It's July!!!

The new medicine interns come in at 5am sharp (about an hour and a half before they really need to), with starched and ironed, never-before-worn LONG white coats. The ICU nurses are watching them. We can smell fear. The corners of our lips our turned up in a slight, patronizing smile before they even open their mouth. We are prepared to teach, but we can't really keep a straight face. We're braced for the worst. They are fresh, eager, faces rigid with the effort of keeping up, let alone staying a step ahead. We are waiting for them to declare themselves to be either one of two things: 1) total moron. 2) pretty good for your first month!

Meanwhile, orders are written in strange ways. Seniors look haggard, their eyes bloodshot. Following an update from the "doctor", family members are often left standing with big WTF??s written on their faces, as the nurse breezes in to translate (or correct, or explain 'differently'). Everything will be OK. The nurses will take care of you. We've got this. We'll get through a month of snarky comments, eye-rolling, and patience-trying teaching moments... and hopefully our new interns will leave our unit primed and ready to take on the world.

I love July.

new foster/ttc blog

I had to move my foster care/trying to conceive blog for privacy reasons. 27andfostering no longer exists. If you follow me here and would like to follow that part of my life, leave me a comment here.

why we do what we do

...because I had a thank you card from a patient and his family member in my mailbox, with a gift certificate. I only had this patient when he was admitted, and one other night. What made the difference was the time I spent talking with his mom. I knew she needed someone to just listen and connect with, and luckily I had the time that shift.

After everything that's happened, I'm going to probably scan my thank you notes and put them in my file!

super-size weekend

What the heck? Why did all of my patients (all two of them, but all sounds better) suffer from morbid obesity this weekend? The first had a panus made of steel... it took a strong couple of arms to lift it so I could get in there, elbow deep, and scrub it up. But damn, nursing has been doing a good job with her, all of her nooks and crannies were intact and yeast-free. Unfortunately, when she sat up for PT, the panus weighed down her thighs, so she could not lift them to march in place. Good god. It's terrible.

The second patient I had weighed over 500 pounds! He was also extremely tall, perhaps verging on giantism. Still, his BMI was about 55. He was too long for our beds, even the bariatric beds. And he was right at the weight limit for our ceiling lifts. He had lymphedema of one of his legs, and this leg alone probably weighed about 100 of those pounds. It took five of us to bathe him.

I don't know what's going on anymore... obviously morbid obesity puts you at greatest risk for landing yourself an ICU bed, but daaaamn. I'm going to kill myself lifting and turning these people!

And just for fun, I will share with you what a terrible condition lymphadema is... the below photo is not my actual patient, but is quite similar to what he was suffering in one of his legs:



Thanks to TAFA Healcare corporation for the photo.

two successes

1) My fourth time putting up a new set for the CRRT. I did it with NO help this time. Got all of the supplies, returned the blood, flushed the sorensen with heparin, took the old set down, put the new set up, hooked everything up into the right place (I think), re-attached the patient, hit the "continue" button and... BOOM shaka-laka! It ran! No hitches! No alarms!

2) Got one of the "Making a Difference" awards that patients or their families can submit about staff members who they felt were excellent. I appreciate the family who nominated me more than they know, because these are all submitted through our managers, and god knows I needed a good mark on my record after everything that's happened.

Take THAT HR. Treat me like a 'bad nurse' and I'll prove you wrong every time!

Also- it's been 10 months since I had a discrepancy in our (Pyxis equivelant) machine. I promised my supervisor I'd make it to one year discrepancy-free. Let's just say my discrepancy track record was NOT GOOD. But here I am, 10 months discrepancy clean and sober! I think he should by me a cookie from the cafeteria when I get to my one year mark...

P.s. I was not snagging narcotics from the machine. Most of my discrepancies were witnessed countback or return errors.

it's still not official

But my manager pulled me aside to tell me that it's going to be a written warning.

I'm ecstatic, really I am, that I'm not getting fired for this bullshit. But even getting a written warning irks me a lot. If they audited every nurse on say, one unit, they would end up with half of the nurses there getting in trouble for viewing files of spouses/family members because they had their verbal permission.

It's just ridiculous.

I've had two floor status patients the past couple days, who were actually really pleasant and appropriate. If all floor patients were like that... ok, I still wouldn't like it, but it was ok for a couple of days. Both were very liberal older people, who liked to read and discuss politics/culture. Very enjoyable conversations actually!

As opposed to the patient I have today, who is much more my cup of tea (elderly, demented, on pressors, lined up) who screams at me every time I try to do anything, and gives me snarky comments when I do something he actually wants. For example, "the lights are too bright". I shut off the lights. "There ya go! It's just one brilliant break through after another in here..." he says.

Basically, it's nursing heaven for me: elderly gentlemen, end of life discussions, pressors, arrhythmias... but I get to go home at 1pm, downstaffed! (I'm on overtime.)

when I was just a little nurseling

I remember this day clearly: I was between my 3rd and 4th year of nursing school, and I had the opportunity to spend a day in the ICU (the one I work in now!). And I HATED it. I couldn't for the life of me understand why those ICU nurses were so crazy about their jobs!

Here it is, my post from 5 years ago: ICU not for me

this is getting boring

It's going to be one boring nurse blog if all I ever write is "they still haven't told me ANYTHING!"

My union rep assures me that no news is good news. Something like, "oh we forgot all about it! And we think we'll just leave it that way. Now go be a good girl and follow all the rules." That would rock my socks!

I've had another whole week off, thanks to downstaffing last weekend. Our census has been at an all time low. Last week I went in and there were 10 empty beds (out of 20)! I have never seen that before! We were running with 8 nurses! (Usually we run with 13-15.) And you know what 10 empty beds really means, right? It really means 10 potential admissions! Not all at once of course, we staff for 3 possible admissions per shift.

So where are all the sick people? Is it too nice out, you'd rather die peacefully in your old age sitting out back, watching the sun set, hearing the birds chirp, drinking your favorite mixer, wearing comfy pjs and listening to your fave tunes? You prefer that to a tube in your urethra, anus, nose, airway, arteries/veins, and several fancy/expensive machines to beep/alarm and otherwise lull you into the great beyond? Even if I promise to hold your hand (for 30 seconds, with a glove)?

Ok fine, have it your way. Stay home. We always have our loyal livers to rescue us when respiratory failure and sepsis are scarce. There will always be alcoholics with GI bleeds, and drug users found down, and our 10 empty beds have been waiting for them with open arms.

therapy

I have done two things today:
1) Seen my therapist
2) Retail therapy

There may be other therapies in which to partake while I await the judgment...

this nauseating wait

No news again today, except for them to say they "need more time" to discuss.

How hard can it be? It wasn't a complicated case! Argh!!!

my weekend in the stocks

I am serving my first sentence for violation of THE PROTOCOL: A 3 day wait to hear what my punishment will be.

Trying to say "chin up!" in my head.

HIPAA is not a joke

I got one of those nasty surprises from work, the one we all dread deep down... an email that I'd done something horribly wrong pertaining to accessing patient files (didn't say exactly what the situation was) and they had scheduled a disciplinary hearing. I confirmed that I would be there and my head was in a total tailspin. What did I do??? Was I going to be fired for whatever it was??? I've been shaky with a roiling stomach ever since. This is my job, my identity, my income, my career, my lifestyle.

I'm so lucky to have a union. I called my union rep, and she was able to tell me the details. Long story short- I had been randomly audited, and "dinged". Yes I accessed this person's files, but I had their full permission. However, said permission had not been submitted as per protocol before I accessed the files. Therefore, I was subject to investigation and discipline.

Lucky for me, I was able to obtain a written signature from the person prior to my disciplinary hearing, that she had given me permission at the time. But even that seems not to be enough. Although they seemed to hint that I would not be fired, the type of disciplinary action they are going to take will not be revealed until Monday, another particular form of torturing me for my failure to comply with protocol.

I have to say, though, that having the union behind me was a big help. My rep knew the procedure and the history of similar cases and was able to get me through it, just like a defense lawyer, I guess. She's got a lot of power, and the administration repects and listens to her. They believe me that I had no ill intent to spy on this person, as this person testified on my behalf, but to what extent they still feel the need to punish me I don't know.

I'll be happy with a written or verbal warning.
Anything more than that, and the union and I will contest the action.
I hope and pray it doesn't come to that.

You cannot even open your own minor childrens' files if they are age 10 and up, even in emergency situations, without prior written consent from THE CHILD on file.

Follow those rules, guys!