You know you've been working too much when...

You know you've been working too much when...you start dreaming of work-related things.

This past week, I'd say 3 days out of 5...I've been dreaming about work stuff. Even today - I kept dreaming about getting doctor's orders over the phone. I woke up thinking "Did I get the order right??" Another night I dreamed that our hospital made a particular floor for only patients admitted with altered mental status & I was getting 5 admits. It's hard enough dealing with one or two confused patients...but five? Frightening!

I put in 4 days after being sent home on Sunday. It's been a strange week - just very strange patients. Usually when I get new patients, it doesn't take long to develop a decent rapport with them. Even with new admits, usually you can make them comfortable & they are easy to get along with. This week they've all been strange...like impossible to please, unable to develop a good rapport no matter what I did & complaining non-stop. It's like why even bother because nothing will please them.

People are starting to expect their hospital stay to be equal to a vacation at the Hilton or Marriott. One of my pet peeves is the changing of the sheets. It's very appropriate when someone is incontinent or blood or some other substance gets on the sheets...but if it's a totally alert & oriented person that is getting out of bed to use the bathroom & the bed remains spotless - what's the point of changing the sheets daily? I had one insisting that she was sleeping in filth. I looked at her like she was insane. You want to say "Do you change your sheets at home every single day?" You know they don't. I've had a patient in the past that wanted his sheets changed every evening at 5 pm. Do you do this at home???? No. Then why are you flipping out that it's not done like that at the hospital? I think they just want to get their money's worth or something. That same person that earlier said they were sleeping in filth - I'm surprised she didn't take the sheets home with her when she left. She took every cup, every alcohol pad,every thing in the room possible to take & then asked for ice water to go...like she's at a restaurant or something. On top of that - she was asking if she could have the supplies that I had in my pocket (tape, pens, etc). Ummm....NOOOOOOO. Strange I tell you...STRANGE!

It was also the week of drug addiction. On Tuesday night I got 2 new admits - relatively young (late 40's/mid-50's) diagnosed with chest pain. Those are "usually" my favorite type of patients because the orders are easy to follow, they are 95% of the time stable & pretty good to take care of. Not these two. These two were experts at knowing how to get seen quickly in the ER & how to get the pain medication they wanted = Dilaudid. I took care of these patients for 3 days - not once did they ever complain of chest pain. One had foot/leg pain and the other had neck pain. I think they learned if they admit that in the ER, they'd be sitting in the waiting room much longer than someone claiming to have chest pain. Drug seekers are pretty easy to spot - they are the most dramatic of them all - "usually." Gina had a patient that could prove that theory wrong, but I'll talk about that later. My drug seekers would cry, shake, act like they were about to die at any moment - until they got their pain meds. Then they were quiet, calm, serene. Don't get me wrong, I find it very sad that they have become addicted to pain medications, but I think it's even more sad that they remain in denial rather than dealing with the real issues head on. The one that was crying - she'd stop crying when she learned she could only have the pain meds every 4 hours. So how real could the pain be if you can instantly stop crying? And the other one - he began referring to Dilaudid as "happy juice." Ugh. I almost got to the point where you just want to kick them out of the hospital to make room for people that really are dealing with a sickness that requires hospital care.

I spoke with the doctor of the one referring to Dilaudid as "happy juice" & come to find out this gentleman's wife went out of town & he didn't want to be home alone - that's why he ultimately came to the hospital. WTF?? That definitely sounds like some kind of psych disorder to me. Out of all the places to go when your significant other goes out of town - the hospital wouldn't even be on my top 100 list.

We had a patient pass away last night. She was a DNR (Do Not Resuscitate) - it's the first time I've seen someone pass away without anyone calling a code. It was pretty quick, she looked so peaceful. The family was called & came in to say good-bye. What I don't understand though - she has had cancer for awhile, the doctor talked to the family earlier in the day about her condition to the point that they agreed to a DNR order, had a hospice consult & she was to be transferred into their care...yet the family was shocked she passed away. So shocked that they want an autopsy. I don't know, I don't get it...it's one thing if you have someone that is awake & talking & hasn't been diagnosed with something terminal to suddenly pass - but she's been non-responsive for quite awhile.......and they knew all of her terminal condition...yet they are shocked. Hadn't even thought of funeral arrangements. Is it denial? Do they think that if they start planning for what happens afterwards, that they somehow will cause it to happen sooner? I think they need to reflect on the fact that she lived a good life & has now moved on. I understand being sad, I would be sad too...but don't hang on to the belief that there's a mystery as to why she died. She had cancer, her body shut down - it's time to let go & grieve.

I helped the nurse with post-mortem care & I have only done that twice since I got into nursing. One time in nursing school & one time when my patient coded & died. It doesn't phase me though - like it doesn't creep me out that I am touching someone that is no longer alive. I don't know why it doesn't...I think it should. It's not like it's happened so often that I've become immune to it. I was talking to a doctor last night & he said he used to work at a hospital that had something like 750 beds & that all he did was work code blues...that was his job. Inbetween he'd eat dinner & people would be like "How can you eat after watching someone die?" It just becomes part of the job he says.

Which leads me to wonder...how in the world did I end up in healthcare??? Just goes to show that you never know which direction your life will travel in or where you'll end up.

I got another new admit last night...mid-50's with chest pain. As much as I like that our hospital has finally come up with protocols - I am saddened that our ER doctor has no common sense. Part of the chest pain protocol is to administer Lopressor...either 50 mg by mouth or 5 mg via IV. This is all well & dandy when the patient has an increased blood pressure or heart rate...it will definitely allow the heart to relax because it slows down the heart rate & usually lowers the blood pressure along with it. However, this patient of mine prior to getting the Lopressor had a heart rate of 66 and a blood pressure of 96/48. Why in the world would anyone...much less a doctor say it's ok to give 50 mg of Lopressor? He didn't need it. By the time he got to my floor...his heart rate was in the mid-30's to 42. Ridiculous that it was ever given in the first place. Luckily his blood pressure was ok & that he was non-symptomatic with such a low heart rate. He was another strange one though - during the admission questionaire, he asks me "Can you tell me if I have cancer?" Excuse me? How would "I" know if you have cancer? He has a feeling he does & would like "me" to find out. Lol...what??? If he said it once, he said it 20 times..."can you please find out if I have cancer?" I told him he would have to express his concerns to the doctor as the doctor is the one that will order the appropriate tests. I also asked him why he didn't seek medical care sooner if he believes he has cancer. He had no answer. Just kept asking for me to find out if he does or not. As if we have the answer hidden somewhere in our chart.

Now to Gina's dramatic patient. This one wasn't a drug seeker, just a patient that loved to scream & cry. She would cry even if you touched her! Flipped out when they put a tourniquet on her to draw blood. Gina asked me to help her put a foley catheter in this patient. Little did I know how dramatic this woman could be. I focused on talking to her calmly, trying to distract her from what was going on, gave her my hand to squeeze, reminded her to breathe....all that went right out the window when Gina tried to insert the catheter. She started screaming hysterically "Stopppppppppp, you're killing me, I've never had so much pain ever in my life." This from a woman that's been through child birth a few times! She continued to scream as Gina & I stood there & watched her. Gina wasn't even touching her & this patient would not stop screaming & crying. She didn't even have her eyes open & continued to carry on as though we were torturing her non-stop. Gina & I looked at each other like what the heck??? It was a bizarre week I tell you!!!!!

I start computer training on Monday night. We are finallyyyyyyyyyyyy switching over to computer charting. The transition day is set for October 22nd - remind me not to work that night as I'm sure it will be a mess. I will be glad to put down my pen though - I am so tired of handwritten charting not to mention the calluses on one of my fingers. It's starting to look deformed. :)

Have a good weekend y'all!!!!

Grrrrrrrrrrr

I went to work last night - clocked in & then saw my name was not on the schedule.  I talked to my charge nurse - they didn't need me & had no idea I was even scheduled.  All this after I talked to the girl that does the schedules on Thursday to set up my schedule for the next 4 weeks.  So I ask "Am I at least on there for Mon & Tuesday?"  Nope.  Luckily my charge nurse likes me, so she added me so I can make some money this week. 

I wasn't upset about it - just frustrated that I slept during the day & got ready, came in & then was sent home.  What a waste of time.  There could be worse things going on, so I'll be thankful it's not that bad. :)

Another week gone by...

I got my raise this month - I should be happy, but I still want to make more.  It's my own fault for not getting the paperwork done to go agency.  I keep saying "I'll do it next week."  I'm just so comfortable where I'm at - although more & more they are pushing things to agitate us.  They are trying to get rid of all per diem staff nurses...basically by telling them they either have to become part-time or full-time staff or resign.  It makes no sense to me because now we are back to being a hospital of mostly travelers or agency and less & less regular staff.  Yet they are shocked when our customer satisfaction scores are in the 1th percentile.  We can't get any lower than that...although I don't know how they are arriving at those scores.  I think we treat our patients pretty darn well & all I ever hear from patients & their families are compliments.  Yet we are at the bottom of the barrel when it comes to patient satisfaction.  You would think that we ignore them or torture them with scores like those.  Our goal is to reach the 70th percentile...I don't think we'll ever see it. 

I worked 4 nights straight this week - it wasn't bad.  By the 4th night my feet are so sore though.  I spent so much time at my patients bedside - one night I barely got my paperwork done on time.  I don't like when my patients don't sleep well through the night.  It makes me nervous.  Especially when they seem a little off.  I had one gentleman that has esophageal, lung, pancreatic & liver cancer.  His family didn't like the way his pain meds were making him sedated - so they requested all meds stopped.  Hellooooooooooo......cancer is painful....especially pancreatic & liver cancer.  You would rather have him more alert but in pain than the opposite?  That irritates me.  Besides, this guy was totally alert & oriented - he can make his own decisions.  I ended up getting an order to get him Dilaudid the last night I had him because he was bent over in pain, trying to breathe.  Where are the family members at that point?  No where to be found. 

I had another patient this week that had a hernia growing into his colostomy = not good.  He had to have emergency surgery on Saturday, went to ICU & by Monday he was with me in PCU.  Things were going smoothly Monday night until about 5 am when he was complaining of nausea.  He was being a little overly dramatic - kept telling me he was vomiting a lot, but I barely saw anything.  He then started saying he was going to die unless I called the doctor.  So I called the doctor at 6 am & got him some anti-nausea meds as well as Milk of Magnesia.  He drank that Milk of Mag & within 2 minutes, he was vomiting a lot.  It wasn't pretty.  In fact, I think he had some sort of blockage going on in the GI tract.  I won't go into details.  :)  The anti-nausea med helped him after that.  Tuesday night I had to prep him for surgery to close the old colostomy (he had received a new one during emergency surgery).  He needed 4 units of fresh frozen plasma as well as antibiotics.  The poor guy was continuously being woken up because I was constantly talking his blood pressure to make sure he wasn't becoming fluid overloaded.  Wednesday afternoon he had the surgery, came back & the anesthesia had made him confused & agitated.  It was not a fun night. 

I think my biggest pet peeve is making a call to the doctor only to find that one of his partners is on call.  I don't really like taking orders from someone who has no clue whatsoever who the patient is.  I called regarding my surgery patient because he needed something for agitation.  The partner orders Ambien = sleeping pill.  I don't like Ambien because you never know how it's going to affect someone.  I've found that when you give it to someone that's already confused & agitated - it makes them worse.  So I didn't give it & just hoped that the anesthesia would wear off & he would get some sleep...which is pretty much what happened although it took all night.  I didn't mind being there to constantly reassure him or to make sure he didn't hurt himself.  Some patients are easy to want to take care of. 

I won't go into my other patients I had this week.  Nothing really stands out.  Gina called in to volunteer to work Monday night - she basically got reprimanded & was told that her & I are the reason agency doesn't want to work at our hospital.  Come on!  She says it's because we pick up shifts at the last minute & they have to cancel agency & now the agencies are tired of being cancelled.  Ridiculous.  Then just tell us NO.  Don't give us b.s. about us being the reason no one wants to work there.  What's funny is...I called yesterday because I was not on the schedule at all for the next month - they couldn't find the schedule I turned in.  When I called, she acted like it would be impossible to add me on.  She pulls out the schedule & they basically need help every single day.  I don't get why they are so dramatic about us wanting to work when they are so short-staffed.  You would think we'd be praised for picking up shifts - especially since we are cheaper than any agency nurse & we are damn good nurses...lol.  Well, we are! 

Which takes me back to the reminder that I need to get my paperwork done in order to go agency.  I need to get a doctor's approval to work as well as a varicella (chicken pox) titer - they won't take my word that I have had the chicken pox.  After that, I can pick up shifts that pay over $40/hr.  Now that's my kind of paycheck.  I'm a procrastinator - can't you tell??? 

Oh, a few of you have written & I appreciate the support.  For those of you in nursing school - if you need any help, just write me.  I have a lot of class notes to share if interested.  One day I'll get around to putting them on Ebay....it's that procrastination thing again...lol. 

Have a good weekend everyone!!! 

 

Back to work

It's that time again....back to work.  I enjoyed having the last week off, but at the same time I think "I should be working."  I got a little bit accomplished around the house as far as organizing.  It's weird, at work I am very organized - at home, forget it.  Maybe it's because I have to be organized at work or else I'll fall behind & I don't like staying after 7:15 at work.  Plus you never know when a patient's condition is going to make a turn for the worse & when a charge nurse or doctor is asking you questions regarding the patient's history & labs/tests - you have to be prepared.  I have a pretty good little report sheet that I use for each & every patient.  If anyone wants a copy, just email me.  It's a word document. 

I'm gonna go take a nap since I'll be up all night.  Hope everyone is having a good weekend!!!

Here goes...

This is gonna be a long post - so sit back & relax...lol.  Sunday night I had a patient that also works at the hospital.  I don't normally like to take care of people I know or that work at the same place I do.  It's just awkward not to mention sort of a test.  I mean this is someone that is capable of telling others how you are as a nurse.  Luckily by the second night, she was praising me & by the fourth night, she was filling out positive comment cards.  Whew!  That's the nice thing about working continuous days in a row - you tend to get the same patients back & can build up a good rapport. 

I'm not going to go into details with each & every patient I've had - that would take way too long and in all serious, their conditions were not all that interesting.  Instead, I will give you my version of "General Hospital" as it has been a dramatic week at work between my patients and their families. 

I had a young man in his early 20's that came in with nausea & vomiting due to stress.  The first night I had him, he was wiped out - like sleeping the entire night.  The report I get from the day shift nurse is that he had a fight with his roommates and the stress had gotten to him.  I get a phone call from his mother wanting to know everything that's going on.  Thanks to the privacy act, I tell her that until he's alert enough to set up a password, I can't give her any information.  99% of the time, this does not go over well with someone on the phone.  She yells "I AM HIS MOTHER."  Ok, well, anyone can call & tell me that, but it doesn't matter - he's an adult, he gets to pick & choose who he wants to hear his medical information & until he is awake, it's not gonna happen.  She insists I transfer the call to his room.  Well, ok...but he's sleeping & probably not gonna say much.  A couple hours later, his fiancee shows up after a 2 hr drive.  She was easy to get along with.  She went in to visit him & he woke up just enough to set up a password so that I could share info with her & she in turn, shared it with his mother.  Everyone's happy, right?  Nope.  He has a step-father that can't stand the mother or the fiancee & he doesn't want them having any contact with the patient.  Ummm, sorry, that's not how a hospital works.  He is an adult, HE gets to choose who he wants to communicate with.  The step-father insists (over the phone) that he wants the fiancee out of the room by 8:30 pm.  Nope, that doesn't fly with me.  If he enjoys her being there & she is the only one that I saw visiting with him the entire time I was there...then she can stay past visiting hours for a little while.  I also got to meet the grandmother who started to share with me the drama & I instantly got myself out of that by cutting her off & telling her if she wants to see him - to go do it now.  I don't have time for all this family dynamics.

I had another patient that came in with chest pain after fighting with his wife or ex-wife or soon to be ex-wife.  I get a call in the middle of the night from his out of town girlfriend telling me to not allow the wife to see him.  Ok, again, this man is an adult, HE can say who he wants or doesn't want to visit him.  We're all thinking that it's just anxiety that caused his chest pain...but surprise, surprise...he was having a heart attack.  See what stress can do!

There was another patient on the floor - somewhat confused to start.  By the time the lab girl came in to draw blood, it got out of control.  This woman was scratching, kicking & spitting.  Ugh, spitting is the worst.  It's just so disgusting.  We ended up putting a mask over her face in which she continued to spit - guess she couldn't figure out that the only person she was spitting on was herself.  Restraints were also applied, but not before she kicked the lab girl in the head.  As if this wasn't enough, a couple of hours later she started screaming - very loudly.  She woke up the entire floor.  I don't think I've ever heard anyone scream as loud as she did.  Quick fix, close the door & leave her nurse inside the room with her...lol.

Gina had a "fun" patient also.  A frequent flyer/drug seeker.  She would complain that she was having excruciating chest pain & within 30 seconds, she'd be sleeping - snoring away.  Then she'd wake up & moan loudly about all the pain she was having & right back to sleep she would go.  She had been in the room for quite a few hours & we figured she had to go to the bathroom even though she was saying she didn't have to.  So Gina tells her she can't give her anymore pain medication until she goes to the bathroom.  We have never seen anyone get up so quickly to use the bedside commode as this woman.  It was actually comical.  I also noticed how she had like 8 bottles of flavored bottled water with her.  Who brings bottled water with them to the hospital while they are having chest pain?  She had a whole bag packed...hmmm...usually chest pain comes on suddenly & you don't really have time to prepare.  Not this lady - she looked like she had packed enough to stay awhile.  As if she was going on vacation...lol.  I'm glad she was Gina's patient & not mine.  :)

There was another family member of some other patient that whenever she got on her cell phone....whoa...the language coming out of her mouth was beyond foul.  We just sat & watched her - it really was like watching a live taping of General Hospital.  Although you couldn't write this stuff out - it was all just natural...lol.

I had another patient in which half his family lives here, the other half in South Carolina & the battle was brewing over where he would go into a nursing home - it was like the Hatfields vs. the McCoys.  It wasn't enough that they were fighting amongst each other, they tried to drag the nursing staff into it also.  Not me, I wasn't getting involved.  After they finally left, the patient was telling me a little about it.  I asked him "Where is it that YOU want to go, because that is all that really matters."  The poor guy felt bad letting either side of his family down if he were to make the choice.  He ended up going to South Carolina.  He was a sweetheart, kept asking me for my address.  I have no idea why, I gave him a copy of the hospital address with my name.  I know his family is going to be like "Why in the world did that nurse give you her name?"  And he probably isn't going to remember asking.  Oh well. 

It was a fun week.  A few of us on the nursing staff had fun picking on one another.  It makes work more bearable.  That's one of the few things I like about that place...the staff.  Most of them are easy to get along with & make working with one another fun.  It's actually the reason I have yet to leave.  I really doubt that anywhere I go will it be this good amongst the staff.  I'm still inching my way towards agency or travel nursing.  Slowly but surely.

I think I'll wrap things up.  I have my niece Elizabeth for a few days.  We're gonna go see "Monster House" & hang out at Chili's today.  Fun, fun!

 

 

 

Ahhhh

What a week it's been!  I have to admit though...my patients were pretty easy to care for.  I had one mishap that actually turned out to be a blessing in disguise.  I had given my normally alert & oriented patient some Ambien because earlier that night he had been given some bad news regarding the fact that he has colon cancer.  He was feeling a little restless & requested some sleep medication.  Ok, no problem...until later.  The thing with sleep medications - you never really know how they are going to affect the elderly.  He told me he takes it at home, but for some reason, it made him confused.  So confused that he somehow ended up on the floor next to his bed sitting up...with his central line (it's basically an IV in his jugular vein) pulled out.  He had just been started on TPN (basically nutrition via the central line) a few hours earlier because he had surgery about 5 days ago.  That's dripping all over the floor since his central line is pulled out of his neck.  I was so thankful that his neck was not bleeding at all.  We got him back in bed, got some IV's started and I placed some calls to his surgeon and the primary doctor.  The surgeon didn't seem to care, he advanced him to a full liquid diet, discontinued the TPN.  We sent him for x-rays, everything was negative...thankfully. 

This gentleman was such a sweetheart.  I had told him the first night I had him that I was going to take him from room to room to show people how to have a great attitude while in the hospital.  He was very thankful & always giving compliments about everyone taking care of him.  Anyways, needless to say...he went pretty quickly from liquids to a regular diet & he was discharged ahead of schedule...pretty much all because he got confused & fell out of bed.  Otherwise that TPN would have probably run for a day or two & then the diet orders would be slowly advanced.  I was happy he got to go home & that he wasn't hurt.  Hopefully he'll be able to deal with the cancer.  The doctor said it was more of a watch & see rather than sending him for chemo. 

I have a lot more to tell, but I'm getting sleepy - so I will resume this later.  Hope everyone is having a great weekend!

I must be crazy

I only have a minute because I'm going to work - again.  This will be my sixth shift in a row.  I must be crazy!!!!  But I will be taking all of next week off...something to look forward to.  I'll catch up soon.  Peace, everyone!!!