good nurse, bad nurse

I got banned from a patient's room, by the patient. She had mental status changes, and was being just goofy... so the service asked me to get a urine sample for a drug screen. She went into the bathroom for a long time, and then I heard her flushing, flushing, flushing. I was getting concerned that she was trying to flush something down the toilet, so I knocked and poked my head in, said "are you ok?" She flipped out, told me I was very rude for opening the door, and that she didn't want to "call the authorities" but she would if she had to.

From then on, she wouldn't let me in the room and I had to have other nurses go in and do her meds. She complained about me to everyone who went in there. The first time she yelled at me I felt like crying. I need some thicker skin, I know. I'm just used to patients really liking me, and not used to dealing with people who aren't at least somewhat polite.

Needless to say, I gave her up to someone else.

the grim reaper

Yesterday I was taking care of a healthy looking 58-year-old man just diagnosed with terminal lung cancer. Supposedly, the service had already told his wife about this. She asked me, suddenly, how many stages to cancer are there? Without thinking, I said "four". She about collapsed into my arms. I held her while she sobbed into my shirt. I had no idea what to say, what to do. I tried my best. She went over to him and hugged him and said she loved him so much. I had to get out of there. Later, the team came in and told her she should take him home, there's nothing more to be done. I had to step out of the room lest I burst into tears, too.

See, I work on a floor where we usually send people home, healthier than they were before. I haven't built up a very thick skin for this kind of stuff.

The charge nurse bought me a cookie. Cookies do help.

houston we have a problem

They are taking some of our beds to form a new unit full of yucky services like oto and plastics. We will go from 48 beds to 36. This is horrible, horrible news because it means our group of nurses will splinter and scatter to the wind. We are a great group that works well together. We are notorious for having the best teamwork in the hospital. Now many of us will be put in a position where we are forced to choose between working on a different unit or finding a job elsewhere, or even switching shifts.

This is terrible. People were in tears. And the kicker is that they are doing it because we complained about having off-services. Actually, we complained that we were taking off-services when cardiac patients were ready to come to the floor. BASTARDS.

good news on the floor!

One of our patients is a fairly young guy (in his 50s) who has been here for 55 days with heart failure, a heartmate (left ventricular assist device), and kidney failure. He was not going to be discharged until he got a kidney and heart transplant. So he was just sitting around every day on top of the transplant list, waiting for a donor to pop up. We took a long walk the other day and he told me all about how he felt perfectly healthy until 10 years ago, and then he was diagnosed with CHF, although he was asymptomatic. He developed a 3rd degree block, and was implanted with a pacemaker, only the small hospital who implanted him put in the wrong kind, which only exacerbated his heart failure. Since then he has had two LVADs and one RVAD and his kidneys have gone into failure.

The day before yesterday his AICD fired several times when he went into sustained VTach. He spent the whole evening scared to death of it happening again.

Yesterday the big news came... a heart and kidneys were on their way! He was wheeled off to OR with this stunned look on his face. I hope he's doing alright. Everyone on the floor is so excited for him!

opportunities for overtime

The nursing world continues on... I have friends now that make work enjoyable, and with whom I can talk about work stuff. Nothing thrilling has happened as far as patient care, nothing noteable, except that I've continued to have nursing students who all seem to like me a lot. It's really gratifying to help others grow in nursing and see how excited they are with what they did at the end of the day. I still remember what it was like to be a nursing student, and I try to be the preceptor I never had but wished for!

The other day was horrible, when three of my patients were off the floor and all came back at the same time. I had a migraine, too. It was a nightmare. I ended up leaving at 7 but made up for it with 16 hours of overtime ever since! In a place where jobs are hard to find for most, I'm really grateful for a job where I can work extra pretty much every week, and get paid nicely for it!

from admit to discharge

The patient I'd taken care of for 8 days was finally discharged to hospice yesterday. It's a rare thing to have someone for more than one day on our floor, let alone 8. I hope that I had some impact on getting the family to understand her desire to be comfortable in her last days and to stop fighting a losing battle. I hope I was able to convey kindness and compassion to her in her last days. That's what being a nurse is all about, afterall.

I actually had three patients whose families loved me and thanked me every day for being there with them and for helping the medical team to hear and recognize their individual concerns. I learned a lot about being a patient advocate and helping someone to either heal, live, or die with dignity.

knocking on death's door

On the first day of four days in a row, when choosing my patients I skimmed the list for the oldest patients up for grabs, per my usual habit. I ended up caring for an 81-year-old stage IV cancer with mets patient who's husband of 64 years had passed away three weeks prior. Over the four days I cared for her, I watched her go from adamantly insisting she be a full code, to begging me to knock her out and let her die. Yesterday I pulled the daughter aside and offered to refer them to palliative care. She didn't seem open to the idea. I called the primary oncology physician who told me she'd "already had this discussion with the family". I said I knew that, but today things were different and per the patient's wishes she should probably reassess. The other children came in later and spoke with the physician about their desire to comply with their mother's wishes and allow her to be comfortable in her final days.

I stepped into the conference room as all the kids started to cry. I felt an obligation to be someone strong in their presence. I fought hard to get this patient morphine from a resident, and then sat with her holding her hand and asking her to tell me about her trips to Europe, to take her mind off of the pain. The morphine didn't work and her begging to be shot and knocked out bothered me a lot. I was grateful that her family members arrived and understood that she was ready to go.

I also had a patient a few days back who came to the psych ER with panic attacks, but because of "chest pain" had to be ruled out for an MI per protocol. It was ruled out, and then some asshole of a doc on cardiology service didn't want to give him ativan, so as punishment for the patient ordered it q4 hours IM. I told him I wasn't going to give it IM when he had a working IV and could swallow pills. I gave it IV and continued to page this guy to change the order. Eventually, he did. I know what it's like to have panic attacks, and I'll be damned if I'm going to stab the patient in the ass just because some prick of a new MD thinks he's drug-seeking ativan because he's never had a panic attack before.

Two words: Patient advocacy.