Friday, September 26, 2008

see it, do it, teach it

I forgot to mention that I had a nursing student put with me last week. Talk about the blind leading the blind. But I told her she could see what it's like to be a new nurse. She really ended up helping me out because one of my 'easier' patients started going down the tube and while I was trying to figure out why suction wasn't working for his brand new NG tube, she and her instructor took care of my other patients.

I figured out yesterday that I make up to $37 per hour for overtime, which definitely is an incentive for me to stay over another 4 hours after an 8 hour shift. I did that yesterday, but had an ill-timed visit from Aunt Flo right at the end, and needed the help of a couple co-workers to fetch me new pants and give my last meds. I love my co-workers!

Saturday, September 20, 2008

old nurses speak out, new nurse speaks up

I attended my grandmother's nursing reunion today. I discovered a sort of animosity for new nurses hidden under all of those flowered shirts and trifocal glasses. One by one they stood up and bemoaned the current state of the nursing profession, with the fact that we no longer wear white uniforms topping the list of reasons that we, as a profession, have trotted too far off the beaten path for professional redemption. Nursing is not respected. And certainly won't be as long as you aren't traipsing around with white uniforms and huge, wing-ed hats.

I had to disagree. I may be new, but I'm also a lot closer to remembering the pride I felt the first time I held my license in my hand, the first time I introduced myself as a nurse, the first time I scribbled RN after my name. I was proud, not just because I passed a test, but because I was a nurse, and my whole life I, along with everyone else I knew, held nurses up with great esteem. I was one of the them. Nursing is very respected to day, which is why I chose to go in this direction. I've never met a patient or their family who didn't think our jobs were important and hard. I've never met a person who didn't say 'wow' when I state what my profession is. I've never heard (yet) a physician or PA say 'what do you know'. In fact, they consistently ask me for my opinion, for my knowledge, for my take on everything.

I'm sorry that older nurses can't see that. I'm sorry that they have been made bitter by their experiences as nurses and as patients. I'm sorry that they feel good nursing care cannot be given without a white uniform and hat. I'm sorry that they feel like nurses only like to sit around and gossip, rather than bathe their patients or turn them or whatever. I was like, no... we do all of these things, still. Oh you should've heard the groans around the room when I said we don't lift our own patients! What is nursing coming to, after all? Well, I don't have time to find 4 other nurses to strain and huff and puff with me, nor do I want to injure myself. I make sure it gets done and I oversee the process. That's the beautiful thing about nursing today, I'm not just a grunt worker. I'm a professional, with decisions to make. I'm not there to haul patients up by their draw sheets every two hours. But I will make sure it happens.

In other news, I had a patient for four days with trisomy 9-q, a 33 year old with the mental capacity of an 18-month-old. I had some long, trying days, let me tell you. The parents came in the first day and ripped me up and down for everything under the sun. I listened, calmly. Let them vent. Then I addressed every single concern they had and followed up with it the next day. I felt the importance of that next day weigh down upon me walking into the building that morning. I had made some promises, and I had to deliver. When I was able to locate a speech therapist, arrange a swallow study, and bring in PT all in the same morning, completely bypassing the medical service, I was thrilled with myself. This is nursing!

Saturday, September 13, 2008

high times

I've had several good days at work, after my return from a long weekend off. My first day back was only four hours, and amazingly, they didn't need me to stay another four. That day was also an "ice cream social" for employees. Another nurse and I went down in the middle of our shift to check it out. They had a ton of ice cream, good ice cream, with all the toppings. It was delicious. They had a lot of other booths and fun stuff, like a booth where money flies around and you have 30 seconds to catch it. The news was there, filming.

Yesterday most of the nurses tried out my brand new electronic stethescope. It's an ADC, cost about $150, and miracle of miracles: I can hear! It amplifies the sound and zooms in on it, it's a million times better than regular stethoscopes. I think it went on everyone's christmas list.

Wednesday, September 3, 2008

what you get for being BORED

Monday night I was bored. I had two patients who didn't need much of anything. I took it for granted. I thought in my head 'this SUCKS. I'm not learning, I'm not challenged.'

So we all know what's going to happen, as soon as you start thinking that way. Tuesday I came in, and my admit came rolling through the door before I was done with report. Not a good way to start. I had to untangle two chest tubes, the oxygen, the SCDs, the IV lines, the PCA and epidural and get them all on a pole, which got me behind to start out with.

Then another patient, an adult failure to thrive post-gastrectomy, needed albumin. He was supposed to have a PICC line placed in radiology while his dophoff tube was being placed, but they sent him back up without putting it in. Now guess what, he has no IV access because his peripheral had stopped working. He was supposed to go back down at 2:30. At 3:30, he still hadn't gone. At 4:30, I started trying to figure it out. I got on the phone with the vascular access team, who said they had nothing to do with it and don't put in STAT PICCs. I talked to his SGI service (his docs), who told me to call radiology. Radiology said he wasn't on their list. I told them, I'm staring at the order right now, how is it that you don't see it? Sorry, was all they said, we can't do it. Re-submit the order. So I resubmit the order. Still nothing, they say they don't have time.

By this time I'd given up on the PICC. I decided to just go with a STAT peripheral for the time being. I page the STAT vascular team. They don't show up. I page out to the floor and get two people on our unit to try. They have a hard time because both of the guys arms are so swollen, they are third-spacing and weeping and he's dry as a bone. Finally, vascular access shows up. The first guy has no luck. The second woman who comes brings an ultrasound, and she can't get it with that. By this time, it's 10pm. I tell service, sorry, no go. What do you want to do? Charge nurse is saying that an MD has to do it. I can see that the MDs aren't going for that. We're basically just SOL until morning when they do the PICC.

While all of this is happening, I'm frantically trying to do my vitals, because my tech? She apparently didn't feel the need to do anything last night. I try to get meds out at least an hour after they're due. I have to restart this guy's tube feeds, and there is no order to use the dophoff. Finally I say, fuck it, he's got no IV access and he needs pain meds, so I use the dophoff, which luckily didn't become an issue later. Now he's got to get this aluminum gunk down the dophoff and it keeps clogging it, but luckily I get it all in and flushed.

My first patient, the new admit, keeps calling for little things and is being whiny. I simply don't have time to be a waitress that day. I have a tech page lift team to boost her up in bed. My friend K, a new nurse, went to help me and oversee lift team. The guy from lift team is a total jerk and says he won't boost her because she's going to slide right down. K tells the tech she'll take care of, to leave me alone because I'm busy. The tech runs right into the med room, with the lift team guy behind her, and both of them stand there telling me they aren't going to boost the patient. All of the other nurses in the med room are just staring at them, and looking at me in disbelief. We've never had issues like this with lift team. Yeah, she's going to slide down again, eventually, just do your fucking job and BOOST her UP! But the guy continues to give me attitude, and we all tell him to get out then and forget it.

Meanwhile, a million other things are flying at me and I feel tears come to my eyes. I'm hungry, tired, and way behind. I don't want to cry though. By the way, I have a third patient who has an LVAD that's not working properly and I haven't given her any attention. Her docs are also trying to find me, so is pain service who wants me to order toradol for my first patient. I have call backs waiting for me and docs who are pissed that I'm not standing by the phone. It all gets very overwhelming and I'm still pissed about lift team.

The end of the night does not let up. My LVAD patient needs two units of fresh frozen plasma. I ruin the first bag they send because I don't clamp the saline, and the whole thing has to be re-done. The other nurses are so nice to me about it though, they tell me they also ruined their first bag. The patient is nice too, luckily. She has been teary all day because she wasn't expecting to need her LVAD replaced, and I feel bad that I have no time to give her any emotional support. My no-IV-access patient has been nauseous, and I basically have to tell him, nicely, to deal with it because we can't give him nausea meds. We asked service about something IM, but they said no.

My last 45 minutes I do all of the stuff no one else would probably bother to do on this kind of day. I post my strips (which I usually do first on my shift), I do my SOAP notes, my care plans, the admit's paperwork. I review my charting. The only thing I didn't do that day was read my patients' histories and labs. I hate that I couldn't do that. I have a headache, my feet ache, and I want to go home.

I guess I did as well as anyone could have, under the circumstances, but if every day was like this one, I'd quit.

Monday, September 1, 2008

day in, day out

I wake up at 6am. It's my fifth day in a row, out of seven. Second twelve hour shift. My work clothes are in the dryer but I still tear the dresser apart looking for another shirt. Sometimes I eat cereal before I go, sometimes I use the milk at work and eat it after report. Once, I tripped on the bottom step on the way to my car, and tore a hole in my pants. At 7, I'm trying to figure out if my assignment is ok, and usually I just say "ok whatever, I'll take it". Now I'm thinking about a cup of coffee, if I can get one off the patient cart, or if I'll try to make some myself. Sometimes it's ok, sometimes I burn it. I don't know how I do that, because I do it the same way every time. I just push "start brew" and sometimes it burns. What a mystery.

I post my strips, I do my assessments, I dole out pills, I fill out care plans, I get walks and baths finished. It's usually nine or ten when I sit down to chart. But no one else is there. Am I just fast? Or am I forgetting something? I answer my lights. I read my patients' histories and labs. I think about more coffee. The rest of the day is meds, walks, and damage control.

Report is when it all comes clear. Did I really tke care of everything? Make things easier on the next nurse? When I get home my feet are achy, despite the ted hose and extra support in my expensive walking shoes. I sometimes still smell c-diff stool. I take off my clothes first thing, but I'm too tired to shower. I feel too tired to eat, but I usually do. I try to stay awake for a while, for Saba's sake. But sleep comes easy, after days like this. I don't need to take anything, or stay up reading long.

I got to sleep in today, ahhh the joy.

work was never so easy (dot dot dot)

A few of my coworkers had some stressful days, but mine were pretty easy. I tried to help by answering lights, walking their patients, getting vitals, buying them bagels, etc. Still, I felt like I wasn't really sharing an equal workload.

I have worked far too many days in a row, and it's starting to feel like home there, a home I don't exactly want to live in but don't really mind, either. There's coffee, afterall, and $1 cookies from downstairs. That's something.

Someone from work just called and said 'can you bring your camera? We are all wearing pigtails today and want to take a picture!'