my unit, my ball and chain

I'm frustrated. As interested as regular nurses seem to be in doing a service trek, management (especially senior management) is not that excited. Well, we've never done it before so I guess it's to be expected. We will just have to will it into being, without any extra support. Maybe when we do it again, it'll be different.

I feel very tied down in this job, the schedule is so rigid and I know that it has to be, to maintain order with such a large collection of employees. Still, it's stifling.

It's still amazing to sign my name with RN, BSN after it.

ambitious projects afoot

Yesterday was a long, tiring, yet worthwhile day at work. Near the end of my 12 hour shift, I had a patient wheezing loudly and desatting rapidly. Respiratory was paged, without response. The supervisor was paged. No response. 20 minutes later they showed up to give this guy his albuterol treatment. I was fuming mad. Only a few minutes later, I gave a scheduled dose of IV metoprolol to 73-year-old patient with a HR of 77. Less than a minute later, she was bradying down to 42. I stat paged our assistant charge, and then paged her service. She was asymptomatic so I wasn't panicking, just concerned. Everything worked out fine with both patients.

I spent much of the day working out the details of our unit trek to Nepal this coming fall. Springing the idea on my supervisor was nerve-wracking. She seemed cautious and I hope the idea will grow on her. We will be able to put a lot more in stone when the holiday schedule and vacation schedule comes out.

Today I met with the program coordinator for the Alzheimer's and Dementia certificate program at my alma mater. She was ready to sign me up for classes right then and there! Unfortunately, financial and time arrangements prevented that. I am hoping to get started right away and can't help but feel SO excited about it. Just working towards another academic goal thrills me to death.

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?