I Love my Job But...

I don't.

I love the patient population, the coworkers, the connecting.
I detest the systems, the paperwork and the constant lack of support.

I found out this week that they are cutting out nurse assistants out of the hospital completely. Nurses will be in charge of 'the total care' of the patient. The patient load is the same---so for some brilliant reason Management decided to cut costs but cutting out the auxillary staff. It sounds good in theory, but in practice? It's total bullocks.

The first day that I was in the new system was this past Tuesday. I felt like I was chasing my tail all day long. It was a constant struggle to stay in the required time-line with the addition of vital signs, bed baths, feeding patients and making beds.

In addition, I had 2 unstable patients that required alot of close monitoring and assistance. Recipe for disaster...? Yes.

I'm dreading going in to work on Friday. Mainly because I think my boss is going to drag me into his office again to give me another speech. At my old job, I was the star nurse, the resource person, the one who knew what she was doing. Here I feel like I'm constantly being called into the principals office or having my coworkers act like I'm inept because my face is so 'young'.

As you can see, I'm having a lousy week at work. I hope the weekend is much better.

Not Taking a Break

I got 'talked to' by the assistant manager on my unit for not taking a lunch break all through my shift. I was soooo busy, running from start to finish, and I didn't even get a chance to eat. And then on top of that, to have to sit in the office and apologize for not taking a break didn't put sunshine in my day.

I get that it's against the Union rules to not take a break, but if I don't have the time, I don't have the time. I hate going on break and then coming back to find so much stuff needing to be done. I'd rather do everything and then go eat in peace. Oh--and obviously I have issues delegating, but that's another post for another day.

I'm not going to talk about my patient's because it wasn't their fault, but even with the additional help of a Lunch break nurse---I was still unable to take a break. So now Big Poppa aka the Manager is probably going to pull me into his office on Monday to have another sit down.

Grrrrr.

Paperwork

It turns out that my boss wanted to talk to me because of some paperwork that I hadn't filled out on an admission. The admit rolled into the unit 5 minutes before change of shift and I actually gave report late assessing her and settling her in. The oncoming nurse (who happens to be a lazy fiend), ended up telling me that since the admit came in I needed to do all the paperwork before I left.

I did the care plan, teaching plan, admit assessment and the only thing left for her to do was her shift assessment. She ends up reporting me for not taking a picture of the patient's butt because the pt had a stage 2 which I had documented but never took the picture of.

Like I'm supposed to be dicking around looking for the fuckin' Polaroid camera when I'm already there 30 minutes past my shift end doing your work.

Bitch.

Wondering...

My boss left a message on my phone today. "Sorry to call you on your day off Vixen, but I really need to speak to you."

I called him right back, and now I'm worried as all get out. I worked the whole weekend, I think I rocked out, but what if there was something I totally flubbed on and he's calling me about it? I know that it's not good to worry and I should just wait until I go in tomorrow, but sometimes worry is my middle name.

Gulp.

My Whole Weekend...

Missing Patient

I had come to work early, eager to start the day after 7 days off. I was still in report, trying to get information on my patients when the charge nurse came in to tell me that I had an admission rolling in. Grrrrrr! Deciding to settle my admit, I took to the floor to meld with the chaotic activity going on. I hadn't even gotten a transfer report from the outgoing nurse or the nurse that had her previously, my patient was in the bed, and I was going in blind.

"Hello! My name is Vixen and I'm your fabulous nurse for the evening" I said in a voice that didn't betray my irritation or anxiety. I settled her in, and dealt with her main issues, then went back to get report. As the shift progressed, she and I became closer, our patient/nurse relationship extending to something more. She had been in the hospital longer than I'd been working in the hospital. Every time she had a ray of hope of getting out, another complication would send her into a careening tailspin. I felt her pain and depression, understanding the futility of even trying to remain hopeful of getting better.

"I hope you'll be my nurse tomorrow," she said as I said goodnight. The next day, I brought her a deck of cards to while away the hours with---as well as 2 bottles of chocolate milk that she had been craving for weeks. She seemed in better spirits on Day 2 and on Day 3 was stronger---even getting out of bed for close to 30 minutes.

Today is Day 4...it's my day off, and I miss her. How can I miss someone that I barely know? I can't wait to get back to work to find out if she's getting better, to find something else to please her or just to see her laugh. Her inner strength amazes me and I see so much of myself in her. I miss my patient.

Vacation

I haven't worked in daaaaays! Although I kinda feel guilty for leaving my coworkers in a lurch, I haven't had a vacation since I started working and my body needed a break from the stress. I don't complain that much about my job---I'm just glad to be in nursing, but sometimes the bureaucracy and paper pushing gets to me big time. I'm glad to be home pushing my own papers around.

I'm going back on Monday, so I'm sure there will be some thoughts later on in the week.

I'm baaaack! Now I have to unpack, do laundry and come back to blog:)

The Assignment

Why is it that nurses fight/argue and bicker over the assignment? It doesn't matter how you split the patient's up, at the end of the day you are still going to be tired and exhausted...so what's the big deal?

I've never been one to jostle for an assignment. Of course, if I was here the day before, I would expect as much of the same patients as possible but if I wasn't? Then I'm easy. I feel that the Universe decides what patients I should interact with and touch that day...and so I'm not arguing with the Universe. They are my assigned patients for a reason.

Today one of the nurses changed her assignment and threw the whole thing out of wack. She switched 2 of my patients with 2 of hers thinking that mine would be better. Guess who was running around all night? Yep, she was. I helped her out by giving her 9pm meds on 2 of her patients, leaving her with only 2 to take care of and I still got out of there faster than she did.

I've had bad days, rough days and crappy days, but I've never had a bad assignment. There is always 2 or 3 patients that are really sweet, just going through alot and need someone to talk to. That's my job, that's what I do...so give me whatever assignment you want, it will never faze me.

Hugs

I got 3 hugs from my patient's today. I had 5 in total, so getting 3 hugs is off the shiznit! I know that as medical professionals we don't like actually getting that physically close to people, but one of my lil old ladies was going through it and just needed a shoulder to vent on. Consoling her was my first hug, and the second was my patient thanking me for such 'excellent care'. She said to me as I was leaving, "I wish you were here everyday. You've been the best nurse I've had ever since I got here."

It's not like I'm tooting my own horn or anything...but it really did make me feel warm and fuzzy inside. I can gripe to the Fiance all night long when I come home, but he knows that on my next scheduled day, I will be going to work. Just because of my patients. The work is hard, the coworkers are clique-ish and the systems aren't that organized. But my patients? They are fuckin' fabulous! And I love every single one of them.

Connecting

Why is it so hard for nurses to connect with their patient? I know alot of nurses 'think' they are connecting, but in actuality, until you've been a patient, I think it's hard to understand what the patient is going through. We are so occupied with our lists, our assessments, charting and routines that we don't even take the time out to chill with our patients, to talk to them, understand a fraction of their pain or just even let them know that we in actuality do CARE about them, not as the patient in room 21, but as the PERSON who's sick and needs our TLC.

Recently my hospital got the patient satisfaction scores from their outside company and it was...frankly quite poor. My old hospital in Baltimore was on the ball with customer service, we did we could to make their stay more pleasurable. The CS lady told us that with each patient, if we could identify their one primary need, the one thing that if they had they would be happy we would actually make their stay more pleasant. For some it's a cup of coffee, a back scratch, back massage, warm bath, shower, hair wash, something to read etc. It's usually something very simple.

As I was saying in my last post...patient's do sense our vibe and aura when we come in. And that's really the fine line between a good nurse and a fabulous nurse. Just for a few minutes in your shift, throw your lists and notes into your pocket, sit on the side of the bed and just talk to your patients. This isn't a case management job---we should develop personal connections with each and every patient we come in contact with. I actually have an emphasis when I give change of shift report to talk about my patient's personal life as well.

1. Room 1: He and his wife have been married for 18 years. She hates looking at blood, but she's at his bedside everyday through his post-op because of their love. They have such a beautiful bond, lots of teasing and a genuine friendship. He thinks he's always right...(even when he isn't!) And Wifey lets him think he's always right even though we know that the women are the brains to the whole marriage operation! She came up to me to let me know she was leaving and asked me to please take good care of her husband. I promised her I would. He wants to pass gas/have a bowel movement so bad so he can go home, not only cos of medical issues but because his copay is $400 a day!
   
2. Room 2: She has 2 kids, a boy and a girl, and 6 grandchildren. Her daughter isn't a control freak---she's just genuinely worried and concerned for her mom! Her husband of fifty + years is struggling with her illness and wants her home, because he can't 'live without her.' She wants her hair washed so bad!
   
3. Room 3: She's not weird because she doesn't want to view or touch her ailing body. She's sick and feels like her body is failing her. She wants to actually trade in this body for another one. She got bad news today, the cancer has metastasized and when she presses the call bell, it's not to annoy you---it's because she's scared, alone and very afraid. She just wants to know that you are there, and that you care. She loves applesauce, prefers it to regular food and likes her back rubbed.
   
4. Room 4: She has been non-compliant with her medication regimen, but that's because she didn't know how serious diabetes was. She's here now to learn everything you can teach her, so that she can go home and live well. She loves boating, gardening and her 20 year old daughter who is even more gorgeous in person than in the picture. Her mother is a feisty lady who is so proud of her offspring, especially her daughter that raised a fantastic daughter as a single mom. And Ms. Patient has a great boyfriend who misses her like crazy, is taking care of her cat even though he's allergic and sends her roses, orchids and lilies every single day. She would give anything for a real shower.
   

So...what's the one primary need for your patients?

Dr. Jekyll vs Mrs. Hyde

My first assignment on my first day of clinical orientation was a combative patient. My preceptor gave her to me saying that, "she kicks, she cusses, but I think you should know how to handle a difficult patient."

Sure thing. I'm flexible. I got report from the night shift nurse and expected to meet frankly, the Mr. Hyde of all patients. When I went into the room for my first assessment, she was in bed sleeping. I decided to let her rest and returned about 30 minutes later. She was awake then, and we talked some about the plan for the day and what tests she had scheduled. With me, she was an absolute gem. We understood each other---she didn't want to be bothered, and I didn't want to bother her..we both just had to work together to get her taken care of.

Her son was at the bedside, and the other 2 patients in the room told me later that I'm the only one she didn't kick and fuss at. When I gave report to the next nurse, I told her specifically, that Ms. Hyde was fine unless she felt like she had no control in the clinical process. I returned the next day to find her on 4 point restriants (apparently she and the evening & night nurse) hadn't gotten along, she pulled out her IV and cursed them out big time.

I assessed her, talked to her and took the restraints off. She had to drink 2 Liters of Golytely for a procedure at noon, and contrary to popular opinion she downed it like she was a champ (actually drinking 1.5 liters of it!) Everyone on the unit, the techs, the nurses, even my preceptor are surprised at the fact that with everyone else, Ms. Hyde is a grade A B...but with me, she's like a lamb. She even let me put a foley & IV in her.

I'm not surprised. I think that patients sense the kind of energy that we present when we come to their bedside. If my energy is good and positive, she feels that and responds to that. Having sickle cell, I know what the other side of the fence feels like and perhaps that's why I'm able to relate.

Joie De Vivre

True happiness is... to enjoy the present, without anxious dependence upon the future. ~Lucius Annaeus Seneca

I was on the phone with all my sisters today and the younger ones both stated that I sounded so happy. It wasn't just because I was having a good day, (actually, I had just gotten back from work and it was an insanely chaotic day and I was tired as all get out). However I think it does have to do with work in a way.

Nursing satisfies me in ways that nothing else can fill. There is something immensely gratifying to go to work and know on the spot that you are helping people. Today I had 2 patients and neither of them spoke any English. The hospital I was at didn't have translators on the weekend so they spent half the morning on opposite sides of the hallway, unable to communicate to anyone at all. My solution was to introduce Mr. Espanol to Mrs. Latina....I actually walked him down the hall and into her room. The rewarding excitement and joy that they radiated in those 15 minutes was probably what gave me the joy and drive to live through the remaining crazy hours at work.

So yes, I've found my calling. I'm fortunate to have found it early and to know that every day I step out of my house, I am doing my small part to save the world, one hurting soul at a time.

The Willing

Today was the first day at my new official job. I happened to meet a new grad as I stood waiting for the elevator and we clicked instantly and chilled for the whole day. It's interesting how people from diverse places and backgrounds can all fall under the wonderful umbrella of nursing and fit in somehow.

I learned that no matter how inexperienced I think I am, there is always someone that knows less than me. I actually felt like kind of a veteran in the room surrounded with all the new grads. They have such a fresh, excited energy that is so enthusiastic, friendly and warm. I hope that the toll of our demanding job won't take that spark from them.

For me, I think the spark is still there. My man tells me every time I come back from a hard shift at work, I come home glowing. "There's something so beautiful about you when you come back from work, something that I've never seen before."

I have no idea what he's talking about, but I do know that ever since I got back into nursing, I have been more satisfied and content with myself as a person. And it is true, when you help others even in the smallest way, some of that good energy comes back to you.

There's a quote I saw the other day that fits perfectly into nursing.

We the willing, led by the Unknowing
Are doing the Impossible for the Ungrateful.
We have done so much for so long, with so little
We are now qualified to do anything with nothing.
~ Mother Teresa

Germaphobic Fiance

I'm taking today off. I've worked 4 of the last 4 nights and my body is screaming...I want some night-time melanin giving sleep!

Yesterday was the first night I realized that all the petty foolishness that exists when women work together still exists in nursing. I worked on a rehab unit, and it was really ugly. The nurses was click-ish, the charge nurse was a royal BITCH..(even the patients complained to me about her). She was so engrossed in unit gossip and politics that she didn't even have the panache of showing me around.

I thank my lucky stars that I'm a good self starter and once I figure out the layout, I can do anything. It helped that the one nurse I met in the elevator was nice and kept me informed of the unit routine cos the charge RN was on another level.

My Husband to be is a total hypochondriac. It's so funny to me his reactions to me telling him about my day. I leave out the gross stuff, and of course follow HIPAA rules, but even something as simple as me boasting that I started an IV on a hard stick is enough to make him nauseous. We actually had to have a discussion to lay the ground rules of what he can handle and what I should leave him out of.

I first thought his reactions very amusing and told him stuff just to tease him and watch him turn green. It wasn't until we had our talk that I realized that this is so much bigger than him being squeamish---he's really a hardcore germaphobe. He told me that he's been like that since he was little, and anything hospital related gets him feeling antsy. So now I know. I'm glad we had the talk. It helped me to see things from his angle.

I'm sure the nurses will agree, it's so easy to get desensitized at our job. I don't even think wiping someone else's BM is nasty anymore---but that is the kind of thing that makes my man all icky. Poor baby.

New rule: Share less of all the gooey stuff. Anything that deals with bodily fluids is too much for him. He loves hearing about interactions with the patient, so I'll just stick to these type of stories from now on.

Whew!

I made it. My first day back was a breeze. Well at least that was after I had a panic attack in the garage downstairs and the Boyfriend had to talk me out of. I was so petrified, with good cause to. In the alternate universe I existed in, the one in my head, I thought I wouldn't know how to do anything and everyone would laugh at me for being a total ditz until I ran from the unit, ashamed, embarrassed and humiliated.

That turned out not to be the case. The unit I was working on was chaotic when I first got on, but as soon as I got introduced, got report and a short unit orientation, I was on the roll, completely in my element. My patients were ideal and there was only one that was really busy and complicated. For some reason, I was able to keep him calm all through the night, and the other nurses were so amazed because he normally is a very hysterical and agitated patient.

The night flew by so well and the nursing supervisor of that unit even came by and offered me a job. The nurses I was working with had talked me up to him, and he told me that he'd observed my bedside manner and would love to have me on the unit. Now I know that if things don't go so well at my real job I can always swoop over to here and will be warmly received.

All in all, it was a great shift and it really did help to rebuild my confidence. My next night at a different hospital was more intense, really busy and I was out of my depth a few times but the nurses rallied and kept me afloat. Big ups to them.

I was supposed to work tonight but got canceled so here I sit...blogging. It's good to be alive, well and working!! Go Me!

Freaked!

Tomorrow is my first day back into nursing. And I'm scared out of my mind. I'm nervous like it was my first day in school. I can't really fathom why I'm so antsy...well probably because I go from being inactive in nursing for 2 years to straight on a floor as an agency nurse with the lives of 4 people dependent on my skills.

Don't get me wrong, it's not like I haven't prepared---I've done ACLS, read my Kaplan books exhaustively and taken every test I could get my hands on. It's not the procedure and tasks I'm nervous about...I'm afraid that for some reason, it won't come rushing back. I'm afraid that I'll falter or maybe miss something very important in my patient's that will determine their outcome.

I'm working tomorrow night shift for the first time in 2.5 years...so if there is anyone reading this around then...say a prayer for me. I need all the help I can get.

Home Free

I got it!!! WOOHOO!! Oh yeah, oh yeah, oh yeah!!!

I just got the phone call and pending work approval, I'm in like Flynn. And they are offering pay commiserate with my previous experience, putting me on the level of a year 4 nurse (when I actually only have 3.5 years backed with 2 years of no nursing, so that's great! I'm so giddy and excited that I don't even know what I'm going to do with myself. I get 4 weeks orientation like I asked, and don't start until the first week in July.

So thanks for all the positive vibes, they didn't go astray, I got the job!

WOOHOO!!!!!!!!

Interview: Redux

Remember last week when I was whining (and I use that word most sparingly) about the job interview that I tanked the week I fell sick? Well, today I had another one with a hospital in Oakland on the same kind of unit that I used to work in back East. I had so much angst heading over there because although it's been 2 weeks since the Interview Freeze I still hadn't gotten my confidence back. I actually came back inside the house and almost called to cancel in a fit of nerves but my roomie whipped me into shape and told me to stop being a punk.

Okay...for the most part I'm not a punk. But I hate to feel like I'm an idiot. I consider myself reasonably smart...perhaps even quite intelligent, so when my brain/memory fails me, especially in situations that I should be able to breeze through, I absolutely detest the feeling. I didn't really go into details about how bad the last interview was on here...it was so bad that I came home in tears and ended up bawling all over the Fiance as I mumbled how many times I had screwed up in a 30 minute interview. I still had flashbacks about it all through the day, and the nursing questions keep playing over and over in my head.

Fast forward to today...I KICKED ASS! Oh yeah, oh yeah, oh yeah! *doing booty shake*. There was this calmness that came over me from the moment I stepped into the office until hours later when I stood outside the pavement jumping up and down. I felt no pressure to perform whatsoever, and just talked to the Supervisor about my previous nursing experience and how I would make a good fit into their unit. He asked me far more questions than the last interview, in much more nursing depth than before as well and I nailed each question leaving him more than satisfied. The best part---no eyes boring into my skull. He was so laid back and chill, it made me more relaxed.

"Why should I hire you?" he asked me towards the end of the interview.

"Because I'm fabulous!" was my first response, which I later segued easily into a list of great reasons. This was the best interview I'd ever had.

He introduced me to the other nurses working that day as Vixen, a registered nurse that will be working on their unit sometime in the near future. Say what?

Oh yeah. He told me twice during the course of the 85 minute interview that he likes me and plans to offer me a position. He is checking my references and then will forward my info directly to HR for a direct hire. This means I skip going to HR to beg for a job from the hospital, this time the hospital is coming to me. It doesn't get much better than that.

Take that, mean lady boring holes into my head with your horn rimmed glasses and PMS-ey attitude. You just lost out on hiring a great nurse. Actually---you just lost out on hiring a fuckin' fabulous nurse.

Boo-yah.

The Interview from Hell

I'm still working on my website, but let me tell you about my first lousy interview. There was a job fair in a hospital about 4 miles from my house. I went there on Saturday about six weeks ago, thinking about filling out an application and turning in my resume alone. The HR people were really excited with me and passed me straight through to interview WITH A POTENTIAL MANAGER.

Holy Mary and the orphans. Gulp!

I soooo wasn't ready to interview. I didn't have my lucky underpants on. I didn't have my interview mindset. I didn't have the slightest clue what I was going to say. Holy fuck! It didn't help that when the manager finally came up to see me, I was stuffing my face with a sandwich. It had onions in it. I hurriedly swallowed my last bite, wiped my hand on a napkin and shook her hand. She gingerly accepted it, as if knowing that the mustard caught at the edge of my lips was on my hand as well.

As we proceeded into the office, I managed to clean up a little bit more and gain a modicum of propriety. "So," she said as she had me sit down on the other side of a huge, organized desk. That should have been my first warning sign. What nice person has an organized desk? Only an anal obsessive type person would have one. She's not gong to be nice. She gave my resume a cursory glance. "Tell me why you got out of nursing and why all of a sudden you want to come back."

Damn lady, just delve into it won't you. "Ummm," fuck. Never start a sentence with ummm, isn't that the interview no-no? Her eyebrows went up at that and I slogged on, determined to recover myself. I started babbling. When I'm uber nervous, I either babble or giggle. Neither are good interview responses. She asked me a few more cursory questions and then hit me with a big one. "What steps have you taken before you started interviewing preparing you to re-enter nursing." SHIIIIITTTTT! No steps, no steps at all, this was just a spur of the moment thing. Don't panic, don't panic. "I have been re-reading my NCLEX Kaplan book---" I started nervously. "Did you take a refresher course?" she pursued relentlessly interrupting me. No heifer, I didn't take a refresher course, that shit costs like 1500 bucks---do I have that kind of loot sitting around? Hell fuckin' no! "Did you take ACLS yet?" "No, but I'm on the wait list for it." She nodded, then brought in her assistant manager to grill me.

Together, with 2 sets of brown searing eyes, they ran me through this interview questionnaire with medical questions to see my critical thinking skills. My actions were appropriate, even I knew that, but they kept asking for the rationale behind everything, and I dithered on the first question so long that they didn't even ask me the rest on the page. After that, Manager lady showed me a VTACH strip and asked me to identify it and give the appropriate treatment. Of course, I incorrectly said VFib which made me look more like an idiot. Fuck a duck!

On my way out, even I know that I tanked the interview. "We'll call you and let you know," Manager said. Yeah right, when hell freezes over. I'd never done so poorly on anything in nursing before. The more I thought about it, the more upset I got, until I ended up parked on the side of the road crying. I managed to contain myself enough to get home but only enough to rush through the house, bid a terse greeting to my hubby and head straight for the bedroom to cry my eyes out.

He came in moments later and between my hysterical tears he managed to piece the sorry interview together. "Don't worry sweetie, it was just a dry run. You'll do better next time, now you know what it's like and everything. You didn't even really want that job anyway," he continued as he soothed and comforted me. "And now you know what to study and focus on and the kind of attitude to have."

It took a while with his positive energy but I was finally able to put things into perspective and get over myself. He's right, there are hundreds of other opportunities and if the last Manager didn't want me, someone else will.