Bye Bye February

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

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

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

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!

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!

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

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!!!!!!!