mandated, schmandated

It's not cool that they mandated me off on my ONLY holiday. I'm pretty sure it's an issue because I was already mandated in September. Totally didn't follow the rules on that one. I wanted the money, dammit!

nurse-patient relationships (and the ambiguous line)

I had a patient going in and out of afib yesterday. When she was out of afib she was generally bradycardic (in the 50s), however this was quite dependent on her positioning. When lying in bed, she would get down to the 40s, when walking she would be up in the 70s. Cardiac consult came in and ordered a dig load and an increase in her beta-blockers. I was looking at her heartrate (53 at the time) and thinking NO WAY am I giving a digoxin LOAD and a beta-blocker! I clarified this with them, they wanted it given. I discussed it with the charge nurse. I ended up giving the dig load first, and having her stand/walk for about an hour after. Her heartrate stayed over 60. I gave the beta-blocker several hours later, and she again brady'd down to the upper 40s, but was asymptomatic. I had her get up, she was in the upper 60s. Craziness!

So that was my first experience with Afib (and with hesitating to follow a medication order). But another issue arose when it turned out that the patient and I got along very well. We chatted a lot and found out that we knew a lot of the same people. But I felt the eyes of the other nurses on me every time I was sitting down and talking with her. I did not neglect my other patients nor did I reveal any information about anyone else to her. But I felt the pressure of carrying on as a professional at the same time I was becoming someone's friend. Where is that ambiguous line drawn? She wanted to give me her email and I did feel ambivelant about that, too. When is it ok, if ever, to develop a friendship with a patient? Is it ever ok to continue a friendship after the professional relationship ends? I suppose this is left somewhat up to individual judgment. I just did the best I could.

I had to re-evaluate my loan payments. There is no way I could make the monthly payment they were requesting... I am going down to 4% of my monthly income. Tough break! Maybe I should go back to school so I can defer...

debt and trouble, trouble and debt

I was a float nurse during our nursing check-offs for LVADs. I covered the other nurses and worked my ASS off for the hour or so that I had their patients. I walked them, cleaned them, passed meds, tried to make them feel like things were finished when they came back. And I got recognition for it which rocked. Also got in trouble twice, once for no gown in a contact precautions room (I wasn't touching the patient!), and once for a chest tube becoming disconnected from suction. Actually, the charge nurse and I had a good laugh about all of the really ridiculous things people were throwing fits about that day!

I went to an EKG class that rocked my socks. It was 12-lead interpretation, and it lasted all day. But I feel about 10x smarter!

Then I felt about 100x dumber when I made a stupid, potentially dangerous calculation error at work. It scared the hell out of me. I guess that's what will make me a better nurse, in the end, making mistakes... you just have to hope you catch them before it hurts someone.

michigan's economy coming down on nurses

I guess I never dreamed that the economy was going to affect my job. I'm a nurse, right? Everyone told me that no matter what happened, I'd always have job security. Maybe they were right, but maybe they're wrong.

This month the hospital's census has decreased dramatically. Michigan families don't have health insurance because of lost jobs, and Michigan families aren't going to the doctor or the hospital. So many nurses have been called off of work at the children's hospital that they are scrambling to find them temporary positions at the main hospital. They have promised that nurses will be the last employees laid off.

Last week, out of 36 hours, I was cancelled 20. This week, I've only worked 24. As much as I love to sleep in, I love paying the bills more. I have used up a lot of PTO time and been mandated off. The union is trying to figure out how to give nurses all the hours in their appointments.

Let's hope the Big 3 pull through. Let's hope people are scared to go to the hospital and they soon feel better enough about finances to come in. Let's hope the Obama administration can pull of something in the way of health insurance for the unemployed.

Or the nursing shortage is already a thing of the past, at least in this area.

into the frying pan

Today I overheard another nurse talking about a seminar on Advanced EKG interpretation. I mentioned that I would love to go to it, and she said "you want to go advanced EKG? Shouldn't you do a regular one first?" Hells no, she did not just say I'm not knowledgeable enough on interpreting EKGs to attend the seminar! I registered for it an hour later. See you there, biotch.

The LVAD guy came to our conference room for an inservice. He told the whole roomful of nurses that if they had any questions, this young lady (pointing to me) was excellent. Same nurse said "oh really? She knew that much?" So there.

A patient of mine today was put on comfort care only. The family flew in, and everyone was standing around with tears and lots of questions. I felt very inadequate but tried to show my compassion. What else could I do?

blind leading the blind

Yesterday I was given a student again. The instructor told me that the students really like me. She said they identify with me, but also, I'm good. I was flattered. I think having a student is a big help, and it's fun to show them new things.

A few days ago I had a elderly patient whose 60-year-old daughter was at outside in the hall, looking teary-eyed. When I asked if she was alright, she told me that her partner of 31 years, who recently passed away, spent some of her last days on this floor and it was terribly difficult for her to be there. She didn't know I was gay, but I decided to let her know by the end of my day. When she prepared to leave, I pulled her aside and said "I think you are incredibly lucky to have spent 31 years with a woman you love. I hope I find a woman to spend so many years with like that." She gave me the biggest hug and thank you.

I also experienced things from a patient's point-of-view when I went into the ER one morning with a terrible migraine. The gown, the IV, the wristband... it felt like a bad dream. Next thing you know, a nurse is going to come in and say "hey hey, time to get you washed up!" Yikes! They gave me compazine and toradol, my headache got better but I slept for 24 hours but fitfully. I don't think I'll go in for a headache again. My BP bottomed out and I had to be bolused with 2 liters. Man I peed constantly for days!

My grandma was recently in a nearby hospital, smaller of course. The nursing care was horrendous, or should I say, nonexistent. The nurse-to-patient ratio there is 1:8, for starters, and neither my grandma or her roommate, who needed a lot more help, were offered washcloths, walks, or even a drink of water. The food was late or the tray was wrong or nothing came at all. Meds were either skipped or given only at my existence. Before she went in, she had heartburn. After coming in, she had a BP in the 70s, she was over-anticoagulated, had restless legs because they didn't give her her medication, and because no one helped her to the bathroom, she was terribly embarrassed that she'd had an accident. What a crock of shite! In my hospital, where a lot real shit is flying around, that shit would never fly!

feeling exposed

Things have gotten a little hairy at work. I was made two mistakes- Y-ing two incompatible meds, and not watching someone swallow their narcs. I also got a call yesterday at 7:20 asking where I was. They said I was written in for overtime- I think not. I didn't sign up for no stinkin' overtime! Wednesday at work I got blood in my eye while discontinuing an IV, and had to go through the whole shibang of reporting a body substance exposure. Luckily, the guy is clean.

I hope the coming month is better. I hope to make less mistakes, and I hope I can try harder not to be so hard on myself when I do.