Venting - for a few minutes

Sorry all - but I have to vent a little bit.  I'm getting closer & closer to really thinking about travel nursing because:

 

My hospital is getting sooooooooooo very nit picky with all these insane things they want us to do.  It's at the point that they truly must be off in fantasyland thinking we can achieve everything they want. 

 

The latest is that they want us to bring our rolling (noisy) laptop computers into the patient's room.....chart in front of the patients- so that we can be "visible" & thus prevent falls (say what???).  Sounds good in fantasy...but the reality is...I have 5 patients.  Charting takes at least 20-30 minutes (I figure it's likely that if we are in the patient's room, there will be at least a few interruptions) and we have to chart at least 3 times a night on each patient.  So....let's see....30 min x 3 = 90 min x 5 patients = 450 min or 7 1/2 hours.....that's just charting.  Granted the first assessment should take the longest, but now they are saying the want full assessments charted at least twice a shift and one assessment where we just focus on why the patient is there.  Again, more unnecessary work.  See....what I don't understand...there is this one choice where we can say "No changes" if nothing has changed.  You would think that would suffice so that EVERYONE understands there has been no changes, right?  Nope, even when we get to choose "No changes"...we still have to chart the same exact things as the initial assessment.  Does that make sense to you?  It's like they are looking for ways to eat up our time - when really, that extra time could be spent actually with our patients minus the computer between us.  Patient care...that should be the priority here, shouldn't it?

 

Now let's move on and add in the medications we need to give & the time to actually assess our patients....probably another 30 min per patient (by the time we check the charts to make sure the medications are accurate - and the repeated faxes & calls to the pharmacy to get the medications we need and also do a full assessment) = 2 1/2 hours.  So now we're at 10 hours of our work day and all we've done is assess our patients, give medications and chart the basics.  10 hours! 

 

We get two 15 min breaks and a 30 min lunch break.  So it's 11 hours.  And that's not including any time for the needy type patients, the family members, the patients that are unstable or crashing, the patients that are incontinent, in pain, nausea/vomiting, admissions, discharges, calls to the doctors, ambulating the patient, dressing changes, and most importantly...keeping an eye on the heart monitor screens, etc.

 

Oh AND now they want us...every hour to assess how much our patients have urinated (seriously, does this really matter every single hour?  Who goes to the bathroom every hour anyways???  Especially at night?) 

 

Plus make sure they reposition themselves in bed on an hourly basis - regardless of whether they are alert and oriented and able to move on their own.  I see it going like this...ummm, excuse me Mrs. Smith, can you wake up (as if we don't wake them up enough at night to begin with), you were on your left side an hour ago when I last checked, can you please flip over to your right side so the hospital administration doesn't think I'm not doing my job???  How well will that go over?  It's ridiculous. 

 

Haha....oh AND they want us to always chart in the patients rooms.  It's impossible.  Our first assessment is at 8, but meds are usually due at 9 and 10.  How can I complete all my charting and get the meds to my patients on time?  Oh, and can you see me midnight and 4 am (our next scheduled times to chart)...rolling in my noisy computer & sitting next to my patient in the dark (cause they should be sleeping at those times) trying to type and chart without disturbing them or turning on a light?  Most importantly, do our patients really want us next to them while they are sleeping?  Doesn't that sound a little creepy?   

 

AND THE MOST OBVIOUS QUESTION OF ALL ----- UMMMM, WHO IS GOING TO BE WATCHING OUT FOR MY OTHER 4 PATIENTS WHILE I'M IN A ROOM FOR 30 MIN OR SO?  The same goes for the other nurses....who is going to be watching out for their patients if we're all in patient's rooms for extended times like that?  It's like they never thought of that.  So the quick answer was...utilize and negotiate with your patient care tech to watch your patients.  As if the PCT's are standing around waiting for something to do.  They are busy too at those times with vital signs and patient care.  And yet another good question was asked - what do we do when we don't have a patient care tech?  Not only that - at night we are lucky if we have a unit secretary, but they usually leave at 11 pm.  So who is going to be answering the phones, putting in orders, answering call lights, etc.

 

If I didn't enjoy being around my co-workers so much, I would be out of there.  Ahhh, the new ideas that "administration" comes up with.  I'd like to see them spend twelve hours on the floor doing what they propose we do.  It's obvious they haven't a clue what the real world of nursing is like. 

 

If they want to prevent patient falls and increase our visibility to the patients and their families - why not work on getting adequate staffing ratios and more patient care techs?  At times there is one patient care tech for 26 patients.  How realistic is it for that person to truly take care of 26 patients?  And many times there is no patient care tech at all - the nurse is expected to be both a nurse and the patient care tech.  I don't think they realize (or care) how tough that can be.  And why not get up to date beds in which the bed alarms actually work?  I think that would be the one feature that would work best towards preventing patient falls.  Combine that with adequate staffing and I would bet money patient falls would decrease.

 

Plus they have thrown in this paperwork that insurance companies are demanding or they won't pay the hospital for certain conditions...it's called quality measures.  In reality, it sounds fantastic....if you do this, this & that for a patient - the outcome is usually better than if you don't.  But it all needs to be documented and the doctors aren't doing it....so it's left for the nurse to do it.  Just more work that really doesn't fall under our job role, yet they expect us to do it. 

 

Sigh......ok, I'm done.  I can only hope it's not like this all over the country.  I have faith that there are some hospitals out there that actually value nursing care and allow their nurses to focus mainly on hands-on nursing care.  I know charting is a must, but it shouldn't take up the majority of our time.  Nor should we be expected to work past our 12 hour shift to "finish up charting" that we weren't able to do during our shift.  12 hours is a long day/night and most of us just want to go home and get some sleep after working.  Sighhhhhhhhhh!

 

On a better note, I saw Lifehouse in concert Wednesday night.  They are awesome.  I could listen to them all night.  It went by so quickly though.  I'll be seeing Michael W. Smith in concert in 2 weeks.  He's very spiritual and I definitely could use some of that right now in my life.

 

Work has been ok.  I've been floating around to different floors.  Nothing major has really happened with any of my patients.  I've had a few that were a challenge.  Like this one gentleman - he came in with congestive heart failure.  For some reason, his blood sugar would not stay in a normal range.  It was running low repeatedly and I could not figure it out.  He started out at 70 one night, so I encouraged him to eat, gave him apple juice, peanut butter and graham crackers, whole milk, a sandwich...figuring that would keep him ok through the night.  I got a call from the lab around 5 am with a critical glucose level of 44.  I wake him up, luckily he's non-symptomatic, but I give him more to eat and drink - recheck it 30 min later and it's barely changed.  So I gave him D50 through his IV.  He was rechecked at 7 am and I think he was like 50 something.  We want it at least 70 or higher, but after all that he had consumed and the D50....it should be well over 100.  Throughout the day, he dropped as low as 31.  The day nurse had given him more D50 and then Glucagon.

 

So when I got him...his blood sugar had reached 100. Yay!  We rechecked it 2 hours later and it was 67.  Grrr!  I finally called the doctor to inform him of all that we've tried and he ordered D5NS.  We don't usually like to give patients with congestive heart failure extra fluids like that, but he definitely needed it to keep his blood sugar up.  Even with the fluids, he still floated around 75-98 blood sugar, but that was good enough for me to relax. 

 

I had another patient that wanted me to help her fill out her living will paperwork because she was having a cardiac cath the next morning and was worried.  It was 2:30 in the morning and I didn't think that was the best time to be making deicisions - but she insisted.  So I sat down with her and helped her fill it out.  After that she was able to go to sleep.  Turns out she did have something major wrong and was transferred over to a bigger hospital that could handle her cardiac problems.  I guess she just knew something was wrong and wanted to get her paperwork in order.  Kinda eery sometimes.

 

It's 4 am, time for me to go get some more sleep.  I must have been really tired yesterday as I slept for about 12 hours altogether (I would wake up for a little while, then fall back asleep repeatedly).  I should work tonight for the overtime - I probably will...but I'll decide later.

 

Hope everyone is having a great weekend!

"Being a Nurse..."

"Being a nurse isn't about grades. It's about being who we are. NO book can teach you how to cry with a patient. NO class can tell you how to tell a family that their parents have died, or are dying. NO professor can teach how to find dignity in giving someone a bed bath. A nurse is NOT about the pills, the IVs and the charting.

It's about being able to LOVE people when they are at their WEAKEST moments and being able to forgive them for ALL their wrongs and make a difference in their lives TODAY.

Nobody can make you a nurse...YOU JUST ARE."

~Author Unknown~

You just never know...so scary

I got a call on Thursday telling me some more sad news. One of my nursing school classmates that I graduated with had passed away at my hospital's ER last weekend. I was shocked! She was 36 years old and I was told that she died from a pulmonary embolism (blood clot in the lungs). It's another reminder that life isn't fair and your entire world can change in a second. You just never know when that will be....soooo scary.

Carlene - I don't know why I thought about that patient from earlier in the week the way I did. I didn't connect it to myself or my family at all though. Maybe I was overly tired & things got to me more than usual. I'm not really sure. It can be a tough job sometimes - having to deal with critical situations, death and grieving families. I can usually separate what needs to be done at work from what I take home at the end of a difficult shift. For some reason...that day I wasn't able to. Sometimes it doesn't always make sense and I'm ok with that. Like anytime in life...there will be some good days and some not so good days.

I'm doing better now. I've been off since Monday and have been doing a variety of things including getting some rest & relaxation, getting back into working out & balancing between staying busy socially and having time to myself. I work tonight and tomorrow night and then will be off until Friday and work 4 in a row...eeekkk...lol. It's spring break for my youngest niece and nephew so I plan on making sure they have some fun. Being around kids is always refreshing....as long as I can send them home after a few days. :)

Enjoy the weekend everyone!

Weird coincidence???

It's nearly the end of March. I cannot believe it. I swear each year flies by faster than the last. The hospital continues to be at max capacity. I don't recall it ever being like this before & that is even with all the people complaining of chest pain via ambulance are diverted to the bigger cardiac type hospitals. I have heard a rumor though that our hospital is going to start focusing on increasing their cardiac procedures - as obviously the need for it is great. I wish we would open up a cardiac only floor. I would love to work in that specific area. Maybe my wish will come true one day.

Speaking of cardiology, I had a patient last week who had multiple things wrong with him - the main one being that his cancer had spread all throughout his body. His blood pressure sat in the 150-160 range systolically and the doctors seemed comfortable with those results. The last morning I had him, his blood pressure rose to the 180's systolically. It was nearly 4 am & I questioned whether this result could be delayed by say an hour - before calling the doctor. I mean it wasn't like his blood pressure was normally 110 or 120 & jumped up to 180. It was 160 to 180...not a huge increase. So as I sat there & debated with myself whether to call & wake up the cardiologist...the phone rang. I answered the phone & guess who....the cardiologist...calling me out of the blue...lol. He was asking me what the first name of this patient was - the same one that had the higher blood pressure. I laughed to myself & thought "how weird is this right now???" I gave him the answer & said "By the way - while I have you on the phone, his blood pressure is this..." He said that was fine, leave it alone. I hung up the phone wondering...seriously...what are the chances of this ever happening at 4 am?

This week was going well...I worked Sat & Sun nights. It was pretty uneventful. Well - until Monday morning. A co-worker & I were waiting to get our yearly PPD shots. The reason we were waiting was because a code blue had been called about 10 minutes earlier & whoever was doing the PPD shots - ran to the code. So we waited & eventually I could tell by the looks on other co-workers leaving the floor that the code was not a success. Another co-worker quickly updated us on who had coded & although she wasn't my patient at the time - I did have her as a patient back in December. I didn't write about it at the time as it was right before Christmas & very sad. She was in her early 30's who came to the hospital because she had trouble swallowing. They initially thought it was pneumonia...only to find out it was 3 or 4 large tumors on her esophagus. Basically she had stage 4 cancer...that is the worst stage there is. She was married and had 3 children at home. Her room was decorated with a Christmas tree & presents back then since she would be spending Christmas in the hospital.

Fast forward approx 3 months & she is the one that they called a code on. As I was processing all of this information, her sister was being led by the ICU nurse to the waiting room and I heard her crying on the cell phone to her mother while saying "She's gone, Mom, she's gone." I keep hearing those words over & over. I came home & couldn't stop replaying those words in my head. I felt miserable. I tried to sleep...took 1 Tylenol PM. I had a sore throat, headache, still not sleepy. So I took 1 Sominex and layed down again. I could not sleep. I ended up calling off from work - because I can't go in with no sleep in over 24 hours & then work another 12 hours. I was tired, but couldn't sleep. Eventually I did fall asleep around 5 pm until 11 pm. I ate, watched tv & went back to sleep & woke up at 7 am.

I feel better today. I'm getting some things accomplished, but still think about that family who lost someone at such a young age. I don't know why it's affecting me - I usually am so good at keeping everything at work. Maybe I'm just more sensitive at the moment. I don't know.

It's just a major reminder that life isn't fair and you have to make the best of it while you still can.

On a good note - I have tickets to see Tim McGraw on May 11th. I cannot wait! I'm also seeing Lifehouse on April 16th. Soooo looking forward to getting out & hearing some good music.

I hope everyone is having a good week!

Another year goes by

I turned another year older on Friday.  I'm 39...eeekkk.  Even I can't believe it.  It also marks one year since I had to put Jagger to sleep...sad, sad memories.  This year was much better. 

Work has been ok.  I've been working the usual 3 days per week.  Lately it's been every Sat, Sun & Monday nights.  Not sure if I like that schedule or not.  I do but I don't.  I guess there are pros & cons to everything.  The patients that I've seen in the hospital for the last month or two have been very, very sick.  They came up with this new thing that anyone with chest pain that is picked up by an ambulance - has to go to a different hospital - even if ours is the closest hospital in the area.  We don't specialize in cardiac procedures.  As a result, we are seeing less & less of the easy to care for chest painers and more of the respiratory & gastrointestinal issues.  I have had patients that have been at our hospital for weeks & months...and they aren't improving.  I'm not used to that.  Usually after 2 or 3 days in the hospital, the patients would be discharged.  Now they seem to stay a long time. 

There was one night that I came in and we had 23 patients waiting in the ER for a hospital bed.  They had been admitted, but we had no rooms/beds available.  That's the busiest I've ever seen it & it was only a Monday night.  It doesn't seem to be slowing down anytime soon.  I imagine it's like that all over the country.

I'm tired - heading to bed.  Hope everyone is having an enjoyable weekend.  Oh...congratulations to Amanda who had twins last week!!!  A boy & a girl.

Oh...one more thing...for Carlene.  PCT's are patient care techs...it is pretty equivalent to what one would call a CNA.  I'm sure they have their slight differences, although I don't know what they are.  They cannot give shots or medications.  They are mostly responsible for vital signs, helping patients, cleaning patients up, feeding patients, transportingpatients, etc.  It's a tough job!

 

 

Refreshed

I hope everyone is doing well.  February is just flying by.  I've had a light schedule at work - which is a nice change.  I had 9 days in a row off, then went back in on Wednesday night.  They scheduled me as the PCT (patient care tech).  It seems the last 5 times I've gone in...I've been scheduled as the PCT.  I don't mind being PCT...but not all the time. 

I can't complain though...the past few times someone else volunteered to be PCT for various reasons.  Another time they pulled me at like 7:20 to be a nurse.  This time however...I was the PCT....but a PCT with an orientee.  That's the best...lol.  It's always nice having an extra set of hands right there to help with patients instead of trying to track other nurses down.  He did really good - jumped right in & started doing vital signs.  It's kinda weird teaching someone to be a PCT when that isn't my usual job role.  I was teaching him from a nurse's perspective & what we as nurses look for when we need help from our PCT's.  It was only his first night, so I'm sure other people will teach him other ways.  I emphasized to him that there is no one way to do things - do what feels right for him.  He seems real helpful & is good with the patients...that's a really good start. 

Most of our patients were alert & oriented....there was only one that I could say was a total care.  We probably could have bathed her, but she was pale as a ghost, full of edema and cold as ice.  I wasn't about to start moving her around in the middle of the night for a bath.  She was getting platelets and fresh frozen plasma.  I got the eery feeling that if we started moving her around, it could lead to a code blue situation.  No thanks...we left well enough alone.

For the next 4 or 5 weeks I'll be working every Sat, Sun & Monday night.  I don't mind - it will be nice to be on a regular schedule & the weekends are usually light with families and doctors.  I'm sure by the end of March I will be tired of this schedule...but the new schedules will be up soon & I can pick & choose what I want.  That's one thing I like about this hospital - the flexibility to pick our own schedule.  We had to sign up for the spring/summer holidays already.  I only had to do one & I chose Easter Sunday...just to get it over with. 

I went to Orlando last weekend & stayed at a really nice hotel....the World Center Marriott (I think that's the name).  It's gigantic...like 1500 rooms and even has a convention center on the ground floor.  It was a nice little get away.  I wish I could go back!  I need more get aways.  Don't we all???

It's late, I need to get to bed.  Hope everyone has a great weekend!!!!!

 

Finally Rested Up

I've been off of work since Monday night/Tuesday morning. I think I'm finally caught up on my rest. I think that's the hardest part about working the night shift- trying to maintain getting enough sleep & still living a normal life.

My schedule is pretty light for February. In fact, after this weekend, I'm off for 10 days. I may pick up some shifts - I'll just play it by ear. I am planning to go out of town for a few days - have some fun in the sun. The weather has been so beautiful lately - I hope it lasts.

Monday night was a busy night for me. I love busy nights and I hate them. I love them because the time flies right by. I hate them because it feels like you'll never get caught up. It was just about 1 am before I sat down & started charting. By the time I got done charting...it was around 3 am. Time was just zipping by.

My patients weren't too bad - all were stable. I had to transfer two of them to med-surg which meant I was open for two admissions & I got them. Admissions aren't bad, just time consuming. Luckily, they were both pretty much with it & just wanted to sleep. That's always ok with me!

My clinical leader was taking report from me when we heard another patient's 02 sat monitor alarming continuously. We went to check on him & it was in the 60's (ideally...we want it above 92). 60's is really, really bad...it means there isn't enough oxygen circulating in his body. He was very pale & although his eyes were open, he wasn't responding. His nurse tried to tell us this is how he always is, but anyone looking at this man could tell he was in some major distress. We called a code & they ran the medicatons & luckily got a shockable rhythm and were able to bring him back. He ended up being transferred to ICU.

Before I knew it, it was about 5:30 am & the end was in sight. I finished up charting, passed my morning meds & waited for the day shift to arrive. Ahhh, the life of a night shift nurse...lol.

Have a good weekend everyone!