Never give up

On Monday night, a "code blue" was called in the ICU.  Gina & I went to observe.  It was an older gentlemen who had been in v-tach during the day.  He had been started on an amiodarone drip.  He went back into v-tach so they shocked him.  That led him into asystole.  That's when they began pumping the drugs into him: Vasopressin, Epinephrine, Atropine & Sodium bicarb.  Nothing was working - he was in asystole for a good 5 to 10 minutes.  The ER doc asked "Does anyone else have any ideas?"  Nope.  So he called the code off.  Gina & I left only to find out later that while they waited to print out a strip of his asystole - his heart started beating again...40, then 60, up to 72 & normal sinus rhythm.  Wow!  Is that amazing or what? 

On a depressing note, there was a 30 yr old female that had been dumped in the ER parking lot late one night.  She had overdosed on drugs & whoever she was with decided to take her to the hospital, pushed her out of the car into the parking lot & left.  Needless to say, she was on life support for 2 days when her family decided to take her off & she passed away. 

My week went fine - not much to really talk about.  I have ACLS class tomorrow.  I just want it over & done with.  I'll write more this weekend.

How?

How in the world did I ever make it through nursing school?  I was planning to spend the weekend studying my ACLS material...reading, making note cards, getting things straight in my head for the mock code I'll have on Saturday.  Guess what I accomplished = nothing.  Yep, that's right...NOTHING.  Didn't even open the book!  I had 4 days off....got nothing accomplished.  Well, not exactly nothing - I did manage to do laundry, clean up around the house just a little bit, spend time with my family, have my niece spend the night - so that's something, right?

I fell asleep last night at 8 pm.  Yep...8 pm.  Don't worry, I taped Desperate Housewives & Greys Anatomy.  I woke up around 2 am & watched those shows...those excellent, excellent shows.  I'm getting ready to go back to sleep - but I must at least do something with this ACLS stuff first (yeah, right)! 

On an off topic, I did manage to win a bet this weekend & as a result...my SUV will be detailed for free thanks to Aaron's misfortune.  We bet on the Nascar race & I won (thanks Tony Stewart)!  It's lovebug season right now (icky nasty bugs that go "splat" all over your car)....so I think I'll wait to collect on the bet until the lovebugs are gone.

Ok......study time!

 

Our First Code

Gina & I got asked to work at #1 hospital on Sunday night with the offer of a $100 bonus. We gave them some conditions of our own first - we both wanted to be on the 2nd floor & on the same wing.  Of course they said ok, what else could they really say?  We got to work & sure enough were both on the 2nd floor - but they had Gina on the north wing & I was on the south wing.  Nope, not acceptable...lol.  We went to the charge nurse & she gladly changed it so that we were both on the north wing = happy.  It's just nice working with a friend.  I don't know why they are so set on splitting us up all the time.  It's not like we are slackers if we work together.  If anything, we work better. 

Anyways, they overloaded us with patients & we had no patient care tech - that's getting typical at this hospital.  Towards the end of the shift - like 5:30 am - the other nurse was walking her pt from the bathroom to the pt's bed.  This was a little old lady - I don't know what her diagnosis was, but she had been alert although somewhat confused.  She kept asking me to look in the kitchen cupboard to find out when her husband's doctor's appt was & she asked why he was depressed.  Umm, I don't know.  So out of that room we hear very calmly:  "Guys, I need some help."  Gina & I went in thinking that the pt fell...because she was on the floor with the other nurse trying to pick her up.  Nope - she was not breathing - no response...nothing.  Gina & the other nurse are picking her up, I get on the other side of the bed & get my arm under the pt's arm & we heave her up onto the bed.  I take a look at her face - her tongue is protruding out & there is no sign of life.  We tell Gina to call a code while the other nurse checks for a pulse & starts compressions.  Gina goes out to the nurse's station to pull the code button, I went to get the crash cart....within 10 seconds, there's about 3 other nurses in the room (ICU is like 20 ft away).  30 seconds later, there's about 10 more nurses there.  Our clinical leaders are looking at the monitor at the nurse's station where the pt now has a heart rate of 72 & normal sinus rhythm.  All we keep hearing over & over is "Why did they call a code???"  Ummm.....because she wasn't breathing!!!!  So they scanned back on the monitor to see what took place & sure enough.....there were very long pauses...like one heartbeat every 30 seconds or so for a few minutes.  That seemed to get the clinical leaders to shut up & stop accusing us of calling a code for no reason.  Gina & I were so panicked during the code because we've never had to actually participate in one before.  I mean we kept calm, but I think we were both clueless as far as what exactly to do.  Looking back - I probably should have stayed in the room with the other nurse while Gina went to call the code.  Someone else would have grabbed the crash cart on their way in.  Oh well, I suppose the only way to really learn is by taking part in them.  We aren't expected to be experts.  The pt seemed to be fine after all was said & done.  In fact, she was asking to get up & go to the bathroom again.  Ummmm...don't think so.

Mon, Tues & Wed we were at our other hospital.  I cannot stand the beginning of shift there - it is just such a mess.  Maybe it's the fact that we are with preceptors & are still under their guidance to a degree.  I have my own way of organization & don't like when that gets interferred with.  For example, I like to get report, go check on my patients & do an assessment, then take the time to review the latest orders & lab/test results.....then pass PM meds & start charting.  The nurse I was with on Monday night seemed more interested in what the chart read than the actual patient themself.  She spends like the first hour or two catching up on that stuff rather than assessing the pt.  The other two nights were better because my preceptor had no problem with me being independent & on my own.  Not to mention I was carrying the majority of her patient load while she was doing charge nurse stuff. 

This floor or maybe it's the hospital is so opposite of my first hospital.  For instance...one of Gina's pt's had a 6 beat run of V-tach.  She looked up his labs only to find out his am K+ was 3.2 & not addressed.  It's like they don't realize how important potassium is for cardiac function.  So Gina had to call & get an order for potassium to bring up his level.  Doctors just love getting calls at midnight as opposed to sometime during the day...don't they????  NOT...lol.   

At about the same time Gina's pt has his V-tach, I also had a pt do the same, only it was a 12 beat run of V-tach.  I didn't find out until over an hour later...nice, huh?  Do they not realize V-tach is not a good thing?  I was about to call the doctor when my preceptor said "Let's get her K+ & Mg levels first."  So she orders them & we have to wait for lab to draw them & get results.  By the time I called the doctor, this episode of V-tach took place 2 hours earlier. Luckily the pt was non-symptomatic & remained normal sinus rhythm.  She was a little low on Mg (1.6) & K+ was ok (3.6).  I got an order for Mg & K+ as well as putting this pt on the electrolyte protocol.  Which is another thing I don't understand - why more pts aren't automatically put on the protocol as soon as they are admitted (unless they have contraindications).  ESPECIALLY when they came into the ER with a K+ level of 2.6 & are admitted with a diagnosis of hypokalemia & the doctor has them on lasix.  I just don't get it.

I had another pt (27 yr old with pancreatitis) whose blood pressure was 191/112.  Granted, his diastolic had been wavering around 100-105 for the past two days, this was the highest it had been.  I asked my preceptor/charge nurse if I should call the doctor.  She said nope.  Instead we gave him some pain medicine & his morning dose of Lopressor early.  That seemed odd to me.  At my other hospital, there would be no question that the doctor would be called.  Gina was baffled - could not believe that they were not alarmed with that high of a blood pressure.  We later confirmed it with one of the hospital supervisors/ICU nurse that no, the doctor would not be called in that situation.  Bizarre!

Ok, I'm up way later than I planned - I need to get some sleep.  Hope everyone in Hurricane Rita's path got out of town & that it isn't too devastating.  I know the anxiety that comes with preparing for a major hurricane as well as the traffic jams.  Let's hope those idiot news reporters don't stand out in the wind & rain in order to convince us that it's windy & rainy.  It seems like there's always a few that do that which I think is dumb.  Then you have one or two that act like they nearly got hit with debris, right?  Anyways...let's all say some prayers for those in Tx & La. 

Angel Cupcakes

The other night at work, a patient gave the nursing staff a cake with an angel drawn on the top in frosting & something like 20 or 30 cupcakes which each had a gold angel pin attached to it as well as flowers for one nurse that took care of the patient.  It was very sweet!  It's nice to be appreciated.

I had the other half of my ACLS prep class today.  It is an excellent class or maybe I just lucked out & had excellent instructors.  The actual ACLS class is in 2 weeks.  Today we all got to take part in mock codes & be the nurse in charge of the code.  Although I don't like having to stand up in front of a room of people, afterwards I could definitely tell my confidence was boosted after walking through the code.  Gina found a great web site for ACLS practice.  I think it's www.ACLS.net. I'm going to check it out shortly.  Practice makes perfect, right???

After class I went to my first hospital to drop off my schedule for October & November = 4 scheduled days.  The woman that handles the schedules was practically begging me to pick up some shifts this weekend.  She even thru in a $100 bonus for each shift I picked up.  I told her I'd call her back in about an hour.  I had to think it over & also see if Gina was interested in working.  We decided to pick up Sunday night.  Why not?  It's extra money.  I have a feeling that we'll be getting more offers like that over the next few months as the snowbirds return from up north & the hospital census increases.  I like extra money.  :) 

I cannot wait for fall weather to show up.  It is soooo hot right now.  I'm talking 96 degrees plus humidity.  As much as I complain about hot weather & hurricanes, I love Florida.  I don't think I could live anywhere else.  Ok, time to go back to my favorite activity = relaxing.  Have a good weekend everyone!

 

Retraction :)

Remember me saying in my last post that I missed my old hospital.  Let me retract that statement.  I don't miss it one bit.  I worked there Monday & Tuesday and was quickly reminded why I sought another job at a different hospital.  The paperwork is beyond ridiculous not to mention the miscommunication & mismanagement going on there.  I think it's sad that we literally do not have a lot of time to spend with our patients because of the numerous amount of paperwork.  I think I spend maybe 20 to 30 min with each patient unless they have something more going on.  I spend about 1 1/2 - 2 hours on the paperwork per patient.  It doesn't make sense to me why there is so much redundant paperwork to fill out at this hospital. I don't get it. 

Come to find out, the woman that handles our schedules assumed both Gina & I wanted to go to a part-time status with "no" benefits (as opposed to the other option of part-time with benefits) even though we clearly stated in our emails to her what we wanted.  Once again...miscommunication running rampant.  Shocking!  As a result, my benefits were cancelled two weeks ago & I just found out about it this week.  Nice, huh?  I take it as a sign to move on from this hospital.  However, I'm not totally quitting (not yet anyways).  I am obligated to work there 2 days a month now.  I think I can endure that.  I just want to get to the month of December because that is the month I officially became a nurse = 1 year of experience = more $$$. 

I'm rambling here & probably boring most of you.  Sorry...just documenting the frustration I have lately with the first hospital.  On top of that - they have become such control freaks to the point that they have assigned seating in the nurses station!  They treat the nurses like we're 5 yr olds in kindergarten.  If you are friends, they separate you.  If you want to take a break or go to lunch - you have to tell your clinical leader as opposed to telling another nurse to cover for you.  They make you wear "locators" so they can track where in the hospital you are.  They send patient care techs home rather than have them assist the nurses in patient care.  What's next?  Having to ask to go to the bathroom?  It wouldn't surprise me!

Ok, enough of my venting.  My patients this week were wonderful.  Nothing major happened, but I do feel as though I'm learning a little more day by day.  I had one patient in with CHF even though his BNP was less than 5.  Anyways...the second night I had him, around 2300 I noticed his breathing sounded rather distressed, lungs sounded awful, he was restless.  I looked at the MAR & saw that the day nurse didn't give him his 1700 dose of Lasix.  On top of that, his d-dimer that evening was positive & he had ordered a CT of the chest scheduled for the next morning because he was on PE (pulmonary embolism) protocol.  His ABG's on room air were not good at all, so I was given the order to up his 02 to 3 liters.  I gave him the dose of Lasix & within a couple of hours, he was doing much better.  His urine output went from about 100 cc's to 1600 cc's by morning.  He was breathing much easier & was more alert.  I was a happy camper.  I don't like seeing my patients in distress. 

I had another patient that was having a heart attack.  He was started on an Integrilin drip & scheduled for a cardiac cath.  I came in that night to find that he had stenosis in a stent (put in last year) & was going to be transferred to my other hospital the next morning.  He wasn't in any pain - he actually felt just fine which is weird considering he was having a heart attack.  I had a ACLS class the next day at the other hospital & ran into his family while I was there.  I think his daughter was surprised to see me - she said "I didn't know you worked at this hospital too."  I'm not exactly sure what the cardiologist was planning to do for this patient, but hopefully he is doing well today.

My 3rd patient was a 90 yr old male that had been in the hospital for a couple of weeks.  He was an ICU transfer & would get very short of breath with any type of movement.  He was a sweetheart though, brought out my mothering instincts.  I tried to spend extra time with him because he didn't have any family coming to visit him.  :(  Both nights he would have runs of V-tach.  Being that he was a DNR, I knew we wouldn't be able to do anything for him should he code...but I really did not want to see anything bad happen to him.  I checked on him when he had the v-tach & he was non-symptomatic.  The cardiologist was aware of the v-tach, but did not prescribe anything.

I had another patient in with CHF.  He was a little tough to warm up to, but eventually I won him over.  He had a chronic cough that would cause chest pain that seemed to only be relieved with morphine.  However, the doctor had told him he would not be discharged until he stopped requesting morphine.  Plus he was deeply afraid of becoming addicted to the morphine because it did work instantly for pain relief & the coughing would also stop.  So I'm not sure what the doctor will do for that. 

My other patient was admitted with unstable angina.  Tests didn't show anything & he was discharged the next day.  My final patient on Tuesday was a 50 yr old woman admitted with chest pain.  Before coming up from the ER, she complained of having a bad headache (most likely from the nitro).  Rather than giving her tylenol...the doctor prescribed Darvocet & it was given prior to her getting to my floor.  Once I got her, she complained of nausea.  I had a feeling it was more connected to the Darvocet as opposed to anything cardiac.  I got her some crackers & ginger ale & after a little while the nausea went away & she went to sleep.  A few hours later, while I was off the floor having dinner...she complained of a bad headache once again & one of my co-workers gave her another dose of Darvocet.  Ugh!  I came back to find her vomiting.  Not fun!  Afterwards she went back to sleep & was fine the rest of my shift.  Needless to say, I passed on to the day nurse the information that this patient needs something other than Darvocet for headaches. 

As I said earlier, I had an ACLS prep class yesterday at my other hospital.  So after working the night before & getting home at 8 am, I managed to get about an hour of sleep before having to be at class.  Luckily the time went by quickly during class & we got out an hour early.  We (Gina & I) went to talk to our manager to clarify some of the rumors we were hearing about nurse/patient ratios & such.  He claims that the usual patient load is 6 to 1 and rarely will we ever see more than that.  So all we can do is wait & see if he's telling the truth.  I'll give him the benefit of the doubt for now.  I still have plans to attend the job fair next month - gotta check out my other options, right?

I have ACLS prep class tomorrow morning & then I'm off until Monday night.  I like having my weekends off.  Somehow we pulled this off - not working weekends.  That's one of the nice benefits of being part-time...you have complete control over what days to work.  It also seems that we won't have to commit to working any holidays (Thanksgiving/Christmas) unless we want to.  Those holidays will be here before I know it.  Time seems to be flying by & I know October will be the same.  Between work & plans for practically every weekend in Oct (Not-so-scary Halloween party at Disney World, Sea World's Halloween Spooktacular & hopefully Halloween Horror Nights at Universal), the month will fly by.  There better not be any hurricanes in October! 

Ok, I think this has been a rather boring journal entry this time.  Not too much exciting stuff going on.  Sorry!  

 

Are there any right words?

I have had a pretty good week this week both with work & personal stuff.  To top it off, Ophelia did turn & take another direction, so it's been a beautiful Florida weekend with barely any rain.  Even though it feels as though I've slept most of the weekend, it is still nice to not hear a thunder storm outside.

The jury is still out as far as what I think about the new hospital.  Both Gina & I had an easy week as we only had 2 patients each.  The load is light since it's our first week there.  I think we both have pretty much figured out the computer system & how it works.  The only thing I am not sure about is how admits & discharges work exactly, but I guess that will come with time.  Also, I have no idea how to get a patient whose condition worsens to ICU.  We have a charge nurse, but she has her own patients & really isn't available to help out.  So it's a mystery as to how the process actually works.  At the same time though, the majority of these patients are in stable condition & the likelihood of their condition worsening is a small one unlike my other hospital where the majority of patients are in guarded condition.  I'll break it down:

PROS: the computer system is awesome: it is so nice not having to do hand-written assessments or nurses notes, having patient care techs (3 of them) on the floor is such a great help, being on the same floor as Gina & being able to help each other out if we need it.

CONS:  change of shift report - I don't know what it is, but these nurses are in no hurry to give report.  We were told to be there at 7 pm.  Gina & I are there, but there are no other night nurses around.  Where are they?  We're told "they're always late."  Huh???  Always?  I think the reason they're always late is because the dayshift is in no hurry to give report.  It seems that for most...starting report at 7:30 or 7:45 is no big deal.  I am so the opposite - I want to get report as soon as possible so I can begin my shift.  And at the same time...when it's 7 am, I want to give report so I can go home.  I have no desire to stand around & chit chat about nothing.  I am ready to go home.  So that is a bit annoying - there was one day when I didn't leave until after 8 am.  I like to be home by 8 am.  The other thing I don't like is what the rest of the staff is telling us when we ask them what is their usual patient load.  We were told the maximum # of patients we would have is 6.  The staff says anywhere from 7 to 9 patients.  Huh?  9 patients?  On a telemetry floor?  Not good.  Not acceptable for me.  I don't see how anyone could take quality care of 9 different people.  Even 7 patients is too much.  The other thing the staff tells us...that our manager decides when we will or won't work.  That isn't what he told us - he said just email the days you can work & he'll try to accomodate.  So who are we to believe?  The manager or the staff? 

Needless to say, by the end of our shift on Friday morning - we were already on the internet trying to see when the next job fair is.  There is one at the end of October in Daytona Beach - perfect.  It's a good opportunity to see what else is out there.  As far as trying to decide who is correct - the manager or the staff - so far it seems the manager is being accomodating.  I emailed him asking when he needs my schedule & he emailed back saying as soon as possible.  So I emailed back giving him the days I can work.  I'll find out this week if he's ok with it. 

I work only 2 days this week at my other hospital.  I kinda miss it - or I guess I should clarify & say I miss the staff - not the paperwork.  I also have an ACLS prep class 2 days this week.  I take the actual class at the end of the month.  Everyone is telling me not to worry about it, so I'm not worrying.  I still have yet to play any part in a code, yet here I am getting certified for Advanced Life Support...how ironic.

Aaron & I went out last night to the Alehouse.  We met up with some guys that were from England - interesting.  We also ran into a guy from high school.  I'm feeling so old...lol. 

Anyways, that's about all that went on this week.  I did have a patient this week that has bone cancer.  He was in the hospitalbecause he fell getting out of his car & fractured his femur.  As it turns out, they ran some more tests & discovered that his cancer has spread to his pancreas & kidneys = not good.  He didn't know of this prognosis while I was caring for him (did I mention that I really dislike having information that the patient doesn't have about their own condition?)  As usual in these situations, this patient started asking me questions.  It's hard to not answer what they ask when you have the information.  He had a needle biopsy scheduled for the next day & he was asking what that was for.  He was also asking why they were letting him walk the halls 2 days ago, but now they tell him he can't get out of bed & he doesn't know why.  He said to me "I wish they would stop with all of the tests & just make me better."  So heartbreaking - he was nearly in tears.  What do you say?  Are there any right words? 

Tropical Storm Ophelia

My mood really isn't loopy, rather it's "tired."  I am getting ready to get some sleep here in a few minutes.  Tonight is my last night of work for the week at the new hospital.  I'll fill ya all in on the details later this weekend. 

We have a tropical storm about 70 miles off the coast over here in central FL.  My county is way overreacting (probably cause of the mistakes the state & local govt of LA made with Hurricane Katrina).  They have closed all public schools AND they are opening up 3 evacuation shelters.  This storm isn't even projected to come onland, so I think they are definitely jumping the gun in order to avoid any negative publicity. 

We have had quite a bit of rain, but nothing really extraordinary.  Hopefully this storm will go away & not come back.  I cannot wait until the end of November - when hurricane season is officially over!