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!!!