, freedom, etc. But for those kids I'd do anything. I'm adjusting to having "kids." Some days are great, other days I just want calgon to take me away. :)

*Ok, now really...enough whining. I get to see Lady Gaga in concert in 12 days...woo hoooooooo.

I hope everyone is having a great weekend!!!!!!!!

It happened again

2011-03-28T19:51:00.002-04:00

It happened again...I lost a patient. I don't know why this still shocks me as most of the people I deal with are elderly & not in the best of health, but this was only my 3rd "unexpected" death in my 7 years of nursing. I shouldn't really say "unexpected"...but I mean it as I didn't expect it "that" night. She was in her late 80's, lethargic (which I was told in report was her norm) & looked like she was knocking on death's door. I couldn't get her to wake up...at least not in the sense of opening her eyes & looking at me. She did have this habit though of somehow taking off her allergy bracelets over & over again....so I figured she wasn't in a coma since she was voluntarily making certain movements that had a purpose. So I let her be....let her rest...thought maybe tomorrow will be a better day for her.

I usually take my last set of vitals around 3 am. Technically it should be at 4 am, but for some reason when I am at work....I am the opposite of a procrastinator (like I tend to be outside of work). I guess I just want everything completed by 6:30 am so I can give report & get home. I never want to stay late everrrrrrrrr. So I am very organized & anytime I can get something done...I do it as soon as possible. This night though...I thought I'd wait until 4. I even pulled out a book to pass the time, since I rarely take any breaks. Plus I'm hooked on The Hunger Games series & was on book 2.

I think I got to the third page & then my phone rings. It's the monitor tech saying "Ummmm, your patient is in V-fib." Uhhhh,,,WHAT????? So I run over to look at her & it's the most awake I'd seen her the entire shift. By awake, I mean her eyes were wide open....but most definitely dying. I told the monitor tech "Uhhh, we've got a situation going on here!" (a little too much Jersey Shore fan). I call my charge nurse into the room & she immediately begins the code. I was like "Uhhh, she's a limited DNR....meds ONLY." Stop with the compressions & the ambu bag. Meds only means meds only!!! Which is basically worthless without the compressions to circulate the meds. Regardless, we have to do it by the book & call the code. It finally hits me that I should call the attending MD. I call his number & I swear I got a 2 minute recording of his office hours, how to reorder medications, what his shoe size is & where he'll be vacationing....before it puts me through to an actual person to page him.

He calls back pretty quickly & of course I cannot understand a word he says because not only is he from another country with a thick accent, but he's half asleep also. No problem, I hand the phone off to the rapid response person....lol. He gave me a look like "WTF?" Ummm...sorry dude, I can't understand what he's saying, maybe you can. I then turn & look for my bff work pal & ask her to call the family. She's good with that stuff. I am not.

It's weird how when it's your code, you can't think at all. Anyone's else code & I know exactly what to do, what to say & how to get things accomplished.

Ok, family is on there way in & the rest of us are standing there basically watching her die, because meds only means meds only & they are not going to save anyone without the other interventions. I was pretty calm, as usual. I don't let work stuff get to me emotionally. I have no idea how I'm able to separate the two, but luckily it's just a natural response for me. That's not to say I don't care about my patients....I connect with the majority of them on a good level. I don't get emotionally involved though.

The daughter and granddaughter show up & I had already alerted my charge that I have no idea what to say to them, so she gets to them before I do. We gave them some time alone, but before that...they tell me the reason they didn't want her to be a full code is because they didn't want trauma to be her last life experience. I truly appreciate & understand that. They told me she had been sick for months & were ready for her to go when it was her time. They should talk to other families who think the exact opposite.

Afterwards I had to ask the dreaded questions...do you have funeral arrangements and do you want an autopsy. Luckily they did not mind those questions. Funeral arrangements had been arranged 30 years earlier....smart people. And no, no autopsy was necessary.

This happened over a week ago & the whole thing is still on my mind. I am not sad, it actually makes me think of other people dying every day. It makes me think of OB nurses & PEDS nurses....how do you handle the death of a baby or a child? I don't think I'd be able to keep the line of not getting emotionally involved when it comes to that. It makes me think of my own parents & how I have had the conversation of what their wishes are. It's a conversation all people should have with one another....because when the time comes....you need to know what they would want. It's too tough of a decision to make when you're in the middle of something happening.

Drama Central!!!

2011-02-23T13:27:00.002-05:00

What an insanely crazy past weekend...and I'm not talking about the patients! A couple of my co-workers were falling apart. I don't know if there was a full moon or what, but there was a lot of crying going on. I've never seen anything like it. I don't know them that well, but obviously there has to be issues beyond nursing that caused them to cry so much...because it wasn't related to patients. Everyone was telling me their problems. My head ached from all the negative energy around me. I'm not kidding when I say I went home & just stayed in bed all day & night. I was physically and mentally worn out. I still am...but feeling a little better. Next time I'm just packing up my charts & sitting somewhere else.

That's the thing about nurses....most of them carry a lot of weight on their shoulders. They are so busy taking care of others...patients, family, friends...that they forget to take care of themselves & the stress will eat you up. So far I've been able to avoid that...I try not to take life too seriously. Of course there are times/problems that have to be serious, but you also need to find the balance. I think I have that. My biggest problem right now is deciding whether to return my smartphone or not...so I can't complain.

Speaking of smartphones...now I'm leaning towards keeping it...because after all, it was FREE. And it's beginning to be convenient. I have 2 days left to decide & I don't have a sure answer either way. I like seeing my email right on the screen & the test messaging is fun. I'm not obsessed, in fact, I leave it plugged in most of the time when I'm at home & only pick it up to answer a text or make a phone call. So I don't know....if it wasn't free, I'd be more inclined to return it...but it was. These are my options...switch back to the 1500 min/5 line plan with no internet & pay $160 a month, or keep the 3000 min/5 line plan with 2 phones having unlimited internet for $190 a month. I can't get rid of any of the lines...they are all being well used. Decisions, decisions. Still love my ipad, but it's not like I can stick my ipad in my pocket!

I'm trying to plan something fun for Spring Break. It's the 2nd week in March. Do I go to Atlanta? My niece & nephew have been wanting to go...check out the zoo, aquarium...world of coke......OR.......do I just get a place near the beach? The weather in Florida has been amazing. I'm just going to wait & see what the weather is like the closer it gets & decide from there. I'm also checking out cruises...to the Caribbean, for later this year. Gotta have something to look forward to & the Caribbean is always paradise....as long as there's no hurricanes looming. Can't predict that.

Work was exhausting this weekend & not just cause of the crying nurses. We're supposed to only have 3 patients per nurse...because we have no techs. But lately they've been pushing us to 4...which doesn't sound like much, but most of these patients are totals & if they aren't totals...they are demanding. It wears me out. Maybe I'm getting older, I don't know if that's the reason. I had a patient on Saturday night....alcoholic who quit drinking in December. Not because he wanted to, but because he was told he needed a new liver & could not be on the transplant list until he was 6 months sober. Well, I can tell you right now...he's not going to make it to 6 months. His liver is failing & now his kidneys are failing. It's a slow, painful way to die. His issue that night for me was his potassium level. That morning it was 5.4....a little high, but livable. When I got there that night, it was 6.7. Eeekkk...don't like that AT ALL. The day nurse gave all the meds the doctor ordered & redraw was at 8. The results = 7.5. Scaring me now...because that can be deadly if left untreated. The patient's main concern = ice chips. I was trying to "educate" him on potassium levels because all he did was complain when I was giving him the medications we were using to try to get his potassium lower. I don't believe he understood, because all he wanted were ice chips. I gave regular insulin, D50, Diuril, Bumex, calcium gluconate, Kayexelate....2 liters of sodium bicarb. Amazingly I got it back down to 5.4...but I knew it wouldn't last. Hospice was being consulted. :(

I got a Baker Act at 3 am Monday morning. She took a bottle of Tramadol & then tried to convince me she just followed the directions of "take one as needed." Uhhh, ok. She's got a 5 month old baby at home....and her drug screen was positive for cocaine. Sad!

The next 2 weekends I work 3 nights in a row. I'm already dreading it!

So sorry

2011-02-18T15:17:00.002-05:00

Ahhhh, soooo sorry it's been a month since I posted. Time just flies by. Work has been ok. Nothing much really stands out other than our hospital seems to be slammed week after week. I don't remember it being like this last year...even with all the swine flu overkill. And the patients being admitted don't even have the flu this year. Lots of respiratory, cardiac, GI problems...but no flu like symptoms. Weird. The nice thing about that is that we no longer have to wear these gas mask looking contraptions on our r/o H1N1 patients. All we have to wear is surgical masks...muchhhh easier to breathe! And we don't look like exterminators. I'll have to take a pic sometime & post it. My fellow nurse now uses hers when she cleans her bathrooms at home...so she doesn't breathe in all the chemical smells. Not a bad idea!

I have had a couple of patients that wrote nice cards regarding how I care for them. That's always nice. And at the other end of the spectrum, there's always one family member that thinks you're the worst person to ever step foot on earth. I would really like to know why her expectations are soooo high. My hospital is one of the best in the nation & we go above & beyond to make sure the patients and families are happy. Every once in awhile we will get a patient come in....like with syncope/dizziness & not be able to figure out why it's happening. Newsflash...that is NOT the nurse's fault. Take your frustrations out on the doctors....they are the ones diagnosing patients. We simply care for your family member & do our best to make sure they don't fall while in the hospital. Ironic thing....the patient would thank us at least 20 times for whatever we did...whether it was to help her to the bedside commode or simply turn off a light in the room....thank you, thank you, thank you...I really mean it, thank you. Why couldn't a little of that appreciation rub off on her family members? Sigh. Done venting.

We have a new manager. She rarely comes out of her office. It really is bizarre to go from having such a social manager who would greet us in the mornings, come out to the nurses station and even occasionally stay later at night to interact with the night staff. This one...in her office all the time. She loves her emails. I'm not judging her...maybe she's shy? She's very encouraging via email. That's fine. It's just different than what we're used to & some people I think are a bit offended by her lack of physical interaction with the staff. I'm ok with it.

Weekend option is still going very well....other than the fact they forced us to pick up an extra shift per pay period. I figure it will come in handy when we do run into the slow season & we're being called off. So I won't complain.

I bought tickets to see Katy Perry in June.....I cannot wait. Lady Gaga in April. And Tim McGraw is coming to town in May. I tried to get Taylor Swift tickets...but all the ticket brokers bought them up. So I either have to pay a lot to see her or just skip it. So far the thought of skipping it is what I'm going with.

I did upgrade my cell phone to a windows phone. However, I'm returning it next week. I hate the camera on it...hate it! And I just can't justify in my head paying an extra $50 a month for my nephew & I to have the internet on our phones. I miss my old easy phone. So I'll be switching back. Just giving it a few more days to see if I get attached to the new phone. I like some things it offers...but cannot justify and extra $600 a year to read my email & be on facebook & have access to the internet. Maybe if I didn't have an ipad.

The weather here in Florida is beautiful. In the 80's for the next 5 days. Hope everyone has a great weekend!!!

Whoa....really?

2011-01-18T12:40:00.002-05:00

It's that time again...already??? I'm starting my 7th year of nursing. Wow! It really does fly by, even though on some of my latest shifts, it seems like it's crawling. Happy Anniversary to me!

It's one of the best decisions I've ever made & even though there are times when it is so hard, I'm glad I followed this path. It has allowed me financial freedom finally as well as job security. The two things I was seeking when I decided to go back to school. I've come a long way since then & happy to report that all is well. Even my ankles are feeling better.

And if that isn't enough, a patient of mine finally wrote to my CEO & praised what a great nurse I am. It's the little things that mean so much, isn't it?

Work has been soooooooo tough lately. Soooo many very sick patients and the acuity is outrageous. Not to mention we are understaffed & admin really doesn't seem to care. I don't get it....they strive how important it is to make sure the patients are happy, yet they shortcut every avenue it takes to make sure the patients are happy. I'm trying to lay low & hoping that this too shall pass. I'd be lying if I didn't think/hope there is some place better out there where common sense does prevail & it's not all about the numbers. I'll always wish for the day that administration actually comes to the floors & spends a few shifts seeing all that we do, but again, I'm probably dreaming. It's better for them not to face reality.

I had a patient the other night who told me he has leukemia and that he wants to die. What do you say to someone who is opening their heart to you that way? He's not a candidate for chemo and he's refusing hospice. He says he wants to stop being a burden to his family, that he sees the worry in their eyes. Heartbreaking.

I had another patient admitted the other morning....who has full blown alzheimer's. So sad, the way she treated her husband. All I could think is that she must have been...at one time...a very kind person to him, for him to take care of her day after day in the condition she's in now.

These aren't the things most people visualize when it comes to their final days, but it is reality.

My weekend option was almost taken away. There are rumors they are going to get rid of it, but so far they are forcing us to not only work the weekends, but to pick up an extra shift every pay period. They rather have us work more than hire additional employees. I hope this is temporary...the not hiring additional employees. My hospital really, really needs more nurses.

I'm gonna go work out & hope my ankles survive. Having dinner later with my nieces...should be fun. Have a good week everyone!

Oops I did it again...

2011-01-07T19:50:00.002-05:00

I tripped & fell while exercising (walking) & now sprained my other ankle. It's not as bad as last time, but how in the world do I manage to do this? Grrrrrrrrrrr!!!!!!!!!!!

I'm taking it as a sign that God does not want me exercising. Just kidding!

I have to work this weekend. I'm hoping it's better by Monday because I want to walk & play Kinect (awesomeeeee Xbox 360 thingy). For now though, I shall rest.

Hope you're having a better time than I am!

Happy New Year!

2011-01-07T10:29:00.002-05:00

Happy New Year! I can't believe I only posted one time in December. Wow. Let me post some updates:

*lost another 5 lbs or so, still doing Weight Watchers although I really don't follow what they say. They switched to a new program which requires you to use a calculator for everything & that is just not me. I think what works is the fact I have to go weigh in every week, so I have really cut back on the junk I eat. I haven't stopped eating it completely & probably never will, but I am making better choices.

*I found a new trail to walk...which is a good thing. The bad thing...I was out there this morning & after a mile of walking, I tripped on a tree root & hurt my other foot. Grrrrrr. It's not bad, but I stopped walking & came home...just so I wouldn't make it worse. Hopefully it will heal quickly. My other ankle is still swollen, but no pain. I'm changing my name to Clumsy!

*Not even a month after I sign the contract for weekend option, my hospital decides to eliminate weekend option. The good news is that my contract is good until November. The bad news is that it won't be renewed. Well, unless they become really desperate. It aggravates me that they are eliminating every perk there is to being a nurse. They got rid of overtime bonuses and now weekend options. You would think they were overstaffed to be doing this, but nope....we are really busy & really understaffed. No doubt it's someone in administration deciding this stuff. Oh well, hopefully things will change.

*With that being said, sometimes I think about going back to my old hospital. Just because it's so conveniently located...5 miles from my house as opposed to 25 miles. I went out to lunch the other day & in the parking lot I see this truck with a license plate of my old hospital. I'm thinking "Who the heck would drive around with a hospital license plate on the front of their car?" Next thing I see...the CEO of that hospital getting into the truck. Is it a sign?

*I worked in ICU a couple of weeks ago & I said goodbye to my patient in the morning. As I'm walking down the hall to leave, I hear him frantically yelling "Jenniferrrrrrrrrr, takeeeeeeee meeeeeee withhhhhhh youuuuuu." I was so embarrassed because he kept yelling it louder & louder. Poor guy.

*I watched the best show ever last night...a documentary on Tim Tebow. I am a big fan....not a fanatic though. I don't have any Tebow jerseys or pictures or stuff like that, but I do admire him. I don't know what it is...when he speaks, I just want to listen. The documentary was awesome, he even makes exercise look fun! I don't think his calling is football...I think he's meant to do greater things than that, but for now, I hope he does well as quarterback in the NFL. They had an energy supplement commercial he supports & I'm sure I'm not the only one that went on & ordered the free sample. It's called FRS...I'll let you know how it is when I get it.

*Speaking of energy drinks, I was talked into trying Spark. Not sure if any of you have ever tried it...but so far I'm not impressed. Maybe because one of the main ingredients is 750% of B12......which should give one some extra energy, but I have Pernicious Anemia which means I cannot absorb B12 naturally, I take injections. I don't know if I feel any more energetic than when I don't drink the energy mix. Plus it has like 120 mg of Caffeine as well as a bunch of vitamins. I'm not sold on it. Thus the reason I'm willing to try FRS.

*I had lab work done last month & the results were great. Much better than when I had it done last March. So I guess diet, exercise & fish oil really do work. I'm actually looking forward to June when I will get lab work done again.

*Lady Gaga concert is in about 98 days. Seems far, but I know the next 3 months will go by quickly. I cannot wait! She better not cancel!

Ok, that's about all I can think of right now. It's time to go rest these weak feet of mine & watch the Jersey Shore premiere. Hope everyone has a great weekend!

Some updates!

2010-12-04T03:28:00.005-05:00

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

*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

2010-11-17T17:14:00.003-05:00

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

2010-11-07T14:17:00.003-05:00

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...

2010-10-26T09:30:00.003-04:00

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

2010-10-15T08:34:00.002-04:00

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

2010-10-10T02:25:00.002-04:00

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

2010-09-30T00:51:00.002-04:00

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

2010-09-24T20:27:00.003-04:00

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

2010-09-09T12:07:00.003-04:00

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

2010-09-05T14:44:00.002-04:00

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

2010-08-18T08:21:00.002-04:00

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

2010-08-08T22:25:00.002-04:00

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!

2010-08-02T01:20:00.009-04:00

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

2010-08-01T06:03:00.004-04:00

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...

2010-07-17T14:44:00.002-04:00

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...

2010-06-28T14:49:00.003-04:00

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?

2010-06-23T22:48:00.003-04:00

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

2010-06-19T02:16:00.003-04:00

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

2010-05-30T23:08:00.002-04:00

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

2010-05-21T16:32:00.004-04:00

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

2010-05-14T01:15:00.002-04:00

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!!!!!

2010-05-09T02:53:00.004-04:00

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!! :))

Miami Vice = mmmmm

2010-04-27T03:29:00.004-04:00

Ahhh, I'm at the tail end of having 6 days off. I've been at my parents house the entire time because they are out of town & it's just nice to be somewhere other than my house. I thought I would do stuff & get things accomplished.....what things?? I have no idea...lol. Instead it's just been a nice time of relaxing & not really having to do much of anything other than relax. They live on the intercoastal waterway & with that comes protected wetlands & with that comes wild animals. It always scares me to let my dog out because I don't know what creature may be lurking around. There have been sightings of panthers & cougars....lovely. I haven't seen any of those, but I have seen bobcats...which I am not crazy about having around my dog. Just now (at 3 am), I let my dog out & she came back in & she goes to the window to look outside & there is some medium size thing roaming around the yard. I have no idea what it is. It looks more on the light side than the dark side...so that rules out raccoon. I don't think it's a possum because it doesn't move like a possum. This is the second time I've seen it & I really don't want to see the mystery animal again. I guess it could be a cat....a really big cat. Who knows? Doesn't seem to move like a cat though. Oh well...let's leave it a mystery.

I go back to work tomorrow night and lucky me...it's a full moon. At least I'll have my orientee for a couple of nights. Last week was rough....not the patients so much, just the being back to work part.

I did have one patient whose daughter was a bit over the top. She was more like a tornado than anything else. Luckily, she adored me & I was spared her bizarre behavior. I don't know what exactly went down Saturday night, but I was told she was so irate that she made the night nurse cry. Huh??? This was the report I got with the added "She'll be here a little later." Oh great! Lucky me! I introduced myself to the patient....and older male whose hemoglobin level kept dropping even though they ruled out any bleed in the GI tract. He & his family were frustrated because the doctors had no answers as well as they hadn't seen a doctor since Thursday & they were just basically pissed off.

Timing is everything & again...lucky for me, the doctor was rounding when the daughter was there. I stood outside of the door (out of sight, out of mind!!) & listened to the daughter scream at the doctor. I give him credit for remaining calm despite her erratic behavior. I just don't get people like that...people that feel the need to scream at other people. This wasn't even the pt's doctor...it was the doctor on for the weekend & was rounding. He barely knew the guy. She didn't care. She gave him everything she had in the yelling department. I had enough & walked away to take care of my other patients. I just have zero tolerance for drama & that's what I felt like she was creating.

I went back in after the doctor left & she was all smiles with me. I informed her his blood count was dropping again & he may need blood. She was fine with it. He got discharged after a couple of more days. They still didn't know why his blood count was dropping. There was talk that it might be pre-leukemia or some type of bone cancer that inhibits the body from making blood cells. Poor guy!

I had another patient that came in with a fever & a little bit of dizziness. So what do they do....put him on special precautions until we rule out the swine flu. Come on.....for a fever??? Beyond ridiculous. I was a little concerned about him as his fever really wasn't responding to Tylenol. He showed up on the floor with a fever of 103.1. The lowest I could get it was 102.4. So I call the MD & ask if we can try Motrin since he has had 2 doses of antibiotics & 2 doses of Tylenol & his fever is still quite high. The response I got....NO, stick with Tylenol. Whatever!

I guess there is something viral going around that has a symptom of a high fever that sticks around for a few days. There's not much medication wise that has much of an effect on it. It's definitely not swine flu. Which speaking of....do we even hear about it any more on tv or in the news? No. Total overhype!

Now to the good stuff...the cruise. I loved it. There is just something different about going on vacation & going on a cruise. It's like an escape from reality. Everyone (well mostly everyone) is happy & nice & gets along well. Then again, it could be all the alcohol most people are drinking. :) The first day/night on the cruise was the time when I drank the most. I learned the most incredible thing that day. In fact, I can't believe I went 41 yrs without learning this sooner. There is a drink called a Miami Vice. It is half pina colada & half strawberry daiquiri. They really should rename it Paradise!!!!

Sometime during that night, we decided to do shots of Alabama Slammer. I can't remember the last time I did shots. We ended up walking around the ship until like 3 am. Crazy...but still fun. The second day was time to get some sun. We were at sea for the day. It was also formal night = lobster tail dinner. Well worth having to dress up. :)

Our first day at port, we were in Grand Cayman. My friend wanted to do this Reefs & Rays snorkeling excursion. I reluctantly agreed. I just am not big into snorkeling or watching sea creatures swimming around under me....especially sting rays. You know...the same type of creature that killed The Alligator Hunter. We had to take a bus to another boat & then the boat drove out like 20 min to the Barrier Reef. The captain was basically like "Ok, here's your gear, stay in front of the boat & have fun." There was like 29 of us just staring at him like "huh?" I am all for being independant, but I have never used a snorkel outside of a swimming pool & seriously...that's not exactly what I'd consider snorkeling. Then he mentions "don't get too close to the barrier reef or you won't survive it." Ummm, what does that mean? What exactly happens? Hmmm, maybe I rather not know. So we are basically thrown off the back of the boat & on our own. It was nice.....not particularly exciting to me....because I am just fine with looking at pretty fish in fish tanks, but it was an experience.

The captain starts whistling for us to get back in the boat. Once again...no assistance given. Just a basic "take your time & climb back in, hold onto your gear." Yeah, easier said than done. He then drives us to another location & tells us all to hurry up & get in the water so he can throw out the sting ray bait. Ummm, is anything else gonna show up...like sharks??? So we all get in the water (like idiots) & sure enough...there are sting rays everywhere. The captain is telling us we can touch them, just don't get near their tail. Yeah, ok, buddy. I'm not diving down to touch a sting ray. I've done it plenty of times at Sea World.

It was creeping me out to look down in the water & see these things swimming under me. I just kept picturing in my head that one will start to rise to the surface & bump into me & get me with it's stinger. No thanks....I got back in the boat after about 10 min. I was obviously not the only one with these thoughts as many others were getting out of the water too. The current was pretty strong too & once again the captain gave us a warning that if we happen to drift past a certain point, we might be goners. Great! Just what I want to hear. Although Grand Cayman is beautiful, it's not where I want to die.

The next day we went to Cozumel, Mexico. That was an adventure in survival skills. We didn't do any excursions...just wanted to mainly do a little shopping & go to Senor Frogs. We took a taxi to get to Senor Frogs, but as we walked towards it, this guy that owned a jewelry store begged us to come in...with the promise that he'd give us a free charm. I don't want a free charm! But they beg & plead, so we're like "fine, dude." Once we're in his store, my friend starts shopping for bracelets. I had zero interest in buying any jewelry, so I was just walking around the shop. As my friend was trying to narrow down her selections, the guy turns to me & says "You want a beer??" Uhhhh, what?? He repeats it again & I was thinking "noooo, I don't want a beer from a stranger in Mexico." I politely decline, but he runs off to go get it. Sure enough, he hands me a can of beer. Luckily, he brought my friend a diet coke, but she didn't want it. So I took her diet coke. I just am not much of a beer drinker, much less foreign beer that I had never heard of.....and in a jewelry store. Ahhh, Mexico!

My friend bought some bracelets & we got out of there pronto...back on track to go to Senor Frogs. That place is crazyyyyy. I can't even really describe it. It is a very interactive restaurant...by that I mean you barely have 5 min to yourself. There's a clown making balloon animals, there's a photographer taking your picture, there's a guy wanting to give you a Henna tattoo. There's another guy that is trying to give you free shots of tequila. There is another guy giving some other free shots away...who knows exactly what it was, but sure enough, we drank it. We did a little more shopping & ended up at Fat Tuesdays. We had one of those in Orlando back in the 90's, so I was familiar with it & definitely more my style.

Our last day on the ship was another day at sea. Only this time it was a very wavy day at sea. I loved it....it was like being on a non-stop mini-rollercoaster. Other people didn't enjoy it quite as much as I did. It pretty much lasted the entire day & night...not sure why, but oh well. Our ship was full...totally sold out. I went on the Carnival Inspiration & although it is one of the smaller Carnival ships....I was impressed with it. For having over 2600 passengers, everything went very smoothly.

I'm already planning to go on another one in November. I cannot

wait. Speaking of cannot waiting.......one week from Thursday & I'll be seeing my favorite guy in concert = Tim McGraw. Lady Antebellum is opening for them. I'm going to spend a couple of days up in Jacksonville....just a mini getaway. Can't wait!

Hope everyone is doing well. :)

I'm Back

2010-04-18T09:50:00.001-04:00

I'm back from the cruise & go back to work tonight...ahhh. No orientee either...she's in nursing orientation this week. Oh well, I shall survive. Then I have 6 days off to spend near the beach...yay, yay, yay. Love Florida!

I'll catch up soon!!

Bon Voyage

2010-04-08T22:14:00.002-04:00

Sorry about the continuous slacking. It seems like time is flying by faster than ever & I cannot figure out why. Usually the beginning of the year is slow, but this year it's on fast forward or something.

Work is going fine. I am precepting again for a new grad. It makes me feel good that they chose me out of all the floor nurses to precept a new nurse. It's hard work in the beginning though. So much to explain & at the same time, try to remember what it's like to be brand new. We had a patient that had an order to call if c-diff results were positive. We found out at 1 am that the patient was indeed positive. Well, the MD wrote the order...so it's got to be followed. I told my orientee if the MD that wrote the order is on call, she can speak with him...it would be good practice & an easy call. He was on call, but the answering service patched me right through to him at home...so I spared her from having to talk to him. I think she was glad as I saw the nervousness disappear when I began talking to the MD. He was pleasant & wanted Flagyl started stat...so no problems waking him up at 1 am for c-diff results.

I am officially on vacation for 11 days. I leave on a cruise this Saturday...heading to Cozumel, Mexico and the Grand Caymans. I cannot wait......although I have barely started to pack. I just am not motivated. I am already in vacation mode. It's a 5 night cruise...got an awesome deal...$319 per person for an oceanview room. That was a one day deal, now it is up to $659 per person & the ship is completely sold out. I'm not crazy about having a full ship, but oh well, nothing I can do about it. So much for there being a recession!

Hope everyone is doing well!!!

Very much

2010-03-20T21:26:00.002-04:00

I am very much a slacker...look, it's March 20th & I have yet to blog anything this month. Sorry! Plenty is going on...that's for sure.

We started our 3 patients to 1 nurse ratio. It's working out amazingly well...except on the rare occasion when they bump us up to 4 patients & add in some patient care techs. The patients seem to like it also...our call lights have gone from like 100 a shift down to about 10....and we're talking about a floor that holds 45 patients. So that is really good. It's still hard work...doing primary care, but I do think it's better.

I took my niece to see Taylor Swift at the beginning of the month. It was a great concert...way better than I ever thought it would be...minus the 14,000 screaming tweens. I also bought tickets to see Tim McGraw (yet again) in May. This will be the 4th time I've seen him!

I turned 41 back on March 7th. It was not a fun day. I was sick that entire weekend....like zero energy & major sinus congestion. I really didn't do much celebrating at all. I guess I'll save that for my upcoming cruise. We are at 21 days to go...woo hoo!!

I went to the beach today....it was beautiful out. Need to work on that tan before getting on the ship.

Hope everyone is doing well!!

Bye Bye February

2010-02-28T23:36:00.003-05:00

I've hardly posted this month & in less than 30 min, the month will be over. Jeez, I'm a slacker!

Tomorrow starts our new patient ratio. At least it's supposed to start. I have doubts as we need to hire like 12 more night nurses & who knows how many on days. Maybe they'll offer some overtime. Not that I really want to work anymore than I already do. I don't know if it's the weather or that I'm getting older or what...but after 3 nights of work, I'm exhausted for like the next 3 nights off. All I do is sleep.

I'll blame it on this cold weather. I cannot stand it. I live in Florida. It should be warm! Last night we were like 9 degrees warmer than Chicago & New Jersey. So not fair!!

The Winter Olympics are over.....I'm gonna miss it. I don't think I've ever watched this much of the Olympics before. Again, I'll blame it on the weather. I have enjoyed it though. 2014 will be here before we know it.

My patient that passed away last week. Still no definite word on why he became septic, so I had to come up with my own theory...just to stop thinking about it so much. I think his gallbladder was infected & possibly burst a little...thus leaking the infection into the rest of his body. The three doctors that came in to see him prior to his death had no clue he was on the verge of death. In a strange way, that makes me feel a little better. I mean if three docs couldn't see it coming, how was I to know? It's still sad though. He was such a good guy...one of those that helped everyone & would say a prayer - even for the not so kind people in this world. We lost a good man that morning, but for whatever reason, God needed him more I suppose. I'm done worrying about it. It definitely was a swift reminder of just how fragile life is & even those of us that aren't overloaded with health problems can be taken in an instant. Enjoy each day.

My birthday is in a week. In some ways it seems like this past year went by so quickly & in others...like it was a very long year. No special plans...just hang out with my family.

I'm back on my own tomorrow night...no more orientee. It was fun while it lasted. Hope all of our new grads do well. It's kinda neat to see how nervous & weary they are. I know I was that way when I started too.

Hope everyone has a great week!!!

My Heart Aches

2010-02-19T17:26:00.003-05:00

Ugh....not even sure how to start this, but I know in the long run it will help me to vent how I'm feeling. I rarely feel this way because I don't allow myself to become connected to my patients. I can get their whole life stories out of them...how they met the love of their life, how many kids/grandkids they have, what type of pets, etc & yet keep a safe distance emotionally as to not feel bad if their condition worsens or if I never see them again. Sounds cold-hearted but if you're a nurse, you have to do this to a certain degree or you wouldn't last very long as a bedside nurse.

I came into work Wednesday evening expecting a good night. Or more like hoping....like I hope for every night. I had my orientee writing down report while I listened...because at this point, she has one week left on orientation before she is completely on her own. So she is supposed to be taking care of my entire assignment with very minimal help from me. So I let her write down the report while I just listen & memorize important things in my head.

The nurse was giving us report on a new admission. He had just gotten to the floor at 3 pm after having spent like 10 hours in the ER. The day nurse said to me "Something just isn't right with him. He's slow to respond, although he responds appropriately, but something is just off. It's not right." She had called the primary doc three times to tell him this...her concern caused the primary to come in just to see this patient. He, too, became concerned. He told me he didn't know if the patient was septic or in diabetic ketoacidosis, but something wasn't right. I had yet to even see the patient as we were just finishing up report at this point. I soooo wish I had asked for an ICU transfer at that time, since everyone was so concerned...but I don't think it would have made a difference. And I had yet to assess the patient myself.

So we go to check this patient out & hang a bolus as his admitting diagnosis was dehydration, nausea & vomiting. His wife & son were at bedside. Very pleasant people. I asked the patient a couple of questions & could immediately see why the nurse & doctor were so concerned. Something definitely wasn't right. The doctor had ordered a CT scan of the brain...to rule out a bleed. Amazingly the CT department came for him immediately & took him down to do the test.

At this point I wasn't alarmed. I figured he was dehydrated & had a low sodium (125) & was a little disoriented because of that. Low sodium levels can cause people to behave a bit differently than normal. I thought we'll rehydrate him, start the antibiotics & hopefully he'll become better through the night.

When he came back from CT, he complained that he was short of breath. Checked his 02 sat & it was 100%. Took his blood pressure & it was in the low 80's systolically. My charge nurse turned up his IV fluids to 500 ml/hr. We called a rapid response because that basically is an ICU trained nurse that is great at assessing people that seem to be having problems. I was talking to the patient and although he seemed very out of it, he was able to answer my questions correctly. I changed his gown as he was all sweaty (he had a fever earlier of 103 that broke) and I got a cool washcloth & wiped his forehead with it as he appeared to be sweaty. He whispered that felt nice.

The rapid response nurse started a Neosynephrine drip on him in hopes of increasing the blood pressure. I had a call out to the primary doctor. We were already making plans to transfer him to ICU, regardless of whether the doctor called back or not. Our rapid response nurse has the authority to do that. They checked his blood pressure after about 15 min of running the Neo. Now it was in the low 70's. They rushed him over to ICU.

I stayed behind because I had another patient we were transferring to another hospital & EMS had just arrived to take him. I figured if ICU had any questions, they could call me or my orientee. She had already called report over to them before the transfer. The doctor had called & didn't order much at all. Guess he figured he'd just place the orders with the ICU staff.

I felt confident that ICU would be able to increase his blood pressure. As a PCU nurse, I like knowing that when a patient goes bad, we have a higher level of care we can take them to & that once I get them there....the problem is out of my hands. The stress stops there. I've done what I could do. It's half the reason I haven't ventured into ICU to become a nurse. There is nowhere else to take your patient when they go bad....it's all in your hands. I'm not ready for that level of stress.

About 2 hours later, I hear overhead....Code Blue ICU & they announce the room number. I wasn't sure what room my patient went to, but I knew instantly that was my patient. I silently hoped it wasn't, but my orientee confirmed the room number & all we could do is wait. I looked at his most recent labs...they showed liver & kidney failure. The CT scan was negative though. I was trying to figure out in my mind what could be causing his blood pressure to remain so low. Why wasn't he responding to the fluids and the medications???

Still though, I was praying ICU would be able to save him. He's too young. He has a wife & kids. He's a good person. We need to save him. Please, please, please.

About an hour later I was informed he didn't make it. Even with all of our interventions and three more doctors/specialists had come in to assess him when he was transferred to ICU, we couldn't save him.

Since my orientee was taking care of my patients for the most part, I spent the next couple of hours looking online for what could have happened. What did we miss? Why did he die? Why was he not responding to the medications?

All I could come up with is septic shock. As I read on, I learned that 1400 people a day die from that. What? I've been a nurse for over 5 years now & this is the first time I've seen it with my own eyes. I mean, I've gotten plenty of older people that were in the hospital being treated for septic shock, but I never saw anyone die from it.

It was so quick, so fast. I cannot stop thinking about it. It makes me so sad. I barely spent any time with this patient, but I feel this loss. My heart aches for him, for his family. I cannot logically figure this out. I am searching for someone to blame...but this time everyone did everything right. There was no delay of care. It was no one's fault. Still hurts quite a bit though.

He was only my patient for less than 3 hours, but the memory of him will last the rest of my life. May he rest in peace and his family be able to feel the many prayers being said for them.

Exciting Changes - kinda

2010-01-29T13:03:00.002-05:00

There are some major changes coming to my unit at the beginning of March. First...we are getting rid of all the patient care techs on our floor. Second...our nurse to patient ratio is supposed to be 3 to 1. I will believe it when I see it. I get the feeling that it will be more like 4 to 1...which will be difficult. 3 to 1...that's doable.

The whole idea behind this is to increase patient satisfaction. Medicare came up with this policy that if the patient's (65 & older) are not satisfied with their hospital stay, Medicare doesn't have to pay the bill. Thus, this is giving hospitals quite an incentive to base everything around patient satisfaction. A lot of the questions are based on nursing...ex. "Do you feel your nurse kept you informed with what was going on? Did you have good rapport with your nurse?" etc.

Sooooooo they think if the nurses spend more time with their patients, the patients will respond appropriately. It's worth a try. I'm not sure it will be successful...because as any nurse knows...a good tech is quite a help. With no techs for assistance, we're going to be relying on other nurses & if we are all busy with our patients...how are we going to help each other? Time will tell.

On the other hand, I am hoping this will allow us to have more patient/nurse interaction. With having 5 patients & pretty much less than a 4 hr window (7pm to 11pm) to assess, medicate & establish a good rapport...it makes it difficult. Most of our older patients want to go to sleep around 9 or 10 & get mad if we are in there beyond that time. I would like to spend more time doing nursing stuff as opposed to charting or orders or talking to MD's. Let us be nurses who care for the patients & have everyone else be less reliant on us.

I heard at another one of our hospitals, they got rid of the patient care techs and the respiratory techs. I guess the nurses are doing the breathing treatments. I would be worried if I were a respiratory tech...I'm sure more hospitals will be switching to this in the future & probably only need a couple of them in the hospital for intubating critical patients.

I still have my orientee for the next month. I love it. She is really doing well & thus making my job easier. She's taken on a lot of challenges & I have stepped back to allow her to start using some of her own critical thinking skills. It's hard to not want to take over & do what needs to be done...but it's the best way for her to learn.

A bunch more nurses left my old hospital. Pretty soon there will be no one left that I know. I'm happy for them. They deserve to work somewhere that they are respected & appreciated.

I read Dear John....very quickly. It's an easy read. I can tell it's going to be a sadddddddddd movie. I don't usually cry when it comes to movies, but I'll have a few tissues with me for this one. I thought it was a good story. I'm going back to reading the True Blood series.....vampires...lol, not much to cause tears.

Still planning for the cruise, but don't have an exact date as my friend is still waiting for her Canadian passport. I hope we are able to take off work at the same time...not sure with all the new changes coming up.

A little of this & a little of that

2010-01-17T20:23:00.002-05:00

Gosh, I feel like not much is really going on...even at work. It seems like the same old stuff. I still have my orientee. I'm trying to teach her the ropes. It's kinda neat to remember back to being a brand new nurse & all the things I used to be scared of...but now have the confidence & patience to get thru pretty much anything.

We had 2 patients last week that were drug seekers & they would watch that clock or call early for their pain meds. I gave both those patients to her...I didn't know at the time that they were addicts. She was so frustrated by the end of the first shift. I had to keep reminding her to relax, let it go, don't let their neediness wear her down. By the end of the second night, she wanted to refuse to have one of them back. I told her to be careful when it comes time to refusing to have someone back...because you could end up with someone even worse. Besides, these two will teach you patience...which she needs. I sent her home with the homework assignment of learning to meditate & letting frustrations go.

The beginning of our third shift....she was a new person. She had a new attitude. I told her to stand her ground & let them know that she was in charge....but in a nice way. I had already demonstrated that morning of how to handle them when they are asking for pain meds early & saying "the other nurses get it for me early." I told her you can be honest, but be kind also...you are their advocate. I think she learned a good lesson...hopefully.

I've been trying to teach her to ask other people for help...that I am not always going to be around to help & she needs to turn to others. So far that hasn't gone too well. She had a patient whose 02 sat was something like 62%. Normal is better than 92%. I was in a room with one of my patients & she could not find me. So what does she do when someone asks her if she needs help...she sends them looking for me. Wrong answer! Turns out the patient's oxygen tubing had gotten pulled out of the wall & had to be hooked back up. That's it. We're going to have to work on her trusting other people, just in case I am not available.

I remember those days though. My preceptor would often leave the floor to smoke & that seemed like when everything would go wrong. Live & learn.

I had my niece for a couple of days. We went to see The Lovely Bones yesterday. I tried reading the book, but I absolutely hated the storyline. So depressing. The movie was just as depressing. It was well done, but just reminded me of how many creeps we have in this world preying on children. My next book to attempt reading is Dear John. The movie comes out soon, but I will make myself read the book first & finish it.

Some good news...looks like I'll be going on a cruise sometime in March. My friend/co-worker & I are both born in March & want to celebrate by taking a cruise. We're just waiting on her to get her passport from Canada, then we'll book it. I cannot wait. The plan is to head towards Mexico. I just want to be on the ship, I don't even care about the ports.

Have a good week everyone!

Still Here!

2010-01-08T19:49:00.003-05:00

Happy New Year 2010!!! I'm still here...just taking a little break from writing. I have an orientee now...a new nurse & it has been enjoyable teaching someone new the ropes. It's also nice to have an extra set of hands to take care of my patients. Luckily she's a lot like me, so we get along well.

I'll write more later next week when I have some time off. Just wanted to say Happy New Year & word of advice...go see Avatar in 3-D......it is well worth it!!!!!

p.s. Can you believe they are predicting snow in Orlando in the morning??? Brrr...it's so cold!

The Week of Grumpsters!

2009-12-18T01:55:00.005-05:00

Ahhh...so refreshing to be back to work after having nearly 2 weeks off...NOT! Monday night was ok....busy, but doable & ok. Then Tuesday night came....sit back, it's gonna be a long one...

I came into work taking back the 5 patients I had the night before. Ordinarily, this would be a good thing & report would be quick & I could be on my way to taking care of my patients. NOT! Two of my patients were ok for the most part. The third was to be discharged...but for some reason, case management thought it was necessary to go discuss with the patient & his wife their hospital bill. This patient was in the hospital for less than 18 hours...diagnosis chest pain. He had an echocardiogram done and a stress test as well as a couple of sets of cardiac enzymes. Case management tells him his bill is $50,000 of which his insurance company will pay 90% and could he please pay them $5,000 before he leaves. What?????? Seriously....what??? This isn't something you say to someone that just 18 hours ago came into the hospital with CHEST PAIN. Were they trying to cause it again? So I get there & the patient asks if I think that amount is excessive. Such a fine line....as nurses we are supposed to be our patient's advocate....they are the top priority of nursing care. At the same time...I get paid by the hospital. So what am I to do or say? I do only what I know how...be honest & say yes...I think it is excessive for not even being in the hospital for 24 hrs. No way can a stress test cost that much. I advise them to go to financial services & ask for a printout of the charges & take it from there. They should not have to go home worrying about this stuff.

Ok, that was not even my top concern as far as patients go. I had another patient who had a son that was one of those that...I swear if he could jump on my back, he would do it. The type that thinks you are the personal nurse of their family member & you have nothing better to do than meet whatever needs they may have or just to listen to them talk. Sometimes I have the time, sometimes I don't. This was one of those times that I didn't have the time. Of course you can't come out & say that...nor can you tell them what is a higher priority at the moment. All you can do is try to slip away without being too obvious & hope it doesn't piss them off.

My top priority was a patient that came back during the day after having a heart cath & she developed a hematoma at the insertion site (femoral artery). By the time my shift started...this hematoma was from her groin all the way over to her hip. It was the largest hematoma I've ever seen. Luckily, the cardiologist had rounded earlier & seen it himself & ordered an ultrasound to rule out a pseudoaneurysm. The patient went down to ultrasound & I attempted to do some charting & start giving the other patients their medications.

Less than 30 min later I get a call from the ultrasound tech saying my patient is positive for a pseudoaneurysm. I was not really sure what that even was exactly as I've never dealt with it before...but I knew it had to be important if the tech was calling me to inform me. I then called the cardiologist...had to page him twice cause he wasn't calling back. He calls back & immediately orders for this patient to be transferred to our bigger hospital for a femostop protocol...again, not familiar with it, but it sounded pretty important. So I inform my charge nurse & we get the ball rolling to get this patient transferred as quickly as possible. I tell the patient & her family about what is going on. The cardiologist comes in & also discusses it at length with them. He tells them "I hope to get you over there within the next 8 hours." I get a call from the other hospital & I already have a bed assigned & transportation is on their way!!

I'm feeling really good about this because it hasn't even been an hour since I got these orders...way under the 8 hr window the cardiologist was hoping for. Transportation arrives...the patient is loaded up & sent on her way...I call report to the receiving nurse. I think "Wow, I did so well!!" I then place a courtesy call to the attending doctor to inform him of what is going on & that his patient has been transferred.

I get a call back & from the time I answered my phone...all he did was yell at me. For a second I was thinking "Are we even talking about the same patient?" Although it wasn't "we talking" it was him yelling....like a 3 yr old having a tantrum. He insists the transfer is not necessary & that he has cancelled it...he then starts giving me orders. I interrupt him & tell him "The patient has left this hospital." How am I going to take orders on a patient who isn't even there? Seriously! I didn't say that, but I sure did want to. He yells at me "No she hasn't, I cancelled the transfer" & then carries on again. Ummmm...I just saw the hot EMS guys that took her & she is not here. So he rants on & on....it wouldn't have surprised me if he had a heart attack with how he was behaving. He then insists on talking to my charge nurse...where he continues his tantrum. She didn't really care....I guess it's typical of this doctor to always be yelling. That's so unprofessional!!!

He has gone as far as reporting it to my manager, who now wants to have a meeting to see how we could have handled this better. I'm hoping she's just doing this because it will please admin & the jerky doctor....not because she seriously thinks we didn't handle this correctly. Because I do not believe anything we did was wrong. It was a complication caused by a cardiac procedure that the cardiologist did that day. Everything was run by the cardiologist...the one doctor that was actively seeing that patient after the complication began. If she was post-surgical & developed a complication...I'd be calling the surgeon, if it was a renal complication...I'd call the nephrologist, if it was a GI complication, I'd call the GI doctor, etc. I would not be calling the primary to handle a secondary complication....unless I could not get in touch with the specialist. Sorry, primary doctors are just not at the top of my list as the "go to" doctors when a serious complication arises.

Wednesday night was another busy night. The son I spoke of earlier was even more of a pest. I try to be understanding & put myself in his shoes. His mother is very sick, but even still...lose the thought process that we are to bow down to your every need. He tells me she didn't eat much that day. I acknowledge what he says & he stands there looking at me like I should do something about that. Ummm, if she doesn't want to eat...what makes you think I can force her? If it were my mom...I wouldn't be relying on the nurse to talk my mom into eating.....I would be doing it myself - because if she isn't going to listen to her own children, it's highly doubtful she'll listen to anyone else. I can let the doctor know in the morning, but I'm not calling him now...because really...what is he going to do at 10:00 at night anyways?

I don't know...maybe people have a different illusion about what we can do as nurses. I wish they'd remember we are human too & most of us are doing the best that we can....even when getting yelled at for no reason.

I had another doctor who promised one of my other patients that he would order her cough medicine so she could not cough so much & hopefully get some rest that night. So I go in to talk to her & assess her & she asks "Where's my cough medicine?" Umm, let me look at what is ordered for you. Nope, no cough medicine. She then shows me the piece of paper where she made the doctor give him her name because he made that promise. Gotta love it...lol.

So I call this doctor & luckily he's on call. I remind him of what he promised this patient & his reply was "So." Uhhhh...so??? So you never ordered it. He then rambles off Hycodan & the rest I could not understand a word of it...like he wanted me to be thrown off & it's not because of a language barrier. He was American. I ask him to repeat it....which brings up another thing. We are told that when we get orders over the phone, we are to repeat it back to the doctor. Only it seems like 99.99999% of them don't want to do this. Usually it's something like "Tylenol 650 mg PO every 6 hours as needed......GOODBYE." And they hang up. It's just so rude. Anyways...I ask him to repeat himself because he mumbled his way through the order. He repeats it & I just add (to clarify)...do you want this PRN (as needed)? Because that is what I'm used to when it comes to cough medicine....take as needed, right? He replies in what I can only describe as a very rude manner..."DID I SAY PRN???????????" I wanted to laugh out loud....seriously. It's like dealing with 4 yr olds...or worse. At least 4 yr olds are fun. Instead I said "Nope, no you didn't, ok thanks!!!!" Which I think pissed him off even more as he was probably hoping to make me feel bad. Sorry, not gonna happen. Maybe as a new nurse all these grumpy docs would get under my skin....but not now. Not when I'm only doing my job & putting my patients first.

I'm off for a few nights & then back to work on Sunday for 4 in a row. I signed up for overtime...hopefully they won't call me off. I need to finish up the Christmas shopping on Fri & Sat as I won't have any more time to do it before Christmas. I can't believe it's only a week away.

Have a great weekend everyone!

Vacation Time

2009-12-06T01:41:00.002-05:00

I'm officially on vacation. Well, I have been technically since last Tuesday at 11:30 pm. I was sick Wednesday night & now I'm off until Dec. 14th. Niceeee! I'm going to attempt to get all Christmas shopping completed AND wrapped before the end of the week. I don't want to even think dealing with crowds or what to get people after my vacation is over. Actually I guess it's called a staycation as I'm not going anywhere. Just gonna enjoy some family time, friend time & time to myself until Dec 14th. Then it's back to work.

I've been needing this time off. The patients are so very complicated and physically exhausting as well as mentally as it seems like we have 3948023 things to think about on a nightly basis.

On a very sad note....my Florida Gators were defeated earlier tonight. It wasn't pretty...there were tears....mine & Tim Tebow's. :) I'm gonna miss seeing that guy lead the Gators. He'll go to the NFL, but I don't think he'll have quite the influence he does right now. He's an amazing man for only being 22.

On a good note...I saw an amazingggggg movie yesterday. It is The Blind Side with Sandra Bullock and Tim McGraw. It's one of those feel good movies that makes you feel even better because it's a true story. Bring tissues....you'll be crying happy tears & for once, it's nice to hear something positive in this world.

Sorry, gotta mention it just so it's documented in my blog when I look back one day...but Tiger Woods.....HOW IN THE WORLD DID YOU JUGGLE 4 AFFAIRS (possibly more) AND A MARRIAGE, CHILDREN AND A SUCCESSFUL CAREER??? Never in a million years did any of us see this coming. I understand it's a private matter....but come on...4 affairs (or more)? He's only been married for 5 years! I don't blame his wife for attacking his car with a golf club. Ok, enough said.

I had lunch this past Friday with some of my current co-workers & some of my past co-workers from the hospital I quit. NOTHING has changed over there. Wait...it has gotten worse, if that's possible. And by the sounds of it...it's going to get even worse in the next few months. It's that administration. A majority of the clinical leaders have left and a majority of their experienced nurses have left. They are hiring more grad nurses to make up for it. Sigh...so glad I left at the beginning.

Speaking of leaving....it has been nearly 6 months since I left. Time has flown by! Kind of like this night has. Time for me to get some sleep. Stay warm everyone...have a GREAT week!!!!!!!

Happy Thanksgiving 2009!

2009-11-26T18:45:00.003-05:00

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!

2009-11-23T17:49:00.002-05:00

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

2009-11-15T21:53:00.002-05:00

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

2009-11-06T22:42:00.002-05:00

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???

2009-11-01T20:31:00.003-05:00

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.

It Happens in Threes

2009-10-30T23:17:00.005-04:00

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

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

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

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

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

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

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

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

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

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

How Awesome is This?

2009-10-23T07:27:00.003-04:00

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

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

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

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

Worst Patient Ever

2009-10-17T04:51:00.002-04:00

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

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

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

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

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

Moving on...it's now around 2 & his pain medicine is due. I push it in the IV, then flush, then start an antibiotic running. Everything is fine...no problems. About a half hour later he is complaining that something is wrong with the IV. I go (and bring another nurse with me to witness cause I knew he was a liar) and check the IV. We kink the IV line to see if we can get blood return in his IV & it's there....which means the IV is in the vein & in the right spot. He is so clueless that he doesn't realize what we are doing, so we explain it. He then starts tugging on the IV & says it's all messed up & infiltrated. Yeah, ok.

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

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

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

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

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

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

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

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

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

Have a good weekend everyone. Stay warm, northerners!

Go Big or Go Home!

2009-10-12T14:12:00.002-04:00

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

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

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

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

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

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

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

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