Ode to Patients

To my favorite patients of the week,

Mr. 32A, for having a smile for me when I walked through the door. For calling me pretty lady and holding my hand. For making your wife blush at your banter. For being cheery even though it seemed like you'd been sick for a while and not getting better. For working hard with physical therapy when your body was wanting to quit. For being patient for 3 days waiting for a private room. For brushing your teeth at night.

Mr. 21, for coming into the hospital the first time in 20 years. For all the wide eyed innocence and simple questions. For not ringing your bell incessantly but grouping all your needs. For introducing me to your whole family as if we were family. For not worrying and trusting me when I said everything was going to be okay. For taking all your pills. For not complaining over all the times we were sticking you. For drinking that cup of coffee like it was better than Starbucks.

Thank you both.

xoxoxo
Your nurse

Thought...

nursing is such a conflicting job sometimes.
we are expected to be human and sensitive so we can take better care of our patients by feeling what they are going through, for their sake.
and yet, we are also expected to detach ourselves from our emotions so we can take care of our patients and make intelligent decisions, also for their sake.

From May's blog: About a Nurse

The Needle Less System

I love whoever created the Luer Lock system. My current hospital doesn't use Luer locks, they have a weird soft rubber system that you have to add a plastic blunt catheter to be able to puncture the rubber part. I think it's tedious and time consuming, and I can't wait to switch to Luer Locks again.

I was trying to explain to my man how effective the needle-less system is, and how good it is that you can retract a needle if you do use one with the one touch method. He has such a huge fear that I might get stuck one day and I was trying to reassure him. I don't know how much it helped explaining the system, but it's another thing I have to thank God for.

Can you imagine nursing 10, 15 or even 20 years before such systems came into effect? How careful you had to be to dispose of the needle properly and how scared one would be all day long under this cloud. It's hard enough working in a health-ruining environment and that's not even thinking about needle sticks.

Good luck to all the nurses out there who work out and do their best whatever situations they find themselves. Stay safe peoples.

Hey!

Okay, I'm back from across the great divide. Wow, I can't believe that you guys still check in. Thanks! I'm doing much better...believe it or not, I got out of the hospital on Friday, had the weekend to convalesce and then had to hit the floor running back to work by Monday. Because I'm 'new', HR pretty much told me that I would lose all my benefits if I don't return to work in 30 days. So back to work I go.

It was rough...I was super tired, but I'm happy to report that I survived, and the attack of nerves I had on the way to work faded away as soon as I got there. It's a good thing I love my job, if not, I would have really had it worse than it was.

On Monday, I was the lunch/break relief nurse, which pretty means I was the scut worker. I think it was apt for my first day back, no patients, no assignment, just pitching in to help everyone out. Tuesday I did get an assignment, but by then, my mojo was back. Nursing is truly like riding a bike...lol.

New License

I'm staring at my brand spanking new Oregon nursing license. I now have 3 RN licenses, one in CA, and another one in MD which is a compact state (it's like having the power of 13!). I have kept them all up, even though renewing around my birthday every year is a huge drain on the finances.

So now I'm gearing up for the move up north. We've decided to purchase a home together, and it looks like Oregon is going to be the family nest. I'm really excited, I've been talking to recruiters and trying to get a good travel assignment in place for right when we move.

I'm a person that loves change and yet at the same time absolutely hates it. I'm in the love mode right now however, staring at my new license.

sick

Vixen is sick she has been in the hospital for the last two weeks hopefully she will be back home this week
this is kafo her sister

Tables Turned

Okay, I have posted in a while because I've actually been a patient. I was at a branch of my Hospital but closer to my house for the last week with a severe anemic attack (H&H 4.3/12.8). Most of the time I was groggy but when I was lucid, I noticed that of all the nurses I had...I only connected with one. Everyone just came to do their job, answer the call bell and leave at the end of their shift. Noone even talked to me as a person...I was the patient in 305B.

Yuck, yuck, yuck! If ever this does realign my outlook towards nursing, I always knew that my ability to connect with patients was something they appreciated, but from the inside looking out now I get it. You're stuck in a world out of your control, constantly bothered for vital signs and assessments, rarely if ever getting a shower that you so desperately crave and wishing that you could get out of this purgatory before you picked up some other disease. You are stuck watching reruns on tv...no cable mind you, and your room mate screams out in distress 24/7.

So many people wander in and out of your room and yet all of them are still strangers to you. Your family rarely stops by so the only consolation you have is reading last week's newspaper or counting ceiling tiles.

When the tables got turned, it really made me wish that I had a nurse as fabulous as I was.

Patient Twelve

The service coordinator of all the Company hospitals found me out on the floor today and shook my hand. "I'm honored to meet you," she stated. My manager was there and they were both smiling at me benignly.

"Ummm, okay, yeah, nice to meet you too!" I said as I tried to extricate myself.

"Vixen, we just interviewed your new patient in room 12 and she's very impressed with you. She said that you two have formed a bond in the last 2 hours and that you were making efforts to help her get a shower---the one thing that she has been desperately craving."

Patient 12 was a new admit from ER, having been down there for almost a day. We joked as I settled her in and assessed her, and her mom was there, showing me pictures of her grand-daughter. I hadn't thought I'd done much, but apparently, P12 did.

"Really?" I asked incredulously. Did they really have the right nurse?

"Yes, she specifically said your name and how helpful you've been. You've shown the kind of service that we want from all our nurses," stated the service director as she shook my hand again, gave me a smile and walked away. My manager winked at me and whispered, "Good Job Vix!"

Hot diggity damn! I mean, I knew I was a fab nurse, but such positive reinforcement was enough to make my month. P12 got her shower that evening, and I got another great reason of why I love being a nurse.

It's about the connection.

The Preceptor

Okay, I've only been back to nursing since July, and I already got made a Preceptor. Talk about fast track. The nurse I'm precepting, she's a total doll, we were actually in New Employee Orientation together. Her son is a year younger than me. I haven't precepted since I worked in Baltimore, so I was a little worried about it, but so far so good.

She knows her stuff. She's solid in assessing a patient, and has amazing nursing instincts. The main thing with her is her lack of confidence...she's very intelligent, but lacks the confidence. On two separate occasions, she followed her instincts and assessment to get the doctor to come in to see 2 patients that ended up needing intensive monitoring the next day. She's a solid grade A nurse.

My preceptor in Bmore was the shizznit! I had alot of trepidation my first day but Betsy showed me how to work wonders on the unit. She taught me pretty much alot of what I know in nursing, who the 'it' people were and how to connect with people. She was fun, relatable, and went out of her way to develop a connection with me. We ended up really good friends and made me want to be that type of Preceptor. It's weird, she was 27 when she precepted me---and I was 21. Wow, time flies.

So anyway, I'm a preceptor. I'd like to think that so far I've been at least half the great preceptor that Betsy was to me. I'm paying it forward.

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?