Thursday, July 29, 2010

Mr. Grouchy Pants

I admitted a patient from the floor in "respiratory distress". I was excited to get a hit, hoping it was something juicy, something challenging.

Well, challenging it was, but not in the way I had anticipated.

First of all, the patient in respiratory distress, was brought up on room air. Room air people! No trach mask, no nothing. His sats when we plopped a pulse ox on his finger? 76%. He recovered nicely to 96 though once we got his trach mask on. On 50% trach mask he was fine. He was fine alllll night long.

So besides not being appropriately sick enough for the ICU, our biggest problem was that he kept throwing his O2 and pulse ox off. He refused to wear them, even after threatening to be restrained, explaining the grissliness of a code (including cracked ribs). He wrote on his paper "leave me alone" and "this is a 3rd rate ICU". Meanwhile, the O2 mask he kept throwing on the floor left him satting somewhere around 75%. You know, if someone really doesn't want our most basic care, let him check himself out, right? I mean, he was totally with it (arguably, I suppose), and even wrote our names down along with our positions (he's a practicing attorney), I guess so he can sue us later for trying to save his life.

At the end of the night, I was SO DONE with this man. If you want to die, fine. Make yourself a DNR/DNI, we'll make you comfortable. Don't call us names, threaten to sue us, and just basically act like a total ass. Just sign yourself out AMA and get the hell out. I'm not going to bend over backwards anymore to be nice to someone who is so obviously a jerk.

Saturday, July 24, 2010

night shift takes its toll

For the first time, I got in trouble. The day shift nurse who took my patient made a list of complaints of things I didn't get done and submitted them to our supervisor. I got an email asking me why I "failed" to change expired tubing, ET tube tapes, and a bag of insulin that had expired. I have no excuse or good reason, either. I should've done all three things, and the honest truth is that I just forgot to check expiration dates all the way around. I told my supervisor exactly that, and that it will not happen again, I will add expiration dates to a list of reminders for myself on each shift. Maybe he will still write me up, I don't know. I feel horrible, like I should be sitting in the corner of the unit with a dunce cap on my head.

See, I always try really hard to do everything at night so that day shift doesn't have to: baths, IV dressings, tubing changes, new yaunkers, new feeding tube bags, new EVERYTHING with a new date. I take pride in handing patients over to the next shift completely caught up. This is seriously the first night I forgot to check tubing dates, and OF COURSE, a tattletale has to take the patient.

I'm just not a big fan of running straight to managers with complaints about other nurses. It was a huge problem on my last floor, and I didn't expect to see it here. I was hoping that if I made a mistake, my co-worker could talk to me about it first. I thought I would at least be given the benefit of the doubt... but I guess not.

I have been miserable on nights since my last post. Extremely tired, cranky, emotional... brought to tears many times by practically nothing. I feel sick when I leave. It's hard to concentrate and I feel like I'm moving around in a fog. I feel like it's hard to be a good nurse because I get so annoyed at little things. I'm glad I switched to ICU, but I don't LOVE my job like I thought I would.

Is it even possible to have a job you love?

Sunday, July 11, 2010

that was good times!!!

I'm on night shift now, and it's not as terrible as I thought. I had a crazy day when I was withdrawing on one patient (only 53, very sad) and he was quite difficult to sedate, the new interns don't know which orders to write and need hand-holding, and he wanted to die NOW. I asked him if he wanted me to put him to sleep, and he said yes. I didn't have orders for fentanyl or versed drips, so I kept pushing them plus ativan and morphine. While I waited for pharmacy to make me drips (after I insisted the docs write for them), I had to keep running in there and push more because he kept waking up. It was horrifying, really, because who would want to wake back up and see your loved ones all hovering around crying???

In the meantime, my other patient was in respiratory isolation way down at the other end of the hallway, and I couldn't really keep my eye on both of them at the same time. To make matters worse, this patient was very unstable, and I would get stuck in his room for long periods of time and couldn't tend to the grieving family or dying patient the way I wanted to. The unstable patient had a blood pressure that bounced around from 60s systolically up to 220 in a heartbeat. I was chasing my tail all night with pressors on, pressors off. I got very frustrated by the end because I kept thinking, am I doing something wrong?? But another nurse came and looked over everything and assured me I wasn't.

The last three nights I took care of one patient, mainly, who wasn't quite as exciting, except for one 5am episode when his trach site started gushing blood. Next thing we know we're getting blood in the vent tubing, blood out of his mouth, he's spewing huge clots across the room, everyone is covered in it. The surgeons who did the trach and anasthesia are all at the bedside, while we're bagging him, considering cutting him open right then and there! My co-worker, who was a godsend, was guiding me through it. She was like, oh we're doing surgery right here right now? Here's some propofol. No, just push it. Let's give him a bunch of versed while we're at it. More fentanyl. She gently nudged me in the right direction throughout the crisis and eventually the patient was whisked off to OR where they found.... nothing. But the bleeding stopped with no more events.