14 mg of Morphine

I am such a trooper...lol.  My night was a little crazy, but I love it.  When I got to work, I saw that the day clinical leader had given 3 (out of 5) of my patients to other nurses.  What the heck???  So I ask her why I am not getting some of my patients back.  She says "Well it's only fair that everyone gets new admissions tonight & that's why I gave your patients to others - it allows for you to get at least 2 admissions."  What????  Does that make any sense?  So I try to at least get 1 out of the 3 back & she gives me the same b.s. answer.  The whole reason I work 3 days straight is so that I am able to get my patients back - because I am familiar with them & they are familiar with me.  Luckily my night clinical leader understood my reasoning & gave me one of my patients back.  The other 2 were going to be discharged anyways.  Turns out the one I got back, I ended up transferring her down to med-surg anyways.  Oh well!  So much for that.

My other two patients I did get back were patients I had for the last couple of nights.  One has a DVT in his right leg.  Not much to say about him other than at one time his heart rate had jumped up from 85 to 135 instantly.  I went to check on him (this is why I love telemetry - you know when your patient is up to something).  He got out of bed to walk around & go to the bathroom.  I had just been through this discussion with him the night before - about how he's on strict bedrest because moving around like that could send the clot in his legs up to his lungs & he could die rather quickly.  I don't think he understands just how serious it is. 

My other patient was a 44 yr old woman admitted with chest pain, but had a history of migraine headaches.  She had been nauseous & vomiting the first night I had her.  I got some Imitrex & Phenergan - both helped quite a bit.  Well, last night they weren't helping.  She was continuing to vomit even with 25 mg IV of Phenergan.  I called the doctor to figure out what to do.  He ordered 75 mg of Demerol IV.  I repeated it back to him because it seemed like a high dosage.  He said "yes."  So I asked my clinical leader about it & the nursing supervisor.  They advised me to give 25 mg first & see how she tolerates it.  Well, it made her dizzy & even more nauseous.  Wonderful.  I wasn't going to continue to give her Demerol.  The last thing I needed was a disoriented patient vomiting everywhere.  She was sweet though.  She kept calling me "Miss Jennifer."  I really wanted to help her, but I was running out of alternatives.  I hope they figure out why she is feeling this way. 

My new patient was a transfer from med-surg.  She was admitted with cancer & needing chemo, but soon they found she had multiple PE's & a DVT...not to mention that the cancer had metastized to her liver, lungs & pancreas.  Not good at all.  I had to restart her on Heparin.  6 hours later her PTT is 166 (therapeutic is 60 to 90).  Eeekkk...call the doctor.  I felt like that's all I was doing last night.

The highlight of the night was my new admit.  I received report from one of our terrible ER nurses.  I swear they are clueless down there.  I'm not sure if it's because the way the department is run or if the nurses down there just aren't all that bright.  I feel like all they want to do is dump the patients on whoever they can.  Half the time they can't even give you a halfway decent report & the other half...they totally mislead you.  My patient was a 46 yr old male in with chest pain.  EVAC gave him 4 Nitro SL tablets...didn't relieve his pain.  While in the ER, he was given 14 mg of Morphine within a couple of hours (gasp)!!!!!  You would think that would knock him out, but nope.  He was still rating his pain at a 7.  Technically he shouldn't be able to come to our floor until he was stable, but our ER doesn't seem to grasp the concept of stablizing a patient.  So I get report & as the ER nurse is rounding the corner on our hallway, we heard a loud awful noise.  My clinical leader said "What's that noise?"  I said "That's my new patient."  The poor guy was vomiting everywhere!  All over himself, all over the bed & all over the paperwork with his orders written out.  Lovely!  We get him to his room, clean him up somewhat...he continues to rate his pain at a7.  3 more Nitro SL 5 min apart...gets his pain down to a 5.  He is continuing to vomit.  Not good signs!  I called his cardiologist, got an order to send him to ICU for unrelieved chest pain.  I love the ICU...I love that they are the place that I can take a patient in distress.  Not that I like dumping patients on anyone, but I know they are in good hands when they make it to the ICU.  I'm curious to see what his second set of enzymes will be. 

My night was busy, but in a way I like it because the time flies by.  As I was leaving, another patient's (not mine) heart rate was sustaining 200 for about 20 minutes.  The guy was asymptomatic.  His blood pressure was normal, he was speaking, said he felt good...it was bizarre.  You could see his fast heart rate through the veins in his neck pulsating.  I didn't stick around to see what happened with him.  I was too tired.  I have two nights off & then back for 3 more nights in a row. 

I got a call from my new manager at the other hospital.  He is sooooooo nice.  I swear it feels like dating - things are so wonderful in the beginning, everyone is so pleasant to one another & then reality sets in.  Things aren't what they were promised, you see more of the bad than the good, etc.  Anyways, the new manager was making sure everything was ok & how excited he was that both Gina & I would be working there soon.  What a difference from our current administration who lectures us about being unreliable.  I'm still trying to figure out my schedule.  I'm leaning more & more towards going full-time at the new hospital & part-time where I'm at now.  There is just so much b.s. at my current hospital & the excuses are getting old quick.  I'm not ready to quit, there are still some aspects that I like as well as some of my co-workers.  Now I just need to decide if I want to go part-time with benefits (requires working 6 days a month) or part-time with no benefits (requires only 2 days a month).  It takes 60 days for benefits to kick in at the new hospital.  Do I want to go 2 months without health insurance?  I don't know.  I'll figure it out later.

I had another patient this weekthat annoyed me.  It was just a weird vibe I got from her.  37 yrs old, admitted with chest pain.  She was in the same room as my N/V/migraine patient, but fled rather quickly when that patient started to vomit.  So we got her another bed in a different room.  She was a jumpy anxious woman.  Gave her Ativan PO.....didn't do much for her.  She was complaining about too much noise.  I offered her the opportunity to move to a private room.  She refused.  I think she was one of those that just liked to complain.  Later she complained of chest pain.  I asked her to describe it.  She replied "When I lay on my left side like this, it hurts."  Ummmm.....then don't lay on your left side like that!!!!!!!!  I tell her to reposition herself & see if the pain is relieved.  She states it is better.  About an hour later, she complains again of chest pain & noise.  I offer her the pain med that has been ordered.  She replies "That didn't do anything for me."  She goes on to say "I'm not a drug seeker, but morphine works really well for me."  Ummmm, ok...interesting how she knows this.  I knew the doctor wasn't going to prescribe her morphine - she couldn't even describe the pain, her cardiac enzymes were all negative & had no signs or symptoms of pain - other than her words.  We ended up getting her Lortab.  Again, it wasn't strong enough.  I put oxygen on her, EKG was done...perfectly normal sinus rhythm.  I try to be tolerant & understanding, but something was just off mentally with this woman.  I couldn't tell whether it was anxiety related or just plain weirdness.  Turns out I wasn't the only one that got that strange vibe.  The cardiologist ran a stress test & it was negative.  He immediately signed off from the case.  As she was being discharged, she began to complain about pain & wanted a prescription for morphine.  It wasn't going to happen.  They sent her out the door - the cardiologist wanted nothing more to do with her.  Can't say I blame him!

I'm getting sleepy - time for a little nap!

 

A sign?

I saw not only my manager this morning, but also the director of the department - not usually a good mix.  The reason for the meeting...calling in more than twice in a two month period.  I got the lecture about how it lets down the unit when I'm not there on a scheduled day & how now I'm viewed as unreliable.  This is one thing I don't like about management - not just at hospitals, but practically anywhere.  They only take the time to talk to you when it's about something negative.  It doesn't matter if you are doing 3904820934 good things, if there is one negative thing - they will zero in on that.  Oh well, that's the way it goes.  I simply listened to the lecture, signed the paper that puts me on probation until November.  When that was said & done...I asked "Who do I talk to about going part-time here?"  They were shocked.  I love my manager - she is really, really nice.  The director is nice, but I really don't know much about her.  They just stared at me.  So I went on to say that I am planning to work at another hospital to gain more experience.  The director asked what type of experience I was wanting.  I said "cardiac."  There were a few more words exchanged, but they couldn't argue with the other hospital being a major cardiac hospital as opposed to ours - we ship anything serious over to that other hospital because we are not equipped to handle anything like that.  My manager said she'd talk to human resources about it.  I hope I didn't make things worse for myself.  I just felt the need to be honest & upfront rather than letting the rumors get around.  They can't fault me for wanting to get more experience.  They seemed stunned though. 

Anyways, I came home & took a nap as I'm working the next 3 nights in a row.  I started thinking that maybe this is a sign to go full-time at the cardiac hospital & reduce my hours greatly where I'm at now.  I don't want to make that decision until I see what it's like on the job at the new place.  I'll use the month of September to base my decision.  On that note...I need to go start getting ready for work.  It's about to storm here.  Hopefully it will be over with by the time I have to leave.  Have a good night!

Uh oh

I got a call today from my manager's secretary. My manager wants a meeting with me. Uh oh! Gina got the same call. All we can think is that maybe the new hospital called our manager as a reference & she is probably wondering what the heck we are doing going to work at another hospital. Either that or using too much PDO (paid days off) time. My meeting is at 9:15 in the morning. The suspense is killing me!

I went into the new hospital & got all the paperwork done & got signed off from the health nurse. Orientation is in 2 weeks. I'm looking forward to seeing what it's like at this new place.

Did anyone see Six Feet Under last night - the episode where they buried Nate? OMG...so sad. I love that show. My other fascination right now is Big Brother. Is everyone voting for Kaysar to get back in the house? If not, you better!

That's about all for now!

Easy come, easy go

I got a call from the other hospital informing me that since I don't have a full year of nursing experience, they can't hire me on as "per diem" (higher pay, no benefits).  Instead he offered me a full-time or part-time position.  The pay is lower...around $23-24 per hour which is basically what I'm making now at the hospital I'm at.  Sigh!  Oh well, the good news is that I am not too, too far from having a year of experience.  Just depends on what they consider the anniversary of one year - is it from the date I was hired as a nurse or is it from the date that I passed the nclex & officially got my nursing license?  We're talking about a 60 day difference.  Regardless, it's something to look forward to if this new hospital works out.  If not, there are plenty of other hospitals out there to explore.  So now the decision to be made is...do I remain at my current hospital full-time (3 days per week) & work at the new hospital once or twice a week?  Or do I go part-time at both places?  I guess in the beginning I'll just work one or two days a week there to see if I like it.  The thing that stinks is that working one or two days extra at my current hospital would result in overtime pay, while working at this other hospital keeps me at the base pay.  I am grateful to have the opportunities & to be making the wages I am, but I also know I need to be careful as to not get burnt out from working too much.  So time will tell & I truly believe that God will lead me to where I belong. 

I had an ok week at work this past week.  Gina & I were on the same floor although Gina kept whining about feeling sick the entire first night (ya baby Gina!). 

I only had 3 patients the first night - it was nice!  One is in with pancreatitis/cholelithiasis (sp).  Basically he has gallstones so he'll need his gallbladder removed, but they also suspected that he might have a stone in his common bile duct therefore causing pancreatitis.  They did an ERCP - no stone nor infection found.  So who knows what was causing his liver enzymes to be really out of normal range.  I believe he was going to have surgery yesterday or today if his enyzmes had improved.  The surgeon on the case is a great one.  If I ever need surgery, he's who I would want operating on me.  He was badmouthing the gastro doctor.  I just have to laugh at how these doctors talk about one another.  While he was talking to another nurse & I, he got a phone call from a patient of his that told him her primary doctor left a message on her answering machine saying her cancer had spread to other parts of her body.  What kind of doctor leaves that type of message on an answering machine???  Needless to say, the surgeon was also badmouthing the primary doctor.  I'm beginning to wonder about these "primary" doctors.

My second patient had an MI a couple days earlier & was a transfer from ICU.  He was very anxious to get home.  It's like he had no clue of the seriousness of his condition.  He was refusing any invasive testing or procedures...he just wanted to go home.  When I got there, he says to me "I feel like I have a sore throat starting & also a post-nasal drip.  Get me an aspirin, dissolve it in water & I'll drink it."  I told him I couldn't do that, informed him I need a doctor's order to distribute any medications."  He accused me of being resistant & unhelpful.  I offered him hot tea, soup, tylenol, etc.  He asked for mouthwash - I got a bottle of it but on the label it said "alcohol free."  He said he needed Listerine - wanted me to go & get him some.  I told him we don't carry it here at the hospital.  He thought I was lying to him.  So he says to get him a bottle of rubbing alcohol.  As if!  I finally get him to take some Tylenol & drink some hot tea, then he went to bed. The next night I came in & he starts telling me about an FAA warning - that pilots are not allowed to eat or drink anything with aspartame in it because it causes memory loss.  I'm looking at him like "Why are you telling me this?"  He wants me to inform the hospital that all of their products should be aspartame free.  Ok sir, no problem.  Why he was still in the hospital, I don't know.

My third patient that night was a 59 yr old man that came into the hospital mid-July with an intestinal blockage.  They did a hemicolectomy to remove the blockage.  As a result, he had a surgical infection that turned into sepsis.  To make matters worse, he aspirated while eating & that turned into a code blue.  Poor guy!  I had to do a dressing change on his abdominal wound.  It amazes me that they don't sew these wounds up.  Once I got all of the 4x4's out of it, I was wondering what exactly I was looking at.  You could see his internal organs.  I'm surprised they don't fall out!  I redid his dressing that night, but the next night we applied a wound vac as he was having a lot of fluid draining out.  I think the wound vac is really neat - amazing how it works & how it looks.  Through the night I was watching to see how much drainage there was & was surprised there wasn't all that much considering how drenched his previous dressings had been.  That all changed when I got him up to use the bedside commode.  The wound vac fluid container filled up in about 10 minutes!!!!  I was rather impressed. 

The second night I also had another patient...a 24 yr old male that came in with a blood sugar over 700 = DKA...otherwise known as diabetic ketoacidosis.  While in the midst of this, he also had a heart attack.  He was an ICU transfer & well on his way to recovery.  He only spoke spanish.  I am going to have to make an effort to learn some spanish in order to communicate with some of these patients.  I didn't spend a great deal of time in his room because I couldn't communicate with him.  He had a cardiac cath done that day which was negative.  I had a spanish speaking nurse tell him that if he wants anything, to call for us.  I also made sure he wasn't in any pain & that the cath site looked good & his pulses were fine. 

It was another week of having no patient care tech to help out & not even a secretary to help with orders.  I'm beginning to think I have the right to add these other jobs to my resume:  nurse/patient care tech/unit secretary/transporter/furniture mover, etc.  Our meetings at the beginning of the shift are a joke/waste of time.  The information they are telling us isn't even accurate.  Not to mention it delays us getting report from the day shift.  My first night - I was in report until 7:45 pm.  That's way too long.  They don't even want to let us know what patients we are getting until 7pm.  So I get there at 6:30 & am supposed to just stand around until 7.  Waste of time! 

I have started doing something I swore I wouldn't ever do.  Last year as a PCT, I noticed the nurses looking at the obituaries to see if they recognized any names of past patients.  At the time, being a PCT, I barely even knew the patients names, much less be able to recall them at a later date.  That is different now - I do know my patients names & my memory is usually pretty good.  While looking at the obits, I saw that the lady I had written about a couple of weeks ago with the stroke & high heart rate passed away last Monday.  I sorta knew that she didn't have a lot of time left.  Oh well, at least she's in a better place now. 

Today also marks a year since the murder massacre in Deltona (just a few miles from my house).  For those of you not familiar with the story, last year 6 people were killed by 4 guys with aluminum baseball bats & knives.  They broke into these people's home around 1 am & slaughtered all 6 of them, one so bad that they couldn't even identify her with dental records.  Sickos!  The reason they did this = an X-box game!!!  I'm glad they were able to catch them quickly & they are now in jail.  The trial starts in January - hopefully they'll all receive the death penalty & never be allowed back on the streets.  If you want to read the full story, here you go: http://www.local6.com/news/3632050/detail.html

I'm finding that working nights really screws up my sleep schedule.  I had a hard time falling asleep last night so I took a couple of tylenol pm around 1 am.  I ended up sleeping the entire day!  Now it's 12:30 pm & I'm wide awake.  Oh well.....one day I'll figure it out.  Maybe I'll run up to Wal-Mart & do some food shopping.  I'm so much fun, aren't I?  :)

Add another hospital to my resume

My interview went wonderful!  I got the job.  So did Gina.  We'll be working on the same unit/same floor.  In fact, the manager seemed pleased that we work well together & has no problem if we want to work the same nights.  How refreshing!  We both will be working PRN/per diem & the starting rate is $31/hr plus differential.  I can't believe it!  9 months out of nursing school & we'll be making over $40/hr.  The floor is similar to PCU where we're at now.  It's considered a cardiac floor but it consists of telemetry, post-surgical patients (non-cardiac) & overflow of med-surg.  We each get our own laptop/cart with meds in it.  The floor always has at least 2 techs.  The scheduling is pretty flexible, they pay us to take ACLS (mandatory) & other classes if we want.  It's just amazing how different it is compared to where we're at now.  I cannot wait to see what it's like.  I go back Monday to go over all of the necessary paperwork plus get my photo ID.  Then they'll give us more info regarding orientation & scheduling.  We should have done this sooner!

Now the hard part - approaching the hospital we're at now & getting them to be flexible with our needs.  Ideally I still want to remain there part-time in order to keep my benefits & to not burn any bridges.  I am checking out getting my own health insurance policy & simply going per diem at both hospitals.  That seems like the best option for me.  However, until that is set up, I need to remain part-time in order to keep my health insurance.  I'll make the call tomorrow & see what happens (fingers crossed). 

I'm going out tonight to celebrate with William.  It's his 40th birthday also...so a double celebration!!! 

Drinks & a movie

Tonight I met Kelly up at Chili's for drinks & then we saw the movie The Wedding Crashers - great movie!  I went to nursing school with Kelly.  She works at a different hospital now, but we get together now & then to catch up on how things are going.  We had read about it in the past, but now it's a reality.  I'm talking about exchanging all of the gross details, facts, stories, situations about what we've encountered at work.  Stuff that non-medical people would freak out over hearing about, much less being able to eat at the same time.  Gotta have a good sense humor to survive!!!!!  Otherwise the stress will eat you alive.

Update on my house situation - both the house I live in & the house I rent are up for sale.  A builder has touched base with my dad & wants to buy all the land we have to sell (about 20 acres).  He is sending a "letter of intent" with his offer.  Hopefully it will be a good offer so we can sell.  I want out of this town.  As much as it's comfortable & I hate the idea of packing up all my stuff...the thought buying another home & starting new sounds wonderful to me.  My only requirement - it must have a swimming pool.  I can't go another summer without close access to a pool. 

Lots of change seems to be looming - a new hospital & a new house - I'm ready for both opportunities.  Bring it on!  Have a good weekend, y'all!!!

Finally some time off

Ahhh, in the past week, I have worked over 80 hours (what's wrong with me???  lol).  Now I have 7 days off to relax & recuperate.  There was a staff meeting at work yesterday.  They went over the new policy of being in the staff breakroom at 6:45 prior to shift change - no later.  Which is fine with me.  I get there around 6:05 anyways.  Rather be early than late.  They reviewed the unit's gallup scores again & showed us what type of remodeling they are doing on the second floor.  All in all...it was boring.  And there's always one person that asks an off the wall question that has nothing to do with the topic at hand.  This time it was chest pain from cocaine & how he thinks we should send everyone to rehab.  Yeah, ok.....discuss it on your own time.

My night went pretty well though.  I had one patient whose blood sugars had been in the 300's & 400's all day...so the doctor ordered "no bedtime snack."  Well, his blood sugar at 2200 was 60.  So much for the "no bedtime snack."  I gave him some graham crackers, peanut butter & low-fat milk.  That got him up to 67.  Gave him a turkey sandwich & more milk & he made it up to 138.  Perfect as far as I'm concerned.  By the time morning labs were drawn, he was up to 255 & counting. 

I had 5 patients last night...all pretty much easy to care for.  My new admit was this undernourished older woman.  She came in with pneumonia, hip fx, diarrhea & dehydration R/O c-diff.  She was confused when she got to the room, was saying mean things to the ER nurse that brought her up.  I got her situated, assessed, talked to her for a little while, made her comfortable & she was praising me.  :)  I had another patient the night before that kept telling me that I was a good girl & she wished she could take me home with her.  Awwwww!  I think some of these patients just really need someone to sit down & give them a few minutes of their time & show them that they care. 

Anyways, my pt above only weighed 85 lbs, was pretty much justskin & bones.  She had multiple skin tears all over her body & all the nursing home was doing for her was covering them with tegaderm.  Who knows how long those had been on.  I informed my clinical leader that we needed to take pictures because she was in real bad shape.  The x-rays also showed that her left hip was broken - but it's not a new fracture - it's old.  So who knows when or even how she actually broke that hip.  Sad!!!  It's weird how some patients can be so confused, yet as I was walking by her room - I heard her reciting prayers & she knew them word for word.  I ended up giving her some Ativan because she was rather anxious & kept pulling off her gown & the leads to the heart monitor.  That calmed her down & allowed her to rest a little bit.

We had another patient on the floor that wasn't mine, but he was confused also.  So confused that not only did he repeatedly try to get out of bed, but he began to be combative.  They put him in wrist restraints & called his wife in to help reorient him.  Instead of reorienting, he began to tell his wife how he was going to kill her & was yelling at her to leave.  This poor little old lady was so shook up & saying "He's gone crazy!"  I felt for her - I couldn't imagine what it's like to hear your husband of many, many years speaking like that.  Hopefully they'll figure out what's going on with him because he was not like this 2 days ago.

It was a much calmer week compared to last week.  I'm thankful.  The administrative staff irritated me though.  I requested to work on the second floor & they wouldn't let me.  They gave me a b.s. excuse.  I would have rather them just straight out say no than lie to me with a dumb excuse.  It's like they simply don't care about their staff.  The hospital morale is so low - I couldn't imagine why!

On a brighter note, I have an interview with the other hospital on Tuesday morning.  Gina has one also.  They are a better hospital - one of the best in the area as far as cardiac care & that's what I want - to learn more about the critical care of a patient as well as be able tocompare hospitals & the way things are run.  Should be interesting!