Sunday, July 30, 2006

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!

 

 

 

Saturday, July 29, 2006

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!

Friday, July 28, 2006

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!!!

Friday, July 21, 2006

Travel Nursing

I've been asked what the benefits of travel nursing are...Linda...just for you...here's the info!!!

Free Furnished Private Housing - on every assignment. Subsidy available.
Double Time for Overtime - on most assignments
Travel Allowance - $400 to $600 per assignment. Paid again if you extend!
Day 1…Free Health and Dental Insurance – No Deduct.
Immediate $20,000 Life Insurance Policy
Immediate 401K Enrollment – with a company match of 50%
License Reimbursement – 100% for each new license required
Immediate Direct Deposit
Vacation Pay
CEU Reimbursement - plus 30 free CEU’s per year
Income Revenue Saver - our Tax Advantage program- $210 per week tax free                                                                                         
And the hourly pay rate is usually somewhere between $30-50/hr.

Can you see why I'm looking forward to it?  On top of all those benefits...you pretty much can choose whatever location you want to travel to & you can change locations every 2 to 3 months if you want!

Wednesday, July 19, 2006

Medication Reconciliation

Guess who's at my hospital this week...JCAHO...ooohh, scary words in healthcare...lol.  JCAHO is the Joint Commission of Healthcare Organizations (or something like that).  We've been preparing for months for them to show up & they are finally here.  They follow you around, watch what is going on, ask questions...anyone working in the hospital is fair game...even doctors.  If they find something out of sorts, expect a large fine to follow.  We've heard all kinds of rumors...such as a doctor not knowing what to do in the event of a fire & the hospital was fined $75,000 or not being able to unlock a bathroom door quickly which brought about another huge fine.  Basically...they are people I don't want to be around.  Because I know for me....I know the information as long as no one is directly asking.  As soon as someone says "What is so & so?"...I go blank.  It's like this also when I go to Blockbuster or a music store.  I will have the movie or cd that I want memorized in my head, but as soon as I walk through the door...it's gone.  What did I come in here for???  Sooooo, lucky for me, I'm not scheduled this week & I plan to leave it that way.  I've been enjoying my time off anyways.  I'll make up for it next week.

I'm sitting here reading Advance for Nurses...which is a pretty good little magazine (if you want a free subscription...go here...http://nursing.advanceweb.com/ & follow the link for a free subscription.  There is an article in here regarding Medication Reconciliation.  This is something new we've been doing at our hospital for quite a few months.  I've been fighting it the entire way because it is too confusing, too frustrating & the patients don't understand it either.  I think a lot of the nurses I work with were/are resistant to it...mostly because the doctors aren't very cooperative & the forms aren't really people friendly.  It's getting better though because I think we all are starting to understand the importance of it. 

And that's why I'm passing it on to all of you...basically the purpose of Medication Reconciliation is so that patients AND their families are well aware of what medications they are taking & the dosages, routes, how often, etc.  What I'm passing on to anyone reading my journal is this...if you &/or your family members, friends, relatives, etc are on medications....write down the name, dosage, how often it's taken & make copies of it.  Put one in your car, in your purse, give copies to your family members, friends...anyone that would most likely be at your side should you end up in the ER or admitted to the hospital.  Because again, if you're anything like me, this important information is erased from my memory as soon as someone directly asks me.  I've seen many patients end up admitted not having any clue what medication they take.  They always seem to describe it as "a little white pill that I take twice a day."  Ok, there are zillions of little white pills...it helps to know which one specifically. 

So I'm putting it out there to save you or your family members the frustration, embarrassment or even worse....having important medications automatically stopped simply because no one knows what they are on to begin with.  Write it down, put it in a good spot & don't forget where that good spot is (like I sometimes do...lol).  :)

Wednesday, July 12, 2006

Merely babysitting?

It's raining, it's pouring....good ol Florida summers.  I don't mind the rain - as long as I'm not out driving in it.  I'm glad I'm home because I was planning on going to Sea World this afternoon/evening.  I postponed it until tomorrow...I hope it's not going to be raining like this tomorrow. 

Work was a breeze this week...all stable, alert & oriented patients...well, almost all, I received one patient last night around 11 pm that was confused, but he slept nearly the entire night...as did my other patients.  Nights like those I feel like I'm merely babysitting the older generation. 

I think my thyroid condition is improving since I've been taking my medication on a normal daily basis.  I definitely don't seem to need as much sleep as I had in the past.  Like even today...I took a 2 1/2 hour nap after work & I'm wide awake now.  Usually I would sleep until 5 or 6 just to catch up on my sleep. 

I found out last night that I'm getting a raise in August.  Woo hoo!  I love more money.  I've actually had quite an increase in pay over the last 18 months....over a $3/hr increase since when I was hired.  It's not as much as what I'd make in other states, but then again...we don't have a state income tax...so I think it washes out.  I'm still looking forward to the income that travel nurses make...soon, real soon.  I do need to start working on getting all the paperwork completed for travel nursing & agency nursing.  It's such a pain...showing proof of immunizations & titers & a zillion other things.  Oh well, gotta get it done sometime. 

I just renewed my nursing license...I can't believe it's that time already.  It has gone by quickly.  We have a new person in charge of our department...she's really friendly & approachable.  She was asking me how I like it at the hospital.  I said all good things & she replied "I think we need to make you the ambassador to speak to all of the new hires."  Eeekkk...nooooooooo. 

We are getting closer & closer to going computerized...I start training at the end of August & I believe October 22nd is our "go live" date.  I'm curious to see how much of an improvement it is...because I can't imagine it being any worse than all of the handwritten charting we are doing now.  It takes hours to chart on our patients.  Watch though...they'll probably increase our patient ratio if this is truly effective with time managment...grrr.  We shall see!!!!!!

My niece is coming over tonight...time to spoil her...yet again.  :)

Saturday, July 8, 2006

I just knew

I started looking in the obituaries yesterday...it's something us nurses do to see if we recognize any names.  I just knew my patient from Monday night would be in there...and he was.  He passed away on Tuesday, July 4th.  I don't know if it was during the day or at night.  I hope his family was at bedside or the nurse or someone.  No one should have to die alone.