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Shell Shocked

My patient died a few nights ago. It was the most bizarre experience ever. I had just been in his room, taking his blood pressure (which was fine), drawing his AM labs and talking to him. I walked him to the bathroom and back, then tucked him in his bed, got him a warm blanket and said goodnight.

I went into my next patient's room to hook up his antibiotics. The Monitor tech calls me and tells me my other patient has a junctional rhythm. I rush in there and he's pale and unresponsive, his head crooked over to the side, his dentures halfway out of his mouth. I instantly freaked and started shaking him, then hit the code button (even though he was DNR). I told the other nurses that he was DNR with chemical intervention but his heart had stopped beating and he wasn't even breathing. The doctor pronounced him at a few minutes after 3am.

How can someone be talking to you and then dead the next minute? He was old, in his 80s and had COPD...beyond that, he should have been fine. The family is not going to do an autopsy, so I'll never know what happened but always have questions.

This isn't the first time that my patient died, it's just the first time that it was so unexpected and random. I was the last person that he saw before he passed. I was the last person he spoke to. I'm still shell shocked. The nurses on the unit accepted it cynically, and almost without empathy. I'm dealing with hella emotions at this point, feeling that if I had stayed in the room for just a few more minutes I could have helped him live.

The next night I had a patient in the SAME ROOM. Unfortunately he didn't get much sleep that night because I kept going in to make sure he was still alive. I checked on him almost religiously, freakishly paranoid that this old 80 year old would die on me too.

How do nurses deal with all these emotions? I don't know what to do.

Cardiac Jitters

I've just started a new job at this super advanced hospital. It's the largest tertiary cardiac hospital in the WHOLE state, and has a reputation of sterling gold. I'm learning so much on this unit, which is great because at my old job I was getting kinda stagnant. It's a cardiac telemetry unit, and when I say cardiac, I mean CARDIAC. They are hardcore about the cardiac ish.

I'm worried about working this week because now that I'm off orientation I'm expected to fly on my own. It's a ratio of 5 patients per night, which isn't hard except I'm still new and figuring everything out. Hopefully they go easy on me the first few days, it would suck if I couldn't hang.

The whole hospital is computerized to the next level, everything is computerized. It reminds me of my old job in Maryland, and the ease that technology adds to everything does make up for the 'fish out of water' feeling that I have. I love the fact that I can do all my charting on my patients on the computer in less than 15 minutes!

It actually gives more time to spend with the patients. I'm doing 12 hour nights, and they have me on 3 in a rows, so hopefully I will stay on top of my game and the Super Nurse will find her wings again.

Wish me luck!

Hello

Hey peoples,

Do I really post that infrequent that noone knows I've been out? Dayum! New Year Resolution, post more often.

I was sick in the hospital since the 5th, not a cool way to start the year but it has been my modus operandi as of the last few years.

Anyway, there is alot to do and say, but first I must catch up on all you blogging freaks out there.

Oh, and although I'm hella late,

HAPPY NEW YEAR!!!

By the way, my new job starts on the 14th, I'm going to be a travel nurse...can I get a hells yeah?

How to Reach 50 Years Together

I was talking to my patient and his wife today, a couple that are still so sweet and loving even after 48 years of marriage. "So what's the magic formula to keep things strong?" I asked. Yes, it might seem a redundant question but her response was one that really tugged chords with me.

"Commitment. There is no out clause for us. We vowed forever and we will do everything in our power to keep that vow." She told me that they had been through some rough times, and there are moments that even she would want to pull his hair out. But she always reminded herself that she "went into this with my eyes wide open and will stay in it with my eyes wide open."

It just got me reflecting on how our generation is so ready to call it quits as soon as the relationship hits the skids or calamity strikes. We have become a generation of fast food relationships, where friends, family and loves are casually tossed aside when they no longer fulfill our needs or something better comes along.

Alot of my patients went through the depression, and they hold on to everything from a shoe string to a piece of tissue paper. What we view as waste, they store and keep for when it will be needed. But I'm getting off topic here...

Oh yeah, so the formula to a long lasting relationship by my lady in room 17;

• Commitment
  
• Good Communication--talk about everything, your thoughts, your actions, your motives etc. This will help you see where the other person is coming from.
  
• Never going to bed mad--and always have sex even if you are fighting. This shifts the energy of the argument and reconnects you.
  
• Don't be afraid to seek counseling or professional help

Oh, and if your guy is sick in the hospital, come with a cheery attitude, some good food and a smile. It will do wonders for his health.

Musing

This weekend was one of those days that if I hadn't handed in my resignation letter already, I would have had to resign all over again. However, it's over and I have today off to recuperate and rejuvenate so I'm not even going to dwell on the torrid parts, but instead, will focus on the goodness.

My coworkers are the greatest! I was so frustrated that I hadn't taken lunch and it was an hour to report. The Charge Nurse practically ordered me to take a break and when I came back everything was done---and I mean everything from my last meds passed, foleys emptied and documented and fingersticks done and insulin given. They even helped me document some of my new patient paperwork and the only thing I had to come back to do was to finish charting and give report. Talk about teamwork. In 30 minutes they had pulled together and finished what would have taken me the rest of the shift to finish.

Man...I hate the fact that I'm leaving. And I think they do too. As the day draws nigh, I start hearing more and more how everyone is going to miss me when I'm gone. It's nice to feel valued, even if I was just on the unit for 6 months, I feel like I really bonded and made some great friends. I really am going to miss not being here anymore.

When I left my first job in 2005, I thought I would never find another place that I adored my coworkers as much, but my crew of 2007 have proven me wrong. I guess it doesn't matter where you go in the US, if you are a genuine person you will make genuine connections.

Happy holidays to everyone.
7 more days till Portland baby!

Doubling

Doubles are so hard to do. The first couple of hours are a breeze but then come 2 o'clock you are still hustling, my body feels like it's shutting down to "rest and relaxation" mode. I just did a slew of doubles last week and can't wait to see how fat my check is gonna be on the 28th.

Sorry, I'm kinda out of it.

What's up with you all?

The Blues

Okay, even as a nurse with an iron stomach, some things totally make me squeamish. It's weird, I can deal with lots of poop and vomit, but let me have a patient that needs regular suctioning and I'll be inwardly cringing. There is something about the Crrrrr sound of suctioning that gets my grout and flips me out. RT's like suctioning, and I know alot of nurses that dig it, but that shit is not my cup of tea at all. Ewwwww!

Luckily in med surg, you rarely run into a frequent suctioning case so it's not something I have to deal with much.

I'm getting to my last couple of weeks on the job and I'm trying to rack up the OT like crazy. I plan to work hard for the next three weeks, bank up that holiday money and take a week vacation between my present job and my new one. I hope that everything works out in my mind like I've planned.

As you can see, I don't have much to say today, but I'm glad that I'm a nurse, even though we are so underpaid for the ish we put up with, the good times for me are far more than the bad. Sorry for the blathering, I'm kinda tired after pulling a double last night but too wired to sleep.

Hugs to the nurses out there.

7 Random Things

I've been tagged by Nocturnal RN and I'm supposed to share 7 random/weird things about myself. I have alot of weird things about me, and I've done this several times on my other blogs, but for the sake of this blog, I'll stick to 7 weird things about me in nursing, to keep it fresh.

1. At work, I hydrate by drinking a gallon of water mixed with 3% lemonade or lemon juice. I can drink this more than just straight water, and it actually makes me feel like I'm staying hydrated.
2. Since the very first day out of nursing school and on the floor, I've taken report the same way, folding an A4 paper into four and sticking it in my pocket for reference. Everything is on there, but if I lose it I can still function because the art of writing the stuff makes it stick in my brain.
3. I coordinate everything about my scrubs. I even coordinate my shoes, socks and hair clips. My watch is coordinated as well as most of my 'nursing' stuff. Getting dressed for work is a ritual for me, it puts me in the mindset of going to work. It's like my supernurse outfit...and TaDa!, I'm ready to hit the floor running as soon as I clock in. Most of my scrubs and outfits are red, pink, green or variations of blue.
4. I always chart at the end of the shift, in the last hour after I&Os and everything is done. I just want to get a complete feeling when I'm done charting, so charting twice irritates the hell out of me. I'll work straight through the shift with minimal breaks and get my patients tucked in by 10 so that I can compose my report and chart in the last hour. That's essential to me.
5. I HATE the pagers...I think everyone does. When mine goes off and it's not my patient, I get very irritated when the nurse covering doesn't seem to care or doesn't deal with the issue. I'm the one that's going, "Are you doing something about your patients' HR of 140?" It's not because I care that much, I just hate my pager going off!! Sometimes I want to slam it against the wall. Almost every shift in fact.
6. I make rounds on my patients' every hour and tell them this when I introduce myself. This is more for me than them, I want to poke my head in, see their chest rise and ask if they need anything. Usually I find my patients end up using the call bell less, because they know I'll be around soon.
7. At the end of the day as I'm clocking out, I give myself a mental pat on the back and say, "Good job Vixen you supernurse you!"

Okay, totally weird but then again, they did ask for weird things. So I'm sending this back out with a twist. Nurses, what are the weird things you do?

The Thanksgiving Weekend From Hell...

Whoa...the last 2 days were bad. So bad that I just couldn't bring myself to wade into poop and mess another day in a row. For some reason, my Manager is always complaining about the budget...so this weekend, he understaffed ALL three shifts, leaving no CNAs on the floor at all, nurses having 5-6 tele patients and a patient load that rivalled a nursing home/post op unit. Only the sickest patients were still in the hospital this Thanksgiving weekend, and everyone was stressed to the max.

Tempers were short, mistakes were happening and we had 4 incident reports in 2 days and 3 falls on Friday. There is only so much you can do and only so many places you can be at one time, at the end something starts to suffer.

Luckily the only aspects my patients suffered in was that they didn't get dinner until 8pm both nights...which is about 2.5 hours late but as soon as I could get to it. In addition, I had 2 patients to feed, which left me charting after midnight on the clock. Night shift actually begged me to stay for a few hours to help them out (they were at 6 patients each) but my tired, bedraggled body could barely make it down the stairs home.

As soon as I got home, I was assailed by sickle cell pain and knew that once again I had over done it. I had to call out today just to get the pain under control and as I'm writing this I'm still dealing with the aftershocks. The whole staff is mutiny with the Management and I have a feeling that this will be one of the main discussions on Tuesdays staff meeting.

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.