I was having my typical work night…busy busy busy…focused only on getting everything done that needed to be done…when something happened that made me stop in my tracks…
I had received report and was doing my assessments and passing my meds when I entered one of my patient’s rooms. My first thought as I entered “This is a sweet old man...I could end up wanting to take him home with me” (of course once home I would just add him to the collection of my sweet old patients). Believe me when I say that thought soon flew out of my head…
As I was giving him his medication, and assessing him, he told me that today was his wife’s and his 50th something wedding anniversary. I told him congrats and that was a long time to be married. He was sad his wife was not able to make it to the hospital to be with him…as I was encouraging him and trying to cheer him up (which could have been a mistake) the next words out of his mouth were… “You are so nice…can I have your phone number?” I think my jaw dropped a little and I asked him why. “Because you know we can hook up sometime” and he winked. (He actually had the nerve to throw in the wink!!!)…
Um…um…What in the world do you say to that???!!!!!!!!!! I quickly told him I didn’t think that was a good idea and “What in the world would your wife think about that!!!???” His reply… “Well she doesn’t have to know”. I just looked at him like…”What are you thinking!!!!”
So one awkward moment down for the night…and it was only 2100…Gee how could it get any better (believe me when I tell you this wasn’t the most awkward moment I experienced that night).
Later on that evening, I entered this same patient’s room because his IV pump was beeping and annoying everyone. As I was replacing his IV fluids with a new bag and fixing the pump, I felt a tug on my pants. At that moment, I felt a cool breeze on my legs…meaning only one thing…the little devil had actually pulled my pants down!!!!...As I grabbed my pants to pull them back up…what else would happen but then one of the other nurses I work with just so happened to enter the room!!!! She looked at me pulling up my pants with a face as red as a fire engine…and at the patient who was smiling from here to all get out…and back again…and opened her mouth but all that came out was a fit of hysterical giggling. She left the room still laughing just as hard. I quickly finished what I had to do in the room, and went to face the other nurse. She of course was still laughing and having way too much fun. Seriously…Really???!!! Why is it always me who gets in these situations with my patients???? I must have a sticker on my head that reads… “Always up for that awkward moment”…At least I’m making an impression on my fellow co-workers. ;)
Wednesday, December 21, 2011
Friday, December 2, 2011
A Night From Hell
One of the hardest (emotionally and intellectually) lessons to learn in nursing…is that sometimes when things go bad…nothing you do is going to make it any better. This evening was particularly frustrating because certain things were not being done as they should have been. There was a shortage of people who were actually working and that was leading to some overworked, and very busy nurses and techs. Since our side of the floor seemed to have fewer patients then the other unit, the other nurse and I were taking turns going over to the other unit and helping them stay caught up. In one of my many trips over to the other unit, I heard a nurse talking to her patient with a sense of panic in her voice (Nothing ever good comes from that much panic in a voice). I ran to the room, and saw the nurse and one of the techs from my unit trying to hold a 400 pound man from falling out of the bed (This nurse and tech are both only like 100 pounds themselves so it was easy to see that they needed some help). As I finished running into the room, someone had managed to pull the code light. So I did the only thing I could…I jumped right into help.
Now usually the way a code happens is, the nurses will begin CPR and ambu bagging if needed while the techs are grabbing the code cart and clearing out the room of any excess furniture or people. The nurses will also be getting the zoll pads on the patient and an EKG strip ran so when the doctors get up to the room everything is ready for what they need to do….now notice I use the word USUALLY…
This night things didn’t go exactly the way they should have…a little background information…this patient was a large patient who needed to be on oxygen at all times. The nurse had been helping him sit up so that he could get out of bed to ambulate to the bathroom. As the nurse was preparing to have the patient stand up, the patient stopped breathing and began to fall out of bed forward. The nurse was doing everything she could to keep him from falling face first off the bed.
As I entered the room, I was followed by about 5 or 6 people in the room, we all started to help get the patient laid back onto the bed, so that compressions and abmu bagging could be started. As we laid him down, there was so much force that he rolled onto his side, which pretty much made compressions impossible. As the rest was trying to turn him, I began to ambu bag him. All of a sudden I felt my scrub pant legs and shoes get soaked. I looked down and felt like puking. The patient had fluid coming from every orifice on his face (eyes, ears, and nose). Another nurse began suctioning to try to get all that fluid out. Rapid response and the doctors arrived in the room at pretty much the same time. From there it became a little chaotic, and there were enough people in the room to help, I left and went back to my unit. Unfortunately after 45 minutes of CPR, the patient was not revived and he was officially declared dead.
As I was walking past one of my patient’s room, I noticed his continuous pulse ox machine was beeping…Now there are many reasons a pulse ox machine might beep. 1) The Pt’s oxygen level is below 90 (which was the normal reason it beeped for this pt) 2)the heart rate may be increased/decreased or 3) last but most common, the sensor may not be working or not reading correctly.
I poked my head into his room to check on him...at this point I wasn't that concerned since as i said before it was usually his oxygen deceasing a little because he would forget to breathe through his nose where the nasal cannula was. I started to remind him to take some deep breathes through his nose, when I just happened to glance at his pulse ox machine. His heart rate was freaking 190. Now that is not a good thing any time, but especially when he is on a Med-Surg floor with no telemetry or monitoring. Now here’s another case of why tonight was not a normal night…Normally I would call the doctor and rapid response and they would be up to look at the patient in a matter of minutes…but as I was calling the doctor I remembered that the doctor and rapid response was over on the other unit in the midst of the code. I went ahead and paged both but knew it was going to be awhile till I heard from either of them…
I went back to my patient’s room to keep an eye on him…he denied having any chest pain or trouble breathing (he was complaining of severe abdominal pain). About 30 minutes later, the doctor returned my page and came to access the patient…she ordered an EKG and a ½ Liter Normal Saline Bolus (she then rushed off to go to another code and said she would return).
The EKG showed (no surprise) ventricular tachycardia and SVTs. The doctor returned and ordered another ½ liter Normal Saline. Rapid response was finally able to come assess the patient. They talked to the doctor and decided it would be best to move him to a progressive bed. Before rapid could move him, they had to cardioconvert his heart (push an IV medication that stopped it from beating for a few seconds, so that when it restarted it would hopefully be in a better rhythm. After four hours I was able to move the patient to a different floor.
Believe me when I say that it was not a very good night for me at all.
Now usually the way a code happens is, the nurses will begin CPR and ambu bagging if needed while the techs are grabbing the code cart and clearing out the room of any excess furniture or people. The nurses will also be getting the zoll pads on the patient and an EKG strip ran so when the doctors get up to the room everything is ready for what they need to do….now notice I use the word USUALLY…
This night things didn’t go exactly the way they should have…a little background information…this patient was a large patient who needed to be on oxygen at all times. The nurse had been helping him sit up so that he could get out of bed to ambulate to the bathroom. As the nurse was preparing to have the patient stand up, the patient stopped breathing and began to fall out of bed forward. The nurse was doing everything she could to keep him from falling face first off the bed.
As I entered the room, I was followed by about 5 or 6 people in the room, we all started to help get the patient laid back onto the bed, so that compressions and abmu bagging could be started. As we laid him down, there was so much force that he rolled onto his side, which pretty much made compressions impossible. As the rest was trying to turn him, I began to ambu bag him. All of a sudden I felt my scrub pant legs and shoes get soaked. I looked down and felt like puking. The patient had fluid coming from every orifice on his face (eyes, ears, and nose). Another nurse began suctioning to try to get all that fluid out. Rapid response and the doctors arrived in the room at pretty much the same time. From there it became a little chaotic, and there were enough people in the room to help, I left and went back to my unit. Unfortunately after 45 minutes of CPR, the patient was not revived and he was officially declared dead.
As I was walking past one of my patient’s room, I noticed his continuous pulse ox machine was beeping…Now there are many reasons a pulse ox machine might beep. 1) The Pt’s oxygen level is below 90 (which was the normal reason it beeped for this pt) 2)the heart rate may be increased/decreased or 3) last but most common, the sensor may not be working or not reading correctly.
I poked my head into his room to check on him...at this point I wasn't that concerned since as i said before it was usually his oxygen deceasing a little because he would forget to breathe through his nose where the nasal cannula was. I started to remind him to take some deep breathes through his nose, when I just happened to glance at his pulse ox machine. His heart rate was freaking 190. Now that is not a good thing any time, but especially when he is on a Med-Surg floor with no telemetry or monitoring. Now here’s another case of why tonight was not a normal night…Normally I would call the doctor and rapid response and they would be up to look at the patient in a matter of minutes…but as I was calling the doctor I remembered that the doctor and rapid response was over on the other unit in the midst of the code. I went ahead and paged both but knew it was going to be awhile till I heard from either of them…
I went back to my patient’s room to keep an eye on him…he denied having any chest pain or trouble breathing (he was complaining of severe abdominal pain). About 30 minutes later, the doctor returned my page and came to access the patient…she ordered an EKG and a ½ Liter Normal Saline Bolus (she then rushed off to go to another code and said she would return).
The EKG showed (no surprise) ventricular tachycardia and SVTs. The doctor returned and ordered another ½ liter Normal Saline. Rapid response was finally able to come assess the patient. They talked to the doctor and decided it would be best to move him to a progressive bed. Before rapid could move him, they had to cardioconvert his heart (push an IV medication that stopped it from beating for a few seconds, so that when it restarted it would hopefully be in a better rhythm. After four hours I was able to move the patient to a different floor.
Believe me when I say that it was not a very good night for me at all.
Monday, November 21, 2011
Not A Rookie Anymore...
So I had a fellow co-worker tell me that I am no longer a rookie nurse…now usually this would be a good thing, but in actuality…this statement was not a welcome statement at all. It was a night of many firsts for me…1) first really bad patient deterioration 2) first code and the final first 3) first pt death.
The evening began like any other shift for at least 15 or 20 minutes then things begin to go wrong. The tech came running into the nurses’ station saying that one of the patients was bleeding. I go into the patient’s room and find the patient sitting up in bed holding her nose. She was gushing blood all over herself, her sheets, and everything else within her vicinity. I grab some towels and manage to get her nosebleed to stop. After getting back to the nurses’ station, I asked the day nurse inform me on this patient next so I would have an idea of what was going on. She was admitted for a GI bleed, but had been stable ever since she had been brought to the floor a couple of days earlier. The day nurse was not aware of any problems or concerns; in fact, she thought the patient was going to be discharged the next day. I paged the doctor just to give them a heads up. They said they would come assess the patient.
The doctors arrived and said that the nose bleed was most likely due to an increase in her blood pressure. They told me to go ahead and give her the scheduled blood pressure medication. I gave the medication and finished my assessment. Everything else seemed to be okay. I asked the tech to get another set of vital signs. Her blood pressure was decreasing back towards normal, but her Heart rate was a little increased. I spent the night keeping a close eye on her with nothing out of the ordinary occurring.
Morning came and it was time to draw labs. She was a nurse draw and had quite a few to draw. I went in there and she was watching tv. As I drew her blood, she was telling me about her family and how she couldn’t wait to see them all again for Thanksgiving, since her children all make the long trip home to see her. I finished getting the blood I needed, and told her I would be back in a few minutes with her medicines.
The lab results came back showing her hemoglobin was 4.2 (a decrease from 10.6 the morning before). I paged the doctor and was ordered to hang 3 units of blood stat. As I was walking into the room to check her vital signs before hanging the blood, I noticed she was lying down in the bed, and didn’t respond when the light was turned on. I quickly went to the bed and found that the patient was not breathing. I yelled for help and pulled the code light. As the tech arrived to check her vital signs for me, I was connecting the ambu bag and began ambuing her. Another tech was grabbing the code cart for me, while the other nurse was entering the room to be of assistance, and checked for a pulse. There was none!!!!. The nurse started compressions while I ambued. The tech arrived with the code cart and we got the patient hooked up to the zoll machine and continued compressions. Rapid Response and the doctors showed up and the craziness began. Amidst all the business of the code, the patient’s daughter walked into the room. (She had gone home for the night, and was just returning). One of the techs quickly grabbed the daughter and pulled her out of the room, and took her to the waiting room.
Unfortunately even with all the interventions being done, the patient was not saved. About the time, the code finished the hospital Chaplin arrived. The doctors and rapid had to take off running to another code. This left the Chaplin and I with the burden of finding the daughter. I had to tell the daughter that we had done everything we could, but we could not save her. The daughter began to cry, which made me want to break down crying with her. (I’m not going to lie, there were tears in my eyes, and it was one of the hardest things I have ever had to do). The Chaplin stayed with the daughter as I went to finish up my shift as if nothing had happened.
So depending on who you ask…I am no longer a rookie nurse because I have experienced my first patient death…I think I would much rather prefer to stay a rookie
The evening began like any other shift for at least 15 or 20 minutes then things begin to go wrong. The tech came running into the nurses’ station saying that one of the patients was bleeding. I go into the patient’s room and find the patient sitting up in bed holding her nose. She was gushing blood all over herself, her sheets, and everything else within her vicinity. I grab some towels and manage to get her nosebleed to stop. After getting back to the nurses’ station, I asked the day nurse inform me on this patient next so I would have an idea of what was going on. She was admitted for a GI bleed, but had been stable ever since she had been brought to the floor a couple of days earlier. The day nurse was not aware of any problems or concerns; in fact, she thought the patient was going to be discharged the next day. I paged the doctor just to give them a heads up. They said they would come assess the patient.
The doctors arrived and said that the nose bleed was most likely due to an increase in her blood pressure. They told me to go ahead and give her the scheduled blood pressure medication. I gave the medication and finished my assessment. Everything else seemed to be okay. I asked the tech to get another set of vital signs. Her blood pressure was decreasing back towards normal, but her Heart rate was a little increased. I spent the night keeping a close eye on her with nothing out of the ordinary occurring.
Morning came and it was time to draw labs. She was a nurse draw and had quite a few to draw. I went in there and she was watching tv. As I drew her blood, she was telling me about her family and how she couldn’t wait to see them all again for Thanksgiving, since her children all make the long trip home to see her. I finished getting the blood I needed, and told her I would be back in a few minutes with her medicines.
The lab results came back showing her hemoglobin was 4.2 (a decrease from 10.6 the morning before). I paged the doctor and was ordered to hang 3 units of blood stat. As I was walking into the room to check her vital signs before hanging the blood, I noticed she was lying down in the bed, and didn’t respond when the light was turned on. I quickly went to the bed and found that the patient was not breathing. I yelled for help and pulled the code light. As the tech arrived to check her vital signs for me, I was connecting the ambu bag and began ambuing her. Another tech was grabbing the code cart for me, while the other nurse was entering the room to be of assistance, and checked for a pulse. There was none!!!!. The nurse started compressions while I ambued. The tech arrived with the code cart and we got the patient hooked up to the zoll machine and continued compressions. Rapid Response and the doctors showed up and the craziness began. Amidst all the business of the code, the patient’s daughter walked into the room. (She had gone home for the night, and was just returning). One of the techs quickly grabbed the daughter and pulled her out of the room, and took her to the waiting room.
Unfortunately even with all the interventions being done, the patient was not saved. About the time, the code finished the hospital Chaplin arrived. The doctors and rapid had to take off running to another code. This left the Chaplin and I with the burden of finding the daughter. I had to tell the daughter that we had done everything we could, but we could not save her. The daughter began to cry, which made me want to break down crying with her. (I’m not going to lie, there were tears in my eyes, and it was one of the hardest things I have ever had to do). The Chaplin stayed with the daughter as I went to finish up my shift as if nothing had happened.
So depending on who you ask…I am no longer a rookie nurse because I have experienced my first patient death…I think I would much rather prefer to stay a rookie
Friday, November 18, 2011
If Only For Moments Like These
Since I have started working at UK, I have had many unique and interesting patients. However, over the past four months, I have had this patient that has managed to bring about so many feelings and emotions for me. He is definitely what would be considered a “frequent flyer” (yes those really do exist). He is also a difficult patient to care for. In fact when most nurses hear his name…they shudder and pray that they will not be the nurse to care for him. He is a difficult patient, for sure, but at the same time, I think he has become one of my favorite patients.
If this patient had a talent it would be to cause emotional rollercoasters for his nurses. One second I feel sorry for him since he is a little pathetic (and he can look at you with his puppy dog eyes and there is no telling him no) and in the next I want to drug him up because he can be the most annoying person on the planet…especially since he knows my name so all night I hear… “ALICIA…ALICIA…ALICIA…ALICIA! ALICIA!!!!!!!!!!!!!!!!!” Let me tell you…it makes for a very long night…
But I just can’t help but feel sorry for the guy…I mean he’s in the hospital in excruciating pain (or at least that’s what he wants me to believe)…with an unidentifiable stage pressure ulcer on his coccyx…so yeah he’s kind of easy to feel sorry for…
Especially when you consider that most of the other nurses do not treat him very well..They see him as more of a laughing stock and a good joke then the human being that he is. They spend their time laughing at him because his mental status is not at the same level as theirs…
Enough ranting about that…I have spent quite a bit of time with this patient in caring for him and trying to calm him down…and we become what he likes to call “buddies” and “she’s the best nurse in the world and she’s my favorite”…surprisingly when you spend time with him and talk to him while you are doing your care you find that he is such a sweet guy who is scared and lonely…
One night he was very upset and would not calm down no matter what I did…so the 45 minutes of torture for the dressing change of his multiple wounds, seemed like forever…while I was talking and distracting him from the pain, I learned that he doesn’t watch much television, but he does listen to the radio a lot and he is a huge country music fan. With this I had a thought.
The next day, I went out and got a cheap radio and took it to the hospital for him. The joy and excitement on his face was priceless. When I turned the radio on, he began to sway to the music and fell asleep (this is a miracle in itself since he almost never sleeps).
That radio became his calming method and any time the music was on, he was much calmer and less likely to call out. Every time I visited or cared for him after this…he would thank me profusely “I love my radio…you are the bestest friend ever…I love my radio I just love my radio”.
From that moment on…I remembered why I had become a nurse…believe it or not it is not for the paycheck or for the benefits or any other reason than for seeing that smile on his face and knowing that I had made a difference in even one person’s life…and that I was there and willing to help in any way possible and that meant the world to someone. Even though I have tough nights and frustrating patients…I think I have the best job in the world…if only for moments like these.
If this patient had a talent it would be to cause emotional rollercoasters for his nurses. One second I feel sorry for him since he is a little pathetic (and he can look at you with his puppy dog eyes and there is no telling him no) and in the next I want to drug him up because he can be the most annoying person on the planet…especially since he knows my name so all night I hear… “ALICIA…ALICIA…ALICIA…ALICIA! ALICIA!!!!!!!!!!!!!!!!!” Let me tell you…it makes for a very long night…
But I just can’t help but feel sorry for the guy…I mean he’s in the hospital in excruciating pain (or at least that’s what he wants me to believe)…with an unidentifiable stage pressure ulcer on his coccyx…so yeah he’s kind of easy to feel sorry for…
Especially when you consider that most of the other nurses do not treat him very well..They see him as more of a laughing stock and a good joke then the human being that he is. They spend their time laughing at him because his mental status is not at the same level as theirs…
Enough ranting about that…I have spent quite a bit of time with this patient in caring for him and trying to calm him down…and we become what he likes to call “buddies” and “she’s the best nurse in the world and she’s my favorite”…surprisingly when you spend time with him and talk to him while you are doing your care you find that he is such a sweet guy who is scared and lonely…
One night he was very upset and would not calm down no matter what I did…so the 45 minutes of torture for the dressing change of his multiple wounds, seemed like forever…while I was talking and distracting him from the pain, I learned that he doesn’t watch much television, but he does listen to the radio a lot and he is a huge country music fan. With this I had a thought.
The next day, I went out and got a cheap radio and took it to the hospital for him. The joy and excitement on his face was priceless. When I turned the radio on, he began to sway to the music and fell asleep (this is a miracle in itself since he almost never sleeps).
That radio became his calming method and any time the music was on, he was much calmer and less likely to call out. Every time I visited or cared for him after this…he would thank me profusely “I love my radio…you are the bestest friend ever…I love my radio I just love my radio”.
From that moment on…I remembered why I had become a nurse…believe it or not it is not for the paycheck or for the benefits or any other reason than for seeing that smile on his face and knowing that I had made a difference in even one person’s life…and that I was there and willing to help in any way possible and that meant the world to someone. Even though I have tough nights and frustrating patients…I think I have the best job in the world…if only for moments like these.
Thursday, November 10, 2011
Aww! So Kind and Thoughtful of You
Now most who know me…know that I hate controversy and will do everything I can to avoid it. I would much rather just do my job or go on with my own business…of course avoiding the controversy as much as I can. But we all need to vent every now and then. So here goes.
It really aggravates me when people become nurses who don’t seem to want to be nurses...you know the ones I am talking about…they sit on the computer all day, talk on the phone consistently, avoid patient rooms, or don’t adequately care for their patients. I mean really, why are you in a profession that is all about caring for people, if you would much rather avoid people and patients????
I arrived at work last night and learned that there had been a new admit about 15 minutes before I was receiving report. Now I understand that in the last 15 minutes of a shift there isn’t a lot of time to get stuff done, or you are just so busy trying to finish everything that you might forget about or not do something…believe me I’m really understanding and normally I’m fine with doing whatever wasn’t done…because I know you tried your hardest and did your best…but when I walk into the nurse’s station and I hear “There is a new patient in this room…I got report…but I don’t really know anything about them…well I do know that they are mentally retarded but that’s about it”…REALLY!!!! WTH!!!! Gee was that really your report??!!!
As I looked over the patient’s orders I noticed that the patient had STAT lab orders (for 10 vials of blood)….these orders were put in at 1830…it was not 1930 and the blood had still not been drawn…of freaking course!!!...
As I was gathering everything I would need to get the blood…the phone rang…It was radiology checking to see if the pt was ready for a CT scan… WHAT!!!!??? I explained that the patient was not, I didn’t know that there was going to be a CT scan and wasn’t even sure of why the pt was in the hospital…the radiologist seemed to know more about the pt then I did (there’s something wrong with that picture)…
I called the primary medical team…and started asking questions…the pt was here for an abscess in the face and may need surgery…the CT scan was to determine if surgery was going to be necessary…As I was just about to hang up the phone, the dr informed me that the pt was going to be sedated for the CT scan. Okay that’s fine…not really my problem…was my thinking at this time…
I returned to getting all my supplies to draw the blood. I decided that since the pt was mentally stunted, I would draw the blood from the IV (of course I would have to be careful to not blow the IV). When I entered the room, I saw two caregivers with the patient. I explained who I was and what I was going to do… “Um…there isn’t one yet.” I looked at the caregivers and explained that I would go ahead and put one in since it was needed for the CT scan…Although what I really wanted to do was scream… “Are you kidding me!!!???”.
This patient had arm flapping, which meant it was going to be almost impossible for me to start an IV in the arms…and I was a little concerned that if I could get the arms to hold still long enough to try, the pt would not help keep the arm steady and would most likely jerk away just as the needle went in which would lead to 1) a blown vessel 2) an unsuccessful IV start, and most importantly 3) another attempt at starting an IV…Now I’m what you might call a nice nurse that really doesn’t like sticking my patients more times then I need to…so I decided to start the IV in the next logical place…the foot.
Just as I was about to start the IV, my fellow nurse told me there was a dr on the phone for me. It was the radiologist asking if I was going to be coming down to recover the patient after sedation since they didn’t have any nurses that could do that…I explained that I would not be able to…but that I would call the team to see if the pt could be sent to the PACU after the CT scan…After finally getting everything figured out, I went back to the pt’s room to finish the IV.
I had never started an IV in a foot before, but “oh well, there’s a first time for everything”. I grabbed a 20 gauge IV (since it had to be a bigger IV, because of the CT contrast). Finally there was IV access…OH CRAP!!!, I forgot to get the blood for the labs!!!!” I tried to draw back blood…but alas, the IV would not draw…I was going to have to stick her again. I was able to get the blood with no problems…the pt did an amazing job…but decided that I was not the most favorite person and anytime I came near, there was an involuntary flinch for the rest of the night. :(
By the time, I got this all figured out, it was midnight and I still had not even started any of my own work, because I was too busy playing catch up from the day shift…I thought that I was going to get back on track…but not so lucky…I had to keep playing catch up until about 2 or 3. It was a very frustrating night that made me want to stack the patients the next morning and give the nurse who had handed me off her patients, really hard patients so that she would know what it was like…but once again…I’m a nice nurse and managed to get everything done so that the day nurse would only have to do her part of the patient care.
It really aggravates me when people become nurses who don’t seem to want to be nurses...you know the ones I am talking about…they sit on the computer all day, talk on the phone consistently, avoid patient rooms, or don’t adequately care for their patients. I mean really, why are you in a profession that is all about caring for people, if you would much rather avoid people and patients????
I arrived at work last night and learned that there had been a new admit about 15 minutes before I was receiving report. Now I understand that in the last 15 minutes of a shift there isn’t a lot of time to get stuff done, or you are just so busy trying to finish everything that you might forget about or not do something…believe me I’m really understanding and normally I’m fine with doing whatever wasn’t done…because I know you tried your hardest and did your best…but when I walk into the nurse’s station and I hear “There is a new patient in this room…I got report…but I don’t really know anything about them…well I do know that they are mentally retarded but that’s about it”…REALLY!!!! WTH!!!! Gee was that really your report??!!!
As I looked over the patient’s orders I noticed that the patient had STAT lab orders (for 10 vials of blood)….these orders were put in at 1830…it was not 1930 and the blood had still not been drawn…of freaking course!!!...
As I was gathering everything I would need to get the blood…the phone rang…It was radiology checking to see if the pt was ready for a CT scan… WHAT!!!!??? I explained that the patient was not, I didn’t know that there was going to be a CT scan and wasn’t even sure of why the pt was in the hospital…the radiologist seemed to know more about the pt then I did (there’s something wrong with that picture)…
I called the primary medical team…and started asking questions…the pt was here for an abscess in the face and may need surgery…the CT scan was to determine if surgery was going to be necessary…As I was just about to hang up the phone, the dr informed me that the pt was going to be sedated for the CT scan. Okay that’s fine…not really my problem…was my thinking at this time…
I returned to getting all my supplies to draw the blood. I decided that since the pt was mentally stunted, I would draw the blood from the IV (of course I would have to be careful to not blow the IV). When I entered the room, I saw two caregivers with the patient. I explained who I was and what I was going to do… “Um…there isn’t one yet.” I looked at the caregivers and explained that I would go ahead and put one in since it was needed for the CT scan…Although what I really wanted to do was scream… “Are you kidding me!!!???”.
This patient had arm flapping, which meant it was going to be almost impossible for me to start an IV in the arms…and I was a little concerned that if I could get the arms to hold still long enough to try, the pt would not help keep the arm steady and would most likely jerk away just as the needle went in which would lead to 1) a blown vessel 2) an unsuccessful IV start, and most importantly 3) another attempt at starting an IV…Now I’m what you might call a nice nurse that really doesn’t like sticking my patients more times then I need to…so I decided to start the IV in the next logical place…the foot.
Just as I was about to start the IV, my fellow nurse told me there was a dr on the phone for me. It was the radiologist asking if I was going to be coming down to recover the patient after sedation since they didn’t have any nurses that could do that…I explained that I would not be able to…but that I would call the team to see if the pt could be sent to the PACU after the CT scan…After finally getting everything figured out, I went back to the pt’s room to finish the IV.
I had never started an IV in a foot before, but “oh well, there’s a first time for everything”. I grabbed a 20 gauge IV (since it had to be a bigger IV, because of the CT contrast). Finally there was IV access…OH CRAP!!!, I forgot to get the blood for the labs!!!!” I tried to draw back blood…but alas, the IV would not draw…I was going to have to stick her again. I was able to get the blood with no problems…the pt did an amazing job…but decided that I was not the most favorite person and anytime I came near, there was an involuntary flinch for the rest of the night. :(
By the time, I got this all figured out, it was midnight and I still had not even started any of my own work, because I was too busy playing catch up from the day shift…I thought that I was going to get back on track…but not so lucky…I had to keep playing catch up until about 2 or 3. It was a very frustrating night that made me want to stack the patients the next morning and give the nurse who had handed me off her patients, really hard patients so that she would know what it was like…but once again…I’m a nice nurse and managed to get everything done so that the day nurse would only have to do her part of the patient care.
Wednesday, November 9, 2011
Umm...And Why Didn't You Tell Me That???
(sorry for the language...but the pt gets across)
I have no idea why, but for some reason, I keep getting crappy reports from nurses who hand off the patients to me…it is very frustrating and makes for a very long night of playing catch up…trying to figure out what in the world I am supposed to be doing for my patients.
On one of these great occasions…I asked the nurse before me if the patient had received the 2 units of platelets, 2 units of packed red blood cells, and the 1 unit of plasma that had been ordered at 1300. She told me yes. However, when I walked into the patient’s room, the family member looked me dead in the eye. “Are you going to hang the blood that the doctor ordered????!!!!” I stared at her and replied…”I’m pretty sure that the blood has already been hung.” Apparently I was wrong…gee what a shock…but of course it took me 5 hours to discover this and by this time…I ended up spending the majority of the remainder of the night in this pt’s room, doing blood transfusions.
On another occasion…I got report from my co-worker and went to round on my patients. Now of course the information that she forgot to tell me…was of course very important…she didn’t tell me that the patient’s family member was in the room, trying to be the doctor…and had decided to soak the patients arms in warm soapy water…Now of course normally this wouldn’t be a problem and I wouldn’t have cared…except this patient had second degree burns up the arms…and the bandages were still on the arms…so much for the use of the sterile field…and the next morning when I warned the SAME coworker who had neglected to tell me…she rolled her eyes and said “Oh yeah, she was doing that all day yesterday”!!!! REALLY!!!! Gee thanks for the heads up…
During my short time…as a nurse I have seen firsthand, and learned from many bad and difficult situations that communication is a very important thing…however it needs to be good communication…communication that actually communicates…gee what a novel idea!!! I know that you have had a long rough day but PLEASE I beg of you…take another 15 minutes and tell me about the patient!!!!!
I have no idea why, but for some reason, I keep getting crappy reports from nurses who hand off the patients to me…it is very frustrating and makes for a very long night of playing catch up…trying to figure out what in the world I am supposed to be doing for my patients.
On one of these great occasions…I asked the nurse before me if the patient had received the 2 units of platelets, 2 units of packed red blood cells, and the 1 unit of plasma that had been ordered at 1300. She told me yes. However, when I walked into the patient’s room, the family member looked me dead in the eye. “Are you going to hang the blood that the doctor ordered????!!!!” I stared at her and replied…”I’m pretty sure that the blood has already been hung.” Apparently I was wrong…gee what a shock…but of course it took me 5 hours to discover this and by this time…I ended up spending the majority of the remainder of the night in this pt’s room, doing blood transfusions.
On another occasion…I got report from my co-worker and went to round on my patients. Now of course the information that she forgot to tell me…was of course very important…she didn’t tell me that the patient’s family member was in the room, trying to be the doctor…and had decided to soak the patients arms in warm soapy water…Now of course normally this wouldn’t be a problem and I wouldn’t have cared…except this patient had second degree burns up the arms…and the bandages were still on the arms…so much for the use of the sterile field…and the next morning when I warned the SAME coworker who had neglected to tell me…she rolled her eyes and said “Oh yeah, she was doing that all day yesterday”!!!! REALLY!!!! Gee thanks for the heads up…
During my short time…as a nurse I have seen firsthand, and learned from many bad and difficult situations that communication is a very important thing…however it needs to be good communication…communication that actually communicates…gee what a novel idea!!! I know that you have had a long rough day but PLEASE I beg of you…take another 15 minutes and tell me about the patient!!!!!
Monday, November 7, 2011
GI Bleed...Ok...That's Nothing to Worry About
Last week I had to go to a patient deterioration class. In this class we discussed identifying patients who are at risk for deterioration and how to spot early signs and symptoms…now one might ask…why is it so important to recognize early signs and symptoms…well to avoid placing yourself in the middle of a Code Blue situation of course.
All during this class all I could do was think about work the night before. I had a patient who was in the hospital for a GI bleed. Now while I was getting report on this patient, a nursing care tech came in and told us that the patient was acting “funny”…the pt was sleeping and not waking up when there was someone in the room like normal. The day nurse just continued to give me report like she wasn’t concerned at all…I looked at her “um…is this normal for the patient?” “Well they never sleep so they are probably just tired”. Uh…huh…
After getting report, I decided the first thing I should do is go in and check out this patient. As I was about to enter the room, I noticed there was a dr in there with the pt…I figured the best thing would be to wait until the dr finished.
About five minutes later, the dr came into the nurses station. “Has the pt been acting like this for awhile now…is this normal…because I was here the last two nights and when I saw the patient they weren’t like this at all?” Ummm….why are you asking me when you answered your own question…is what I wanted to say. But I told her “Actually I have never had this patient before, but the tech who was here earlier said that it’s abnormal.” My fellow nurse spoke up… “I had the patient before and this is not normal…they are never like this…they usually are talking from the moment you walk in the door until you leave”. The dr looked at us and said “Well, I’m sure it’s just because they’re tired…keep monitoring, I’m sure there’s nothing to worry about”
Off on a little side note here…WTH does it mean when a dr tells you “keep monitoring the pt” What exactly does that mean!!!! What do you think I have been doing since I got here and the last 8 hours!!!???? Ok back on point.
I continued monitoring the patient…who slept for the next 6 hours but would wake up when I was in the room. Throughout the night, I kept in contact with the dr…but got the same message… “Oh it’s fine…” Well that’s what I heard until I checked the morning labs and saw the hemoglobin was 4.5 and the hematocrit was 18.3%,... which means nothing until you consider the last labs from yesterday showed a hemoglobin of 11.2 and a hematocrit of 29.2%...
Don’t you love how it was no big deal…oh yeah…except the patient was actively bleeding out!
All during this class all I could do was think about work the night before. I had a patient who was in the hospital for a GI bleed. Now while I was getting report on this patient, a nursing care tech came in and told us that the patient was acting “funny”…the pt was sleeping and not waking up when there was someone in the room like normal. The day nurse just continued to give me report like she wasn’t concerned at all…I looked at her “um…is this normal for the patient?” “Well they never sleep so they are probably just tired”. Uh…huh…
After getting report, I decided the first thing I should do is go in and check out this patient. As I was about to enter the room, I noticed there was a dr in there with the pt…I figured the best thing would be to wait until the dr finished.
About five minutes later, the dr came into the nurses station. “Has the pt been acting like this for awhile now…is this normal…because I was here the last two nights and when I saw the patient they weren’t like this at all?” Ummm….why are you asking me when you answered your own question…is what I wanted to say. But I told her “Actually I have never had this patient before, but the tech who was here earlier said that it’s abnormal.” My fellow nurse spoke up… “I had the patient before and this is not normal…they are never like this…they usually are talking from the moment you walk in the door until you leave”. The dr looked at us and said “Well, I’m sure it’s just because they’re tired…keep monitoring, I’m sure there’s nothing to worry about”
Off on a little side note here…WTH does it mean when a dr tells you “keep monitoring the pt” What exactly does that mean!!!! What do you think I have been doing since I got here and the last 8 hours!!!???? Ok back on point.
I continued monitoring the patient…who slept for the next 6 hours but would wake up when I was in the room. Throughout the night, I kept in contact with the dr…but got the same message… “Oh it’s fine…” Well that’s what I heard until I checked the morning labs and saw the hemoglobin was 4.5 and the hematocrit was 18.3%,... which means nothing until you consider the last labs from yesterday showed a hemoglobin of 11.2 and a hematocrit of 29.2%...
Don’t you love how it was no big deal…oh yeah…except the patient was actively bleeding out!
Wednesday, November 2, 2011
I Know I'm Forgetting Something...
Since I can’t stay out of trouble at work…because 1) its just way too boring if I do and 2) being a new nurse just invites trouble…Of course I have a story about my shift tonight.
One of my lovely co-workers asked me to help her hang a blood product since she had never had this experience before…
And of course thanks to one of my patients…I have quickly become a pro at hanging blood…so being my nice self…I graciously agreed to help…
The other nurse pre-medicated the pt with Benadryl and then went down to the blood bank to get the blood. The tech took the pre-blood vital signs…and we were ready to go.
We compared the information from the blood, with the blood paper. We gathered the Normal Saline and the blood tubing…(we even made sure to make sure it was legitimate blood tubing…with 2 spikers). We were on a roll.
So naturally we spiked the normal saline and flushed out the tubing. We were then ready to go to the patient’s room, and compare the arm band with the unit of blood. All this vital information matched…nothing was going to stop us now.
The nurse spiked the bag of blood and flushed the line…she then started the infusion, and wrote down the time of initiation. We then reviewed what she was going to assess for in the first 15 minutes…any signs and symptoms of a transfusion reaction (including…rash, back pain, fever, feeling of doom). I then left the patient’s room to go about the rest of my nightly duties…
Of course the story doesn’t end there…it wouldn’t be a typical “me” story if it did. Along comes the clinical nurse expert…she was checking in on us since it was the other nurse’s first time. My fellow nurse reassured the expert we were fine and we had this…then the expert asked a question… “Is there consent in the chart?” “SAY WHAT!!!???”
Probably one of the most important part of the process and both of us had totally forgotten to even think about the consent. I think at this moment…both of our hearts jumped out of our chests and we just looked at the expert in sheer panic…
She laughed at us and went on to calm us down. After looking in the chart, we felt much better, seeing as how the consent was already signed and in the chart.
“Phew…I guess I get to keep my job for a little bit longer! Thank goodness!!!”
One of my lovely co-workers asked me to help her hang a blood product since she had never had this experience before…
And of course thanks to one of my patients…I have quickly become a pro at hanging blood…so being my nice self…I graciously agreed to help…
The other nurse pre-medicated the pt with Benadryl and then went down to the blood bank to get the blood. The tech took the pre-blood vital signs…and we were ready to go.
We compared the information from the blood, with the blood paper. We gathered the Normal Saline and the blood tubing…(we even made sure to make sure it was legitimate blood tubing…with 2 spikers). We were on a roll.
So naturally we spiked the normal saline and flushed out the tubing. We were then ready to go to the patient’s room, and compare the arm band with the unit of blood. All this vital information matched…nothing was going to stop us now.
The nurse spiked the bag of blood and flushed the line…she then started the infusion, and wrote down the time of initiation. We then reviewed what she was going to assess for in the first 15 minutes…any signs and symptoms of a transfusion reaction (including…rash, back pain, fever, feeling of doom). I then left the patient’s room to go about the rest of my nightly duties…
Of course the story doesn’t end there…it wouldn’t be a typical “me” story if it did. Along comes the clinical nurse expert…she was checking in on us since it was the other nurse’s first time. My fellow nurse reassured the expert we were fine and we had this…then the expert asked a question… “Is there consent in the chart?” “SAY WHAT!!!???”
Probably one of the most important part of the process and both of us had totally forgotten to even think about the consent. I think at this moment…both of our hearts jumped out of our chests and we just looked at the expert in sheer panic…
She laughed at us and went on to calm us down. After looking in the chart, we felt much better, seeing as how the consent was already signed and in the chart.
“Phew…I guess I get to keep my job for a little bit longer! Thank goodness!!!”
Monday, October 31, 2011
And What Is Your Profession?
I have discovered a new answer to this question
Seriously some nights I feel as if all I do is pass out pain medications like it is candy.
The other night I had two pts that had pain medications due q2h. Now they couldn’t have made my life simple…no instead, they had to be on separate schedules…so yes…I was passing pain medications every HOUR. It makes it very difficult to get anything done or focus on anything…when your pts call out on the dot every hour of the night.
I understand that you are in pain…but sometimes I catch myself wondering if you are really in as much pain as you say…I know it’s horrible…especially since I learned in school that pain is… “what the PATIENT says it is”…
But really, if I have given you 4-8 mg of morphine (and of course always the 8mg) q2h and 1-2 percocet (of course 2 tablets) q4h…and on top of that…since that isn’t working…how about 2-4 mg of dilaudid prn for break through pain…it is very surprising to me…that you are STILL alert and coherent enough to keep demanding your pain meds…especially since you asked for 10mg of ambient on top of all the pain meds…I mean really!!!???? How in the world are you NOT sleeping???!!!!!
And it is especially frustrating when I am trying to control your pain, and I see that you are beginning to experience side effects that include: falling asleep in the middle of having a conversation, seeing things that aren’t there, and saying things completely out of your mind…While these may all be a little entertaining…to me they are in actuality a sign that…guess what…I may need to hold off on the pain meds, the next time around…
And while it may be hard for your family members to understand…this does not mean I that I need to be belittled, yelled at or overhear a conversation including…”She is not a very good nurse…She does not care that you are in pain…she just doesn’t care about you at all!!!”…when I hear this…it makes me want to just turn around and walk back out the door and not give you any more pain meds or help with the pain!!!!
Believe me when I say that I do in fact care…I care so much that I am only trying to protect you as the patient…and I would rather keep you alive then have you die from overdosing!!!
Yes…one of the things I spend most of my time at work doing is passing pain medications…and next time you ask me what I do for a living…I swear I’m going to tell you “I’m a LEGAL DRUG DEALER”…now if only I got paid like one ;)
Tuesday, October 25, 2011
Some vs All Nights
Recently I have been having second thoughts about my career choice…actually to be truthful…they go a little more like… “What in the world was I thinking???!!! Why did I ever become a nurse???!!! AGHHHH!!!!”
Some nights, I wonder why I was ever foolish enough to become a nurse… Some nights I wish I would have become a doctor so I didn’t have to deal with all the craziness…Some nights I know that I made the biggest mistake of my life…Some days I dread the afternoon, because I know it means I have to spend another night at work and be a part of the crazy.
I arrived on the floor ready to have another night of caring for my patients. I knew it would be the usual busy…I just didn’t expect it to be outrageously hectic. I was already tired as working the night shift really messes up a person’s body and sleep schedule.
As I was receiving report, I noticed that one of my pts was not doing well and had deteriorated quite a bit from the night before. The pt was on 7 liters of oxygen via nasal cannula (which is not a good thing, since 6 liters is the maximum that a nasal cannula should be set at) and only having oxygen saturation of 85-89%. As if this wasn’t bad enough, the pt was also having a rough time coughing up mucus plugs. In other words, this particular patient was not doing very well at all.
For a brief second, I had a freak out moment… “I have no idea of what to do…my pt is going to die on me and I still don’t know what to do…WHAT AM I GOING TO DO!!!???” Now when I say brief…I mean very brief…I took a deep breath and collected myself.
And I did the only thing I knew to do…
I went and found a more experienced nurse and begged for some of their very valuable insight.
After I explained the situation, the other nurse amusingly raised her eyebrows at me… “Oh gosh, I thought…here it comes…she’s totally going to make fun of me…because I should know what to do…She’s thinking I’m a complete idiot”. As I waited for the taunting to commence, she quietly advised that I call the doctors and also Rapid Response so they would have a “heads up” on the patient’s condition. “Oh yeah…what a novel idea…why didn’t I think of that in the beginning!!!!”
As I was calling the pt’s medical team, a different set of doctors showed up…they were called in to consult on the case…(sometimes I swear pts have more doctors than they know what to do with)…
They began to question me about the pt and why she was still on a nasal cannula…
“um…I guess that would be…because I just got here and that’s how she got handed to me and um…I don’t know what to do” is what was running through my head…but heaven forbid I say that out loud to a team of doctors…wouldn’t want them to get the wrong idea and have them think they are smarter than me ;)
They suggested that we change the nasal cannula to a face mask to increase the oxygen getting to the pt…I went to grab the face mask…but of course I had to find all the equipment necessary first. I finally made it back to the pt’s room, only to hear the doctors change their minds about the face mask (of course they would)…instead they wanted to try something else. A little frustrated, I only smiled and went off to follow the new orders…and of course to call Rapid Response.
Within 5-10 minutes Rapid had arrived on the floor and once again I found myself giving report on the pt. They decided the patient ABSOLUTELY had to be moved to a different floor, where more adequate monitoring could be done. However, that’s not as easy done as said…after 2 or 3 more hours…I finally was able to transfer the pt off of the unit and the night finally slowed down for the most part.
Some nights I sure don’t want to be in the hospital…and DEFINITELY would rather be at home or hanging with friends…Some nights I hate my job…Some nights I get so frustrated…but I would never trade my job for all the nights in the world.
Some nights, I wonder why I was ever foolish enough to become a nurse… Some nights I wish I would have become a doctor so I didn’t have to deal with all the craziness…Some nights I know that I made the biggest mistake of my life…Some days I dread the afternoon, because I know it means I have to spend another night at work and be a part of the crazy.
I arrived on the floor ready to have another night of caring for my patients. I knew it would be the usual busy…I just didn’t expect it to be outrageously hectic. I was already tired as working the night shift really messes up a person’s body and sleep schedule.
As I was receiving report, I noticed that one of my pts was not doing well and had deteriorated quite a bit from the night before. The pt was on 7 liters of oxygen via nasal cannula (which is not a good thing, since 6 liters is the maximum that a nasal cannula should be set at) and only having oxygen saturation of 85-89%. As if this wasn’t bad enough, the pt was also having a rough time coughing up mucus plugs. In other words, this particular patient was not doing very well at all.
For a brief second, I had a freak out moment… “I have no idea of what to do…my pt is going to die on me and I still don’t know what to do…WHAT AM I GOING TO DO!!!???” Now when I say brief…I mean very brief…I took a deep breath and collected myself.
And I did the only thing I knew to do…
I went and found a more experienced nurse and begged for some of their very valuable insight.
After I explained the situation, the other nurse amusingly raised her eyebrows at me… “Oh gosh, I thought…here it comes…she’s totally going to make fun of me…because I should know what to do…She’s thinking I’m a complete idiot”. As I waited for the taunting to commence, she quietly advised that I call the doctors and also Rapid Response so they would have a “heads up” on the patient’s condition. “Oh yeah…what a novel idea…why didn’t I think of that in the beginning!!!!”
As I was calling the pt’s medical team, a different set of doctors showed up…they were called in to consult on the case…(sometimes I swear pts have more doctors than they know what to do with)…
They began to question me about the pt and why she was still on a nasal cannula…
“um…I guess that would be…because I just got here and that’s how she got handed to me and um…I don’t know what to do” is what was running through my head…but heaven forbid I say that out loud to a team of doctors…wouldn’t want them to get the wrong idea and have them think they are smarter than me ;)
They suggested that we change the nasal cannula to a face mask to increase the oxygen getting to the pt…I went to grab the face mask…but of course I had to find all the equipment necessary first. I finally made it back to the pt’s room, only to hear the doctors change their minds about the face mask (of course they would)…instead they wanted to try something else. A little frustrated, I only smiled and went off to follow the new orders…and of course to call Rapid Response.
Within 5-10 minutes Rapid had arrived on the floor and once again I found myself giving report on the pt. They decided the patient ABSOLUTELY had to be moved to a different floor, where more adequate monitoring could be done. However, that’s not as easy done as said…after 2 or 3 more hours…I finally was able to transfer the pt off of the unit and the night finally slowed down for the most part.
Some nights I sure don’t want to be in the hospital…and DEFINITELY would rather be at home or hanging with friends…Some nights I hate my job…Some nights I get so frustrated…but I would never trade my job for all the nights in the world.
Wednesday, October 5, 2011
Careful...They are Everywhere!
There is a million dollar question that seems to hang in the air on my unit…How in the world did I end up working in a psychiatric hospital and not know it…Did I sign myself up for this?” Apparently the answer is…um…yeah…Duh!!!!
Working on a med-surge unit is just asking for a crazy busy night…however when there is a full moon that craziness and busyness takes on a whole new meaning. Believe me when I say…”It really is true that full moons make the craziest night in a hospital”. I don’t know why or what makes it happen but it is inevitable.
Tonight, I got a new admission. I was already tired because the shift had been plenty busy…but that doesn’t really make much of a difference. So I grabbed my paperwork (I thought I was going to be efficient and get my paperwork and assessment done all at once) and entered the patient’s room.
As I entered the room, I quickly saw this was going to be an extremely tough patient. She was lying in the bed screaming…”Don’t let them get me…they can’t have me…get away from me!!!” In addition there was a lot of inappropriate and explicit language being yelled in my direction. I took a deep breath and walked closer, wishing the whole time, I didn’t really have to.
The pt was in a lot of pain…with no pain medication ordered (why does that not surprise me)…I paged the doctors, but to no avail. Finally one of the doctors called back and informed me they were not going to give any pain meds because of concerns of mental issues. I so badly wanted to tell the doctor… “Fine…then you can come care for the patient all night since you will not give adequate pain control!!”…but I held my tongue and decided I would do everything I could to help the pt.
I re-entered the room hoping to get my pt profile and paperwork done…however the pt had other ideas. The pt was sitting up in bed, screaming and crazy out of the head. The pt was attempting to throw the stuff in the room and herself out of the bed onto the ground, with every movement creating more and more unbearable pain, causing the craziness to escalate even more. I knew I had to protect the pt from harm. I called for a nursing tech to come help me…and ran to keep the pt from harming itself.
As I got within arm reach of the pt, I bent over the bed to help move the pt back onto the bed…but before I could get to the pt…the pt grabbed ahold of my arm…
I have absolutely no idea where the pt was getting her insane strength from…but I seriously thought my arm was going to be broken. Just as the tech was arriving in the room…the pt had gotten my arm in between the bed frame and her body. However the tech and I were able to wrestle my arm away from the pt.
Of course for the rest of the night…I made sure to stay a safe distance away as much as I could. Finally the doctors ordered some pain meds and the pt was able to calm down enough to get some sleep and allow the rest of the night to be uneventful.
I definitely feel like I work in a psych hospital…but then again I WAS warned in school… “There are psych patients everywhere”.
Working on a med-surge unit is just asking for a crazy busy night…however when there is a full moon that craziness and busyness takes on a whole new meaning. Believe me when I say…”It really is true that full moons make the craziest night in a hospital”. I don’t know why or what makes it happen but it is inevitable.
Tonight, I got a new admission. I was already tired because the shift had been plenty busy…but that doesn’t really make much of a difference. So I grabbed my paperwork (I thought I was going to be efficient and get my paperwork and assessment done all at once) and entered the patient’s room.
As I entered the room, I quickly saw this was going to be an extremely tough patient. She was lying in the bed screaming…”Don’t let them get me…they can’t have me…get away from me!!!” In addition there was a lot of inappropriate and explicit language being yelled in my direction. I took a deep breath and walked closer, wishing the whole time, I didn’t really have to.
The pt was in a lot of pain…with no pain medication ordered (why does that not surprise me)…I paged the doctors, but to no avail. Finally one of the doctors called back and informed me they were not going to give any pain meds because of concerns of mental issues. I so badly wanted to tell the doctor… “Fine…then you can come care for the patient all night since you will not give adequate pain control!!”…but I held my tongue and decided I would do everything I could to help the pt.
I re-entered the room hoping to get my pt profile and paperwork done…however the pt had other ideas. The pt was sitting up in bed, screaming and crazy out of the head. The pt was attempting to throw the stuff in the room and herself out of the bed onto the ground, with every movement creating more and more unbearable pain, causing the craziness to escalate even more. I knew I had to protect the pt from harm. I called for a nursing tech to come help me…and ran to keep the pt from harming itself.
As I got within arm reach of the pt, I bent over the bed to help move the pt back onto the bed…but before I could get to the pt…the pt grabbed ahold of my arm…
I have absolutely no idea where the pt was getting her insane strength from…but I seriously thought my arm was going to be broken. Just as the tech was arriving in the room…the pt had gotten my arm in between the bed frame and her body. However the tech and I were able to wrestle my arm away from the pt.
Of course for the rest of the night…I made sure to stay a safe distance away as much as I could. Finally the doctors ordered some pain meds and the pt was able to calm down enough to get some sleep and allow the rest of the night to be uneventful.
I definitely feel like I work in a psych hospital…but then again I WAS warned in school… “There are psych patients everywhere”.
Wednesday, September 28, 2011
Live Like You Are Dying
While I know that I am still learning a lot about nursing, I had completely forgotten that I am still pretty stupid when it comes to life in general. I guess even though I graduated from school, there are still many things to learn here and there ;)
My patient was an elderly man who just happened to be one of the most interesting patients I will probably ever take care of. While he was passing through the area, he blacked out and fell while getting on the bus and ended up in the hospital where his day got much better because he got to meet me! ;) As I was talking with him, I became intrigued very quickly. This man had done so much with his life.
He had been to every continent and all the states in the US. As if that was not enough, just last year, he had climbed Mount Everest and the year before he had fought bulls in Spain. He was doing all this while he was well past the age of 80! Needless to say he became the patient that I spent the most time talking to that night. However, as I was talking to him, I found out that he had no family or friends. He had been a loner for most of his life and his family really did not try to stay in contact. The saddest part is he was being treated for recurring cancer and the end was near.
He could tell that I was a little disheartened to hear this. He grabbed my hand and stared into my eyes, “Don’t despair for me. My life has been good and every minute has been exciting and lived to the fullest…so instead despair for the empty moments in your life”. As the night wore on…I became busy and was not able to spend much more time talking to the patient, but I could not shake the words that he had spoken. These words have stuck with me and made me resolve to live my life to the fullest extent so that I can have few and far in between regrettable moments.
"I've had my moments, days in the sun. Moments I was second to none. Moments when I knew I did what I thought I couldn't do. Like that plane ride coming home from the war. That summer my son was born. And memories like a coat so warm, a cold wind can't get through. Lookin' at me now you might not know it. But I've had my moments" -Moments, Emerson Drive-
My patient was an elderly man who just happened to be one of the most interesting patients I will probably ever take care of. While he was passing through the area, he blacked out and fell while getting on the bus and ended up in the hospital where his day got much better because he got to meet me! ;) As I was talking with him, I became intrigued very quickly. This man had done so much with his life.
He had been to every continent and all the states in the US. As if that was not enough, just last year, he had climbed Mount Everest and the year before he had fought bulls in Spain. He was doing all this while he was well past the age of 80! Needless to say he became the patient that I spent the most time talking to that night. However, as I was talking to him, I found out that he had no family or friends. He had been a loner for most of his life and his family really did not try to stay in contact. The saddest part is he was being treated for recurring cancer and the end was near.
He could tell that I was a little disheartened to hear this. He grabbed my hand and stared into my eyes, “Don’t despair for me. My life has been good and every minute has been exciting and lived to the fullest…so instead despair for the empty moments in your life”. As the night wore on…I became busy and was not able to spend much more time talking to the patient, but I could not shake the words that he had spoken. These words have stuck with me and made me resolve to live my life to the fullest extent so that I can have few and far in between regrettable moments.
"I've had my moments, days in the sun. Moments I was second to none. Moments when I knew I did what I thought I couldn't do. Like that plane ride coming home from the war. That summer my son was born. And memories like a coat so warm, a cold wind can't get through. Lookin' at me now you might not know it. But I've had my moments" -Moments, Emerson Drive-
Saturday, September 24, 2011
Accidental Confession at Work!
Aww…the situations I get myself into at work…
Tonight one of my pts was an elderly woman with severe dementia who was being worked up for a liver transplant…(I was surprised that they were going to do a liver transplant on a woman in her 80’s but hey good for her). She had been very uncooperative for the day shift and had even gone so far as to punch the tech and absolutely did not want anyone coming near her…especially if they had the intention of touching her.
Of course I was a little apprehensive about caring for this patient. But what could I do, so I walked into the room and introduced myself as Alicia, her nurse for the night. “Why do I need a nurse?” she asked, with her eyebrows furrowed and quite frustrated. I responded by saying, “Well honey, it’s because you are in the hospital, and I’m here to take care of you.”
Um…this may just have happened to not be the best answer, because at this statement her eyes got wide and just about popped out of her head. Her eyes were now set in a dead glare…man if looks could kill…I would surely be dead. “You think this is the hospital!!!!!!???? Girl, this is my home, you don’t know what you are talking about?”
I looked around the room…a little unsure of what to do but knew I had a decision to make. I could argue with her….wait the correct way to say that is to…reorient her to her surroundings (hahaha), which of course is the textbook correct thing to do, or I could make it an easier night for both of us…so of course I choose the easy way! Surprise, surprise lol.
“Oh, I’m so sorry dear, I get terribly confused sometimes…Yes, we are at your house. Your daughter asked me to come by to check on you…she must really love you!” The lady got this big grin on her face and replied, “Why yes, my mother does love me.”
“Well you have a good mother. Is it okay if I listen to you breathe?” At this point she was willing to do anything I asked and within a few minutes we had finished the assessment with no problems at all. As I finished, she asked “How many blocks do you cover?” “Um…blocks?...um Eight?”
“You cover EIGHT whole blocks…baby doll you must be crazy!!!”
Now I was the one who was confused, and had no idea what we had just talked about. The next time I went into her room, she asked me the same question, this time my new answer was six blocks. This was still too high a number and apparently I was still crazy lol. When I returned with her medication, the question was repeated a third time. I thought for a minute and said “Four. How many do you cover?” Here I thought I was socially interacting with the pt and developing a therapeutic relationship when all of a sudden I hear, “Girl, I don’t get paid for working corners!”
Wait!!! “But I do???!!!” What in the world did I just tell my pt I do for a living?!!! All I could do was stand there with my jaw about to hit the floor…and of course a nice little cute blush was beginning to take over my face.
A few hours later the question was repeated. “I don’t get paid for that” I replied too afraid to say anything else at this point. “That’s good” was her quiet reply.
Hmm…maybe those textbook correct ways to handle situations are actually the best. Not only did I accidentally make a “confession” to my pt about my secret life outside of the hospital…the other nurses I was working with were of course in the hallway and overheard the confession also…man however am I going to live this down now? Oh the joys of being a RN.
Tonight one of my pts was an elderly woman with severe dementia who was being worked up for a liver transplant…(I was surprised that they were going to do a liver transplant on a woman in her 80’s but hey good for her). She had been very uncooperative for the day shift and had even gone so far as to punch the tech and absolutely did not want anyone coming near her…especially if they had the intention of touching her.
Of course I was a little apprehensive about caring for this patient. But what could I do, so I walked into the room and introduced myself as Alicia, her nurse for the night. “Why do I need a nurse?” she asked, with her eyebrows furrowed and quite frustrated. I responded by saying, “Well honey, it’s because you are in the hospital, and I’m here to take care of you.”
Um…this may just have happened to not be the best answer, because at this statement her eyes got wide and just about popped out of her head. Her eyes were now set in a dead glare…man if looks could kill…I would surely be dead. “You think this is the hospital!!!!!!???? Girl, this is my home, you don’t know what you are talking about?”
I looked around the room…a little unsure of what to do but knew I had a decision to make. I could argue with her….wait the correct way to say that is to…reorient her to her surroundings (hahaha), which of course is the textbook correct thing to do, or I could make it an easier night for both of us…so of course I choose the easy way! Surprise, surprise lol.
“Oh, I’m so sorry dear, I get terribly confused sometimes…Yes, we are at your house. Your daughter asked me to come by to check on you…she must really love you!” The lady got this big grin on her face and replied, “Why yes, my mother does love me.”
“Well you have a good mother. Is it okay if I listen to you breathe?” At this point she was willing to do anything I asked and within a few minutes we had finished the assessment with no problems at all. As I finished, she asked “How many blocks do you cover?” “Um…blocks?...um Eight?”
“You cover EIGHT whole blocks…baby doll you must be crazy!!!”
Now I was the one who was confused, and had no idea what we had just talked about. The next time I went into her room, she asked me the same question, this time my new answer was six blocks. This was still too high a number and apparently I was still crazy lol. When I returned with her medication, the question was repeated a third time. I thought for a minute and said “Four. How many do you cover?” Here I thought I was socially interacting with the pt and developing a therapeutic relationship when all of a sudden I hear, “Girl, I don’t get paid for working corners!”
Wait!!! “But I do???!!!” What in the world did I just tell my pt I do for a living?!!! All I could do was stand there with my jaw about to hit the floor…and of course a nice little cute blush was beginning to take over my face.
A few hours later the question was repeated. “I don’t get paid for that” I replied too afraid to say anything else at this point. “That’s good” was her quiet reply.
Hmm…maybe those textbook correct ways to handle situations are actually the best. Not only did I accidentally make a “confession” to my pt about my secret life outside of the hospital…the other nurses I was working with were of course in the hallway and overheard the confession also…man however am I going to live this down now? Oh the joys of being a RN.
Thursday, September 15, 2011
VIPs...Yes They Do Really Exist
This lesson will most likely haunt me and possibly all new nurses (of course when the have the privilege of seeing it first hand) for the rest of my career…haunt me as in make me very angry at the injustice of the whole ordeal kind of way. I’ve always heard of VIPs (very important patients). As naïve as I am, I always thought they didn’t really exist…I thought it was just nursing/medical lingo that was made up or used to describe very difficult, needy patients…once again…I learned that in the real world of nursing…sadly this is not the truthVIPs really do exist…and when they arrive in the hospital…they expect to be seen and treated as if they are the only person in the whole hospital…actually they expect to be treated as if they are the president of the United States…point in case.I had a pt that arrived at the hospital very sick. It was not a happy time for this pt or family (which of course it usually isn’t when someone is admitted to the hospital). I received report from the transferring nurse. As the report was coming to an end…the nurse informed me… “Oh, by the way…this pt and the family are all VIPs…just a warning”. I was like “What!!! What is a VIP?!!” I turned to ask another nurse and she went on to inform me that “VIPs expect to be treated like royalty and are usually hard to please and difficult to care for”. “Great" is all I could think..."this is going to be a long night".When the pt and family arrived on the floor, I witnessed right away the behavior that gives away the VIP status. Within 5 minutes of being in the room, I had already heard a million complaints. “This room is way too small…I don’t want to be across from the nurses’ station…It’s too loud in here…there is not enough channels on the TV…Why is it so quiet in here…I need a bigger room…and oh yeah…while you are at it…I need some food right now” “Um….Okay then”.It doesn’t matter that by this time it is already 0100 and there is really nothing with any food…especially for the pt’s family and not the pt themselves. When I explained this…the family was not happy and demanded I get them something to eat…I held my tongue and remained polite…although what I really wanted to say wouldn’t be considered that polite or customer service friendly.As I turned to exit the room, the pt yelled they were in pain and wanted medication. Because the pt had a liver diagnosis, the drs were being cautious about the pain medication administered….when I said that I would see what was due…the pt demanded “Make sure you bring me 2 tablets instead of 1”. “Yep, this is going to be a long night…just shoot me now”.Needless to say…the rest of my night was spent keeping this one pt and the family happy…I spent four times the amount of time and energy on this pt then I did the my four other patients…because of course “if you don’t keep me happy, I’ll report you to Dr. X, who just so happens to be my friend”. And so the anti-polite, unfriendly thoughts once again enter my head “How in the world do you have any friends at all if you act this way all the freaking time!!!!”After that night, I realized that I have a strong objection and opposition to VIPs…not only are they pain in the butts for nurses…the greater truth is that should I not be treating all my patients the same…no matter who they are, how much money they have, or who they may or may not know?
Thursday, September 1, 2011
Beginning of a New Exciting Adventure
Who am I??? That just so happens to be the million dollar question...and I hope to find new answers to that question as I continue this next chapter of my life.
As a newly graduated med-surge nurse the first thing I have learned is...being a new nurse is scary, exciting, terrifying, exhilarating, and frustrating all at the same time; however I love every minute of it. As much as I love it…with the good comes the bad…believe me when I say there is a lot of bad…or at least entertaining frustrations…and sometimes I just have to get it all out…and besides I know everyone loves to hear my stories…so here is a way I can keep everyone updated on the funny, sad, or just the everyday stories of being a tired night med-surge nurse.
As a newly graduated med-surge nurse the first thing I have learned is...being a new nurse is scary, exciting, terrifying, exhilarating, and frustrating all at the same time; however I love every minute of it. As much as I love it…with the good comes the bad…believe me when I say there is a lot of bad…or at least entertaining frustrations…and sometimes I just have to get it all out…and besides I know everyone loves to hear my stories…so here is a way I can keep everyone updated on the funny, sad, or just the everyday stories of being a tired night med-surge nurse.
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