I had some learning experiences at the beginning of this week. On Tuesday I had a patient who's BP bottomed out. I had to get our Rapid Response team to come, and we had a hell of a time getting the service there. In the end, he went to the unit. The rapid response nurse was awesome, made we want to work in the unit just to get a better handle on things.
I thought no day could've been worse than that, but the next day was. I had a THE patient who developed a leak in her cervical incision, and also threw a fit and refused to cooperate with me when I told her we needed a new IV. Then there was a different patient who appealed her discharge, and I had to get patient relations and social work involved. I requested out of that team and had a calm, relaxing two work days after that. Patient's who are nice, cooperative, and stable. Ahhh.
I'm most excited about getting together on March 7th with my trek nurses. I can't wait to see the group dynamic and get everyone excited about Nepal.
Saturday, February 21, 2009
Monday, February 16, 2009
escape artists
On my second twelve in a row, I had a patient with declining mental status and hepatic cirrhosis. He was also a 'code brown-er' (meaning poo, and lots of it!). But just as nice as could be. I'd requested a sitter but no one was available until 3:00. He had yanked out his IV and his Foley bag was full of blood. I would have to keep a close eye on this one. I asked a tech to take him for a walk while I discharged someone else. I came straight back from the discharge to check on him... not in his room. The tech said he'd left him there a half hour ago. His tele monitor wasn't picking up, meaning he'd left the floor. He'd removed his brief (diaper), which meant somewhere in the hospital was a confused 47-year-old in a gown with his bare butt hanging out the back, a walker with a big 'ole 'Property of Hospital' sign on it, and a telemetry monitor to boot.
I called security while the techs searched the floor. I felt like a big dope calling the physicians and saying "I lost the patient". He was found outside of the hospital, starting down the road, in the snow, in his little hospital footies. His feet were like blocks of ice. I felt like a parent saying "Where were you? I was worried SICK!"
Needless to say, I got a sitter.
Ah, adventures!
I called security while the techs searched the floor. I felt like a big dope calling the physicians and saying "I lost the patient". He was found outside of the hospital, starting down the road, in the snow, in his little hospital footies. His feet were like blocks of ice. I felt like a parent saying "Where were you? I was worried SICK!"
Needless to say, I got a sitter.
Ah, adventures!
Monday, February 9, 2009
gift upon gift
I think I would actually like to do home health nursing for a while. My mother did it when I was growing up, and I think I would like it. I will stay where I'm at until the two year mark, I think, but then we'll see. I do know one thing- before I go anywhere else, I'm taking time off and traveling! To Nepal of course, but I will do a few other things, too, while I'm at it. Bangkok, Lhasa, India... I'm in dream world, but I can't help it. I feel so trapped in this nursing job. I can't take time off without pay no matter what I do.
I got a starbucks gift card from a patient I only had for a few hours before sending her to OR. She and her family really liked me, I think because I was in a funny mood that morning. People like to laugh, right?
My french-speaking patient's grandson-in-law wanted me to come over for dinner. But when I got there hours went by and dinner still wasn't ready, and I had to leave. I wanted to do good by this patient as far as lowering his sugar, but I don't want to become too entangled in the family. I've done that before and it's not good for anyone. I am still "the nurse" and I am there for one reason only. I have to keep reminding them and myself of that.
I got several nominations from patients who filled out a form, basically a kudos award. You don't really get anything for it but a certificate, but it looks good in your file. And it makes me feel good.
I got a starbucks gift card from a patient I only had for a few hours before sending her to OR. She and her family really liked me, I think because I was in a funny mood that morning. People like to laugh, right?
My french-speaking patient's grandson-in-law wanted me to come over for dinner. But when I got there hours went by and dinner still wasn't ready, and I had to leave. I wanted to do good by this patient as far as lowering his sugar, but I don't want to become too entangled in the family. I've done that before and it's not good for anyone. I am still "the nurse" and I am there for one reason only. I have to keep reminding them and myself of that.
I got several nominations from patients who filled out a form, basically a kudos award. You don't really get anything for it but a certificate, but it looks good in your file. And it makes me feel good.
Monday, February 2, 2009
I believe
I believe I will remember this patient for the rest of my life. I believe that I am doing the right thing, even if I'm breaking the rules.
Today I called the outpatient clinic and scheduled an appointment and interpreter for the French-speaking patient I mentioned in the last post. Then I called the house, without response. After work I drove out to the address listed in the patient's file. It was in the poorest area on the outskirts of a small but diverse university town. The apartment complex was crowded in next to the freeway, and almost every apartment had plywood for windows, except for the patient's. The apartment was being rented by his granddaughter, with whom he is staying, as well as her husband (I assume) and four small children.
I was greeted at the door by a shy but friendly five-year-old and an 18-month-old (by my estimate) wearing a dirty shirt and a diaper. She put her arms up and clamored to be picked up, so I did. The granddaughter, her husband (or who I assume to be her husband), and the patient all came out and hugged me, kissed me, shook my hand, and hugged me some more. I was offered a seat on the couch where the small toddler sat contentedly on my lap and drooled away. I made small talk in my very limited French, and in English with the little girl who told me her name and that she went to kindergarten. There was a basinet set up in the livingroom, where the seven-week-old baby sleeps during the day. The little girl brought me a bottled water.
The patient appeared healthy and well, much to my relief. He told me via the grandson-in-law, the only English speaker in the house, besides the kindergartner. His blood sugars had remained in the mid to upper 200s. A look of worry passed over the young man's face when I said that the patient had an appointment tomorrow afternoon. I then asked, quickly "can I pick him up at 12:30?" He responded with a huge smile and translated for the patient. After a few more minutes, I told them I had to go, but would be back the next day. "Demain!" I said in French, reaching to shake the patient's hand. "Demain!" He exclaimed, and gave me a big hug and a very French pecks on each cheek.
This family is the essence of goodness, I feel. And I wonder what took me so long to realize that this is my calling. These people live in our backyards, people with no one to look after them. People who are sent home from hospitals as lost causes. People who open their doors with complete trust, hoping against hope that in this hard country where everyone lives behind locked doors, and no one speaks to their own neighbors, that a good person will show up and do the right thing.
It's not just me, either. Over the past few days, I found nurses on my own floor who told me stories of dropping by an elderly patient's house a few days after her discharge, to check her wounds. Nurses who invited patients living nearby to come to their apartment to learn how to use their glucometer. I felt extremely proud of them. Going out on a limb, risking your own neck, sweeping aside rules set up by big business and beaurocracy in the name of good, that gives me hope. Our humanity gives me hope.
Today I called the outpatient clinic and scheduled an appointment and interpreter for the French-speaking patient I mentioned in the last post. Then I called the house, without response. After work I drove out to the address listed in the patient's file. It was in the poorest area on the outskirts of a small but diverse university town. The apartment complex was crowded in next to the freeway, and almost every apartment had plywood for windows, except for the patient's. The apartment was being rented by his granddaughter, with whom he is staying, as well as her husband (I assume) and four small children.
I was greeted at the door by a shy but friendly five-year-old and an 18-month-old (by my estimate) wearing a dirty shirt and a diaper. She put her arms up and clamored to be picked up, so I did. The granddaughter, her husband (or who I assume to be her husband), and the patient all came out and hugged me, kissed me, shook my hand, and hugged me some more. I was offered a seat on the couch where the small toddler sat contentedly on my lap and drooled away. I made small talk in my very limited French, and in English with the little girl who told me her name and that she went to kindergarten. There was a basinet set up in the livingroom, where the seven-week-old baby sleeps during the day. The little girl brought me a bottled water.
The patient appeared healthy and well, much to my relief. He told me via the grandson-in-law, the only English speaker in the house, besides the kindergartner. His blood sugars had remained in the mid to upper 200s. A look of worry passed over the young man's face when I said that the patient had an appointment tomorrow afternoon. I then asked, quickly "can I pick him up at 12:30?" He responded with a huge smile and translated for the patient. After a few more minutes, I told them I had to go, but would be back the next day. "Demain!" I said in French, reaching to shake the patient's hand. "Demain!" He exclaimed, and gave me a big hug and a very French pecks on each cheek.
This family is the essence of goodness, I feel. And I wonder what took me so long to realize that this is my calling. These people live in our backyards, people with no one to look after them. People who are sent home from hospitals as lost causes. People who open their doors with complete trust, hoping against hope that in this hard country where everyone lives behind locked doors, and no one speaks to their own neighbors, that a good person will show up and do the right thing.
It's not just me, either. Over the past few days, I found nurses on my own floor who told me stories of dropping by an elderly patient's house a few days after her discharge, to check her wounds. Nurses who invited patients living nearby to come to their apartment to learn how to use their glucometer. I felt extremely proud of them. Going out on a limb, risking your own neck, sweeping aside rules set up by big business and beaurocracy in the name of good, that gives me hope. Our humanity gives me hope.
Thursday, January 29, 2009
health disparites enrage me
Here is a copy of the email I wrote to the nurse educators on our floor about the patient I took care of yesterday:
Hi [nurse educators],
I would like to pass along the plight of a patient who was recently discharged from our floor. Because you are a nurse I very much respect, I thought I would share his story. This gentleman is 66 years old, a military official from Guinea, Africa, recently arrived in the US to visit his daughter and grandchildren. He collapsed in their home and was brought [here] by EMS. Unable to afford missing work, and caring for four young children, his family did not accompany him to the ER and did not arrive until the next day. He speaks no English, and required a French translator for all communication.
The patient was found to have a blood sugar greater than 500. He was re-hydrated and put on a sliding scale and intermediate acting insulin for meal coverage. Even this did not control his blood sugar, he still had chemsticks consistently in the 200-300s. He told us via interpreter that he took insulin in his home country of Guinea, but did not know what kind, and had not brought it with him to the US because he "felt fine".
His service was Medicine Newburgh, and they decided to discharge him the same day, but had to wait for family members to arrive before he could go. I took care of him both days. When his granddaughter arrived to take him home, she also spoke so little English that she required an interpreter as well. I paged social services and the MN service to come in and talk with her and the patient. The resident came in and told the patient that he could go home now. He did not mention to the patient that he would require insulin injections and frequent blood glucose monitoring. He did not explain to the patient what diabetes was or its consequences. After the physician left the room, I asked him about patient teaching. I was told that it "didn't matter", he was going to "end up in the ER again anyway". His discharge paperwork included prescriptions for a glucometer, insulin syringes, and novolin insulin to be taken 10 units BID.
I brought our glucometer, and insulin to the patient's room and with the interpreter present, I spent more than an hour and a half discussing and demonstrating how to check the blood sugar, what is normal and what is not, what to do if sugar is very low, or very high, what symptoms he might expect, to test and write down his glucose levels four times a day, how to draw up insulin, where to inject it, what to do if he misses a meal, the importance of eating consistently and a healthy diet... etc. I taught everything I'd ever learned and remembered about diabetic care. The patient and his granddaughter are very intelligent, he demonstrated back to me how to check his sugar and inject insulin correctly on his first try, and they both asked intelligent questions. I gave them written materials in French. I could tell that they were very concerned about money, and social work was working with them on temporary insurance. I sent them down to our pharmacy with the interpreter.
The patient is supposed to have a follow-up in the clinic within one week. I asked the physician for the name of his clinic nurse, so I could let her know ahead of time to speak slowly and clearly when scheduling an appointment with the family. I was told that he has "no clinic nurse". I worry that the patient will not receive an appointment time, or that he will not understand instructions on the phone. I also know that the insulin coverage he will administer to himself will not adequately control his blood sugar, and the long-term consequences will be devastating. I am disgusted with the care he received from the MN service, and wonder how it might have been different if he had had insurance, or had a been a white English speaker. The way I see it, those patients who face the great challenge of communicating across a language barrier, or who are unfortunate enough not to have insurance, ought to be given extra attention the best care that we are able to give, not simply sent home as though we do not care what happens to them just because they have no money, or don't speak English.
I have discussed this case with [our nurse manager]. I know that disparities in healthcare for minorities exist, but was shocked to see it playing out right under our noses on [our unit].
Thanks for reading.
Hi [nurse educators],
I would like to pass along the plight of a patient who was recently discharged from our floor. Because you are a nurse I very much respect, I thought I would share his story. This gentleman is 66 years old, a military official from Guinea, Africa, recently arrived in the US to visit his daughter and grandchildren. He collapsed in their home and was brought [here] by EMS. Unable to afford missing work, and caring for four young children, his family did not accompany him to the ER and did not arrive until the next day. He speaks no English, and required a French translator for all communication.
The patient was found to have a blood sugar greater than 500. He was re-hydrated and put on a sliding scale and intermediate acting insulin for meal coverage. Even this did not control his blood sugar, he still had chemsticks consistently in the 200-300s. He told us via interpreter that he took insulin in his home country of Guinea, but did not know what kind, and had not brought it with him to the US because he "felt fine".
His service was Medicine Newburgh, and they decided to discharge him the same day, but had to wait for family members to arrive before he could go. I took care of him both days. When his granddaughter arrived to take him home, she also spoke so little English that she required an interpreter as well. I paged social services and the MN service to come in and talk with her and the patient. The resident came in and told the patient that he could go home now. He did not mention to the patient that he would require insulin injections and frequent blood glucose monitoring. He did not explain to the patient what diabetes was or its consequences. After the physician left the room, I asked him about patient teaching. I was told that it "didn't matter", he was going to "end up in the ER again anyway". His discharge paperwork included prescriptions for a glucometer, insulin syringes, and novolin insulin to be taken 10 units BID.
I brought our glucometer, and insulin to the patient's room and with the interpreter present, I spent more than an hour and a half discussing and demonstrating how to check the blood sugar, what is normal and what is not, what to do if sugar is very low, or very high, what symptoms he might expect, to test and write down his glucose levels four times a day, how to draw up insulin, where to inject it, what to do if he misses a meal, the importance of eating consistently and a healthy diet... etc. I taught everything I'd ever learned and remembered about diabetic care. The patient and his granddaughter are very intelligent, he demonstrated back to me how to check his sugar and inject insulin correctly on his first try, and they both asked intelligent questions. I gave them written materials in French. I could tell that they were very concerned about money, and social work was working with them on temporary insurance. I sent them down to our pharmacy with the interpreter.
The patient is supposed to have a follow-up in the clinic within one week. I asked the physician for the name of his clinic nurse, so I could let her know ahead of time to speak slowly and clearly when scheduling an appointment with the family. I was told that he has "no clinic nurse". I worry that the patient will not receive an appointment time, or that he will not understand instructions on the phone. I also know that the insulin coverage he will administer to himself will not adequately control his blood sugar, and the long-term consequences will be devastating. I am disgusted with the care he received from the MN service, and wonder how it might have been different if he had had insurance, or had a been a white English speaker. The way I see it, those patients who face the great challenge of communicating across a language barrier, or who are unfortunate enough not to have insurance, ought to be given extra attention the best care that we are able to give, not simply sent home as though we do not care what happens to them just because they have no money, or don't speak English.
I have discussed this case with [our nurse manager]. I know that disparities in healthcare for minorities exist, but was shocked to see it playing out right under our noses on [our unit].
Thanks for reading.
Tuesday, January 27, 2009
language lessons
I had a patient today who spoke no English, only French. His family was not around, so I spent the better part of my day trying to remember high school French. I did ok... I guess. The interpreter came for the important stuff. My friend had a guy down the hall who only speaks Hindi... I did much better interpreting for him. I just love the fact that we are a hospital in such a diverse area, with so many beautiful cultures and languages flowing around us. It's refreshing.
So my Pod, or the section of our unit that I'm assigned to, has been nicknamed 'The Pod of Death'. Our acuity level is sky-high, with a ton of off-service total care patients. All these broken bones, and ostomies, and seizures... they need to go! We want CABGs, esophagectomies, and lung biopsies! This is other stuff is just... crap. And we're working like slaves.
So my Pod, or the section of our unit that I'm assigned to, has been nicknamed 'The Pod of Death'. Our acuity level is sky-high, with a ton of off-service total care patients. All these broken bones, and ostomies, and seizures... they need to go! We want CABGs, esophagectomies, and lung biopsies! This is other stuff is just... crap. And we're working like slaves.
Saturday, January 24, 2009
what a day, what a day
I never knew it was possible to do a 12 hour shift like I just did. Two discharges before 11, two admits before one. My first experience with a foley irrigation system, and a fresh esophagectomy who yanked his NG tube out 10 minutes before I was supposed to go home. Coffee, coffee, more coffee, and not enough time to pee.
My feet flew all over those halls, the hour hand on the clock was spinning out of control, but in the end I had a couple of satisfied patients, I think. At least, I'd like to think it made some difference.
My feet flew all over those halls, the hour hand on the clock was spinning out of control, but in the end I had a couple of satisfied patients, I think. At least, I'd like to think it made some difference.
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