Today I got the punishment for something that was not my fault.

I got a patient yesterday from ICU. Meningitis, had a rough time of it but was pulling through. Very sweet lady who was an L&D nurse for over 20 years. Her family was at the bedside, a little anxious but generally kind and friendly. I joked around with her sons, we made each other laugh. They even gave me a recommendation for a local Middle Eastern restaurant with excellent food and low prices. Things were going swimmingly.

I was excited to have her as a patient again today. But there should have been alarm bells early on in the shift when the pt and her friend (another retired RN) asked when she was going to be moved to the other unit.

Now, I hadn't heard anything in report about a downgrade to Med/Surg, or an upgrade to Stepdown, so I said "I don't think you're going anywhere." Then I got busy enough with the start of shift that I pushed it to the side for a little while.

Then at about 1630 I got a phone call from the manager of our sister unit, who is covering for our manager while she's on vacation. She said that my pt was going to be transferred to her unit as part of a "customer service recovery" issue.

I couldn't get many details, but the gist was that the family was unhappy with her care on our unit during the NOC and AM shifts. The AM shift RN told me that one of the sons was grumpy with her, but I didn't think much of it since he has sort of a sarcastic sense of humour.

I can't imagine anyone being so upset that they request a whole new unit. Plenty of people request not to have certain RNs again, and we're very accommodating to that. But to change floors?

The manager of the other unit said "The family is happy with you. Don't worry about it too much" but wouldn't give me more than that.

So a little time passed, and the family showed up to help the pt get to the other unit. I knew it was bad when the manager was personally escorting the patient. Her son asked if he could fill out one of our "above and beyond" cards about me (we'll see if it happens; it'd be my first one!), and said that he emailed people saying that he was glad to have my care. He even asked if I could get transferred with the pt or if she could stay through the end of my shift.

So one of my best patients gets taken away from me for something other people did/didn't do. It sucked, and I was furious. But my anger doubled when about 15 min later I learned that since I now had an opening (the only free spot), I was getting a new admission from ER.

Luckily it was a pretty easy pneumonia case, walky-talky A&Ox4. Sweet older guy. Thank god.

The worst part about all this is that our unit looks bad. We've spent a lot of energy trying to get the unit's reputation out of the mud, and this is just one more stone weighing us down. "Look at Tele! People are begging to get transferred out!" When our manager comes back, we won't hear the end of it for awhile.

I hope the patient continues to recover well, and that something like this never happens again.

One of my patients was put on comfort care today, about 2 hrs before my shift started. They had called RRT on her for non-responsiveness and trouble breathing. When I got her, she was on the CPAP and pretty much nothing else.

I tried to be as comforting and supportive to the family as possible. I think I was doing a pretty good job of it.

Until ED started wanting to send people up, and we had no nurses to take them. Since comfort care doesn't require tele monitoring, she was to be moved to the next unit over.

The family was *not* happy.

I apologized profusely, and tried to explain that I was needed to take a patient who required monitoring. Really, there's no good/nice/easy way of saying "We need you out so someone else can come in." No matter how lightly you try to put it, you sound like an asshole.

So I asked the family to try to get their things together, as there were a lot of them there with a lot of stuff.

I saw the bedside table get shoved angrily out the door into the hall. There were a lot of reddened eyes and scowls. I assured them that the transfer would be quick and painless. One of the sons was concerned about her breathing, so I hooked her up to the portable O2.

Things were not made better when we got to her new room and there was no O2 hookup in the wall. I had to run down the hallway and steal one from an empty room. More glares.

I tried the best I could, and still felt like a jerk. I hate feeling like I have no control. I tried to ignore the guilty feeling so I could continue with my shift.



Then about an hour or so later, the two sons came to the unit looking for me.

They apologized for being so harsh. It really made my day, because I was not looking forward to trying to sleep tonight with a guilty feeling.

I hope all goes well for them, and that the patient's transition is peaceful.

I love that old people seem to lose their filters...

89 year old female, here for GI bleed. Tarry stools. Lots of fun. Anyway, the CNA and I were doing some cleanup.

The CNA had soaked a bunch of washcloths in rather warm water, and squeezed them out over her crotch to help get off some stool.

My patient says, "Oooh. That feels nice. I haven't had anything that hot down there in ages!"

It was all the CNA and I could do not to dissolve into giggles.

Argh. Stupid House...

Episode "Teamwork"

Chase hangs a piggyback but uses the blue extension hook on the piggy, not the primary. It's never going to go in, jackass. Maybe that's why your treatments don't work! Never send a doctor to do a nurse's job....

Never gets old, does it? Kinda makes you wanna... break into song?

I love sundowners
I love the bed alarms
I love old gentlemen
And their eccentric charms
I love telemetry
And its adventures

Boom de yada
Boom de yada
Boom de yada
Boom de yada

I love the C-Diff
I love the GI Bleed
I love CHF
Even COPD
I love telemetry
And all its smells and sounds

Boom de yada
Boom de yada
Boom de yada
Boom de yada

I love AV blocks
I love my rhythm strips
I love new A-fib
And starting heparin drips
I love telemetry
My job is pretty cool...

Boom de yada
Boom de yada
Boom de yada
Boom de yada.....



(copyright by me. written after watching one-too-many youtube videos)


Readers!! I need your feedback, as I'm torn on the very last line. Should it be "my job is pretty cool" or "my job is killing me"? The latter is (much) more accurate, but I was actually thinking of making a video for it that management could someday see...

The V-Fib came out of nowhere....

It had been a slightly rough start to the shift. I found out I had two patients with behavioural issues on either side of the station. Luckily my ETOH W/D had a sitter, but the other one did not.

She was under 50, but had had a recent stroke. Until a couple days ago, there had been no residual. But then she stopped being able to perform ADLs, and her husband brought her in. Now she was agitated, trying to crawl out of bed, and almost nonverbal. Plus she mostly only spoke a foreign dialect that only one of our CNAs (the one who was supposed to be siting with my ETOH) knew, so he was in there trying to keep her calm.

The offgoing nurse let me know that she'd gotten haldol a couple times his shift, and he saved a X1 ativan for me. A little before 1600, the ANM said that now might be a good time to give the ativan so the CNA could go sit with my other patient. Within 10 minutes she was calm and sleepy, all systems normal.

The MDs were concerned about her having seizures because of the location/type of brain damage she suffered, so we started her on dilantin.

I went to go print my strips. She was normal sinus rhythm. I turned to say hi to a nearby doctor, then turned back to the monitor to finish the strips. All of a sudden, V-Fib. For a split second I thought "This can't be real" so I went to go check on her.

There were 2 nurses outside her door, about to go in and do a skin check (THANK YOU GUYS SO MUCH FOR BEING THERE FOR ME!!! YOU ARE AMAZING NURSES!!!) They saw the look on my face when I went into the room, and followed me.

She was slumped over in the bed. It almost looked like an absence seizure or a stroke. Her tongue was protruding, and she was making blubbing noises. We sat her up a little more, did a shake and shout, sternal rubbing, checked for pulse. I had almost hit the code button when she took a deep gasping breath. We felt a moment of relief before we realized that she was probably not going to be taking another breath.

I hit the code button and we started CPR.

From that point, it's a blur of people and activity. Within 10 seconds there were at least 20 people in the room. It felt completely unreal. Like I was trapped in a TV hospital drama, except this was my patient.

I remember people hooking her up to the defibrillator. She was in Torsades de Pointes. The MD yelling for Mag, which was *not* in the cart where it should have been. Finally they bring another tray and we get the Mag for him.

We stop the dilantin infusion, start NS running full blast. Put a compression sleeve on the bag to make it go faster. Starting a central line. CPR still going, intubation in process. Everyone clear for the defibrillator. Still no pulse, CPR continues. I try to clear debris off the floor so no one slips. There is packaging everywhere. Another shock. I took over for chest compressions for awhile. More feeling of unrealness. Drugs are going in. Triple lumen central line in place in the groin. One of the docs stitching the line down to the thigh. That must hurt, I thought, then remembered my ACLS instructor saying "It doesn't matter what you do in the code. The person is dead and not feeling a whole lot" The MD forgetting to let go of the guide wire before the next shock until another doc told him to drop it. Shock again.

The pulse came back. I go give report to ICU who has a bed for her. She's on the unit even before I finish giving report.

From hitting the button to sending her to ICU was around 30-35 minutes. Part of me feels like it lasted so much longer than that. Part of me feels like it was over so fast. I totally forgot I had other patients. It was probably the most in-the-moment I've ever felt. It was also probably the most disconnected from reality I've ever felt as well.

The ANM congratulated us on doing a good job. I was certain I'd get in trouble or something. I must have done *something* wrong to make this happen. Turns out she had an MI related to an LAD blockage. Not my fault. Thank god.

I was pretty shaken so I took dinner early. Went to the garden near L&D. They have lavender and rosemary growing there. I laid on a bench, listened to some music on my phone, watched the clouds, and tried to will my heart rate to go down below 100.

I can no longer boast about never having a patient code on me. But I no longer have to fear it eventually happening. And that's probably the better of the two options.

Sigh. I had hoped she would recover...

I posted about a girl with lung cancer back in June. She and her friends got me dinner from Jack in the Box when I forgot mine. Everything seemed so bright and hopeful when she was finally discharged.

Today while heading out of the break room I noticed a new magnet on the fridge.

"In Loving Memory, P*, *1981-June 14, 2009" with what appeared to be her Senior Photo in the middle.


Really bummed me out on my way home. She was such a sweetheart. And yet the 85 yr old non-compliant CHFers just keep ticking. Stupid world.

New syringe design makes re-use impossible

I'm glad people like Marc Koska exist... Truly brilliant

Man I love children...

At work last week a dad came up to the back station with his two kids (8ish and 12ish?). Their mom was on our unit, and the kids were understandably worried. The dad wanted to help reassure the kids, as well as see how his wife was doing.

He asked if the kids could take a look at the telemetry monitor at the desk. I said sure and brought up the appropriate strip window and turned the screen towards the kids.

It was a picture-perfect sinus rhythm, 60-62. I didn't know the patient, so I don't know if that's on the brady side for her or what, but it looked fine to me. I asked if either of them had seen something like this before, and the older one said it looked like in movies. I said that the heart runs on electricity, like a machine, and the bumps were little jolts of electricity. "When the heart gets shocked, it squeezes up tight, just like when you get a static shock and you feel yourself twitch a little bit" I pointed out the QRS complex: "This point here is what tells the heart to beat. See how everything is very smooth, and the bump (P wave) is nice and round, and the spike (QRS) is thin and pointy? Those are all good signs of a healthy heart."

The kids looked a little relieved, as did the dad, I think. lol I brought up another strip, with had a fairly jagged baseline, the occasional missing P wave, and huge blocky QRSs. I pointed out how different it looked from their mom's. Hers was just plain prettier to look at.

Then I told them about the monitor techs in the cockpit looking after her heart, and the phones we carry calling us automatically if something bad happens "but something bad won't happen" interjected the dad. I hope he's right. The dad thanked me for explaining things to them. I told him it was probably the best thing that happened for me all week.

I really enjoyed the interaction. I miss young people a lot. I miss being able to educate people who have open minds and vivid enough imagination to make sense of what I'm telling them. I need to get the hell out of telemetry.

Spotted this on Nurse In Australia's blog. Had to share....

Be warned, the injection techniques are somewhat scary. What licensed person would even *think* of doing it like this?

Had an odd, yet very good, shift this evening

When I got my assignment at 1500, I was a little concerned. One of my pts was going to cath, and not coming back. One was to be discharged ASAP, as the family was getting antsy. This would leave me with two spaces for admissions. Wheee!

So I got my two out of there as soon as I could. While I was trying to get ducks in a row for my DC, I get a text from monitor tech saying that one of my pt's leads was off. So I go into the room, and my pt is practically dancing out the door, tele box on the bed. I ask her what's up, and she said "The doctor said I can go home!" "Well that's all well and good, but we prefer if you tell the nurses before you start tearing off equipment." She laughed and apologized, and I went to go see if there was a discharge order. Sure enough, in the space it took me to go see her and get back to the station, there was a new order. Okeydokey, I thought. Why not just let another one go...

Did the DC in record time. I was down to one patient by 1630 or so. And my last patient was a young walky-talky who came in for ACS, and had been chest pain free since the morning. Pretty much just here for Lovenox to thin his blood so they could try to avoid another cath (he'd had one in July).

So I was the best damn nurse I could be to my one patient. I also helped 2 other nurses pass meds. Frankly, I was bored lol. I was told I'd be getting an admission, but by 1830, no one called to give report. The Charge and I did the math, and figured that I could go on committee and give my pt to one of the incoming RNs at 1900.

When on committee, you're supposed to do audits and paperwork. I ended up being more Resource-like (as I always do) because it helps the unit far more than all the paperwork in the world. I got to help orient one of our new traveling RNs, a nurse who'd been on the job since I was in kindergarten. I know it's hard getting used to a new hospital with a new system, but she seemed extra frazzled. I helped her out with the computers, drew some blood for her (she said she wasn't very good at it) and found her brain when it went missing. She gave me a hug and a peppermint candy when I found her brain lol. It was very cute.

When I finally went on dinner around 2015, I decided that today would be the day I EKG myself. I've had a weird arrhythmia for a couple years now. Hard to type out, but it's something like lub-dub, lub-dub, lub-dub, lub......DUBlubdub, lub-dub. Everytime I have one of the weird beats, I imagine it looking like a PVC on an EKG. Not that I think/know that's what it is, but it's what it feels like if that makes any sense.

Alas, plain old normal sinus arrhythmia.

After all that effort to hook myself up (granted I only used 5 leads out of laziness) I hoped at least the mysterious rhythm would be identified. No such luck. Maybe I need to be hooked up for an hour or so, maybe overnight, to give my heart a chance to act up.

I even got the opportunity tonight to make the assignment for the unit at 1900 and 2300. I hope I did it okay, and no one was too mad. I think those assignments are easier than the 0700 one. At 0700, *everyone* leaves and you have to start fresh. At 1900 and 2300, only 2 people left each time, so you just sorta fill in the blanks. It was good experience, though, despite the battle with the copier that followed.

I can only hope for another good night tomorrow, day 5 out of 5 in a row. I can't wait for some days off!!!

Attention! Just a helpful PSA for all those involved in patient care:

We use "emesis" basins as a spittoon for people brushing their teeth in bed. They make great trash receptacles for used tissue. If new and clean, they are useful for containing snackyfoods on the bedside table.

But when a patient turns into a vomit-breathing dragon s/he is *not* going to be able to aim for that little thing.

We try to make sure everyone has a big basin upon admission, but it seems there is never one in the room when the patient needs it OMGNOW!!!!! If you throw a basin away, pleeeease bring in a replacement one.

And that's it for my barf-related rant. :)



Thanks very much to NursingBirth for letting me use the image. Funniest thing I've seen online today. Guess that says a lot for my sense of humour lol.

Handwashing Detectors... interesting

http://www.msnbc.msn.com/id/33297138/ns/health-health_care/

"When health care workers enter a patient's room, they wash up and run their hands beneath a nearby HyGreen sensor. The HyGreen sensor activates a green LED light on workers' badges to signal that their hands are clean.

A proximity monitor by the patient's bed then sends out infrared and acoustic signals to the badges, and when the health care workers approach, the monitor verifies that the green badge light is illuminated. If it isn't, the badges quietly vibrate to alert health care workers to clean up. "


"Whenever the HyGreen bed monitors verify if health care workers have washed their hands, they send that information, along with the time and location, to a wireless database maintained by the hospital's infection prevention team. That way, hospitals can know in real time which workers aren't washing up. And, if a hospital-acquired infection breaks out, they can pinpoint the source more accurately."


I'm all for handwashing. I know how important and essential it is. But this seems creepily Big Brother to me.

At least they're discreet. Though I'm wondering how clunky a vibrating badge would have to be. I'm picturing a restaurant pager hanging from my chest lol. And a vibration that buzzes as loud as my cell phone. That wouldn't be good. The last thing I need is a confused little old lady going "what's that?!"

I know I'm not perfect in my handwashing. Especially when I have my hands full of something as I'm entering the room. I wish we had some sort of clean surface to put things on outside the pts' rooms so we could use the gel, then grab the stuff and go in. Most of the time, I end up going in the room, putting the things down on the garbage can lid (because it's the only available flat space in the room), then using the gel. Not the most hygienic practice.

I look forward to the day when we can just irradiate our whole bodies every time we enter a room lol....

A quickie....

I am in the middle of a scheduling block from hell. 5 on, 1 off, 1 on, 1 off, 5 on. Tomorrow will be my first day off. I don't know if I'm going to survive. This is frickin' ridiculous. I'm thinking I'll call in sick Thursday so I can get 3 days off in a row to recuperate. My back it sore as hell from moving heavy people around, and it feels like I'm walking on shards of glass.


As for the quickie, the other day I was going to pull up insulin. Our B station med room was out of the 50 unit syringes, so I went to A station. They had about 20. So I gave Material Services a call and they said they'd take care of it. I did my 1800 med pass, went to dinner and didn't think about it until 2100 fingersticks.

I checked the med room and we didn't have any more syringes than we started, so I called MS again. This time I was informed that they were out.

Yes, the storeroom of a *major* chain hospital was *out* of 50 unit insulin syringes. "We might get some tomorrow," I was told.

So tomorrow (ie, yesterday) comes and we still don't have them. We have to use the 100U ones, which are a pain in the ass to dose accurately. I asked the ass.man. about it and he said he'd call again. Here's hoping today we'll actually have the supplies we need to do our jobs...



But an even bigger hope is that Staffing calls me off today so I can rest my weary bone. I'm too damn young to feel this old.

Fun doctors' notes, part II....

Do I sense a series beginning? Anyway, here goes:

"CODE STATUS: DNR/DNI and pressors okay partial code. Son Dr. R (psychologist ) easily reachable and involved in the patient's care. Go to sleep man"


I can only imagine what "go to sleep man" refers to... Is it a reference to the son being involved in pt's care? Or a note to another MD to get some rest? Or to himself?

No one knows....

Can't a girl catch a break?

So it's 2253. Just did a final rounding check on my patients. They're all comfy in bed, falling asleep. Came back to the computer to make sure I'd finished all my charting. I notice on the monitor that one of my patients' pacemaker is acting very strangely. He'd been tachy in the 120s all day (each QRS with a pacing spike before it) but this time each QRS had two pacing spikes. Having never seen that before, I decided to call cross-cover and let them know. He'd had the battery replaced recently, and I figured any info on it would be helpful.


Two minutes later I get a text from the monitor techs. "rm 55 leads off. thx"

Immediately I get a sinking feeling. Rm 55 is a 90/f who fell yesterday and broke her hip. She has Alzheimer;s, and is confused easily. When asked, she is oriented to person and place. In an odd way, though, it's like her answers are recited and not understood.

"Do you know where you are right now?"

"Big Shiny New Hospital"

But she does not know what it means to be at the Big Shiny New Hospital and she can't remember why she's here.

So I head on down the hallway with the sneaking suspicion that she pulled all her wires.

Why can't I ever be wrong?

Not only has she pulled her tele, she is naked except for her SCDs and a smile, and her two IVs are sitting on the bedside table, along with some kleenex that was obviously used to stop the resultant bleeding.

At that moment I get a call back from cross-cover, who tells me to do an EKG on Mr CrazyPacer. Standing outside a naked woman's room.

I get off the phone as quickly as humanly possible and attend to Ms Sundowner. Still A&Ox2, and pleasant as can be. As she had all day, she would respond to any statement with "Whassat?" until it was repeated several times. I tried to explain, yet again, that I was her nurse and that I would help her. Happened to see my watch. 2257. There's no way I can clear this up in 3 minutes, so I call my Resource.

She comes in and takes over so I can give report to the poor girl who is taking over for me.

Report is given in record time, with much sighing and eye-rolling (understandably. I love you S! *grin*) from my replacement. Since we've finished quickly enough, I tell her I'll take care of Mr CrazyPacer's EKG.

It's 2315 and I get into the room and start up the machine, and I get a call from the Ass.Man. who is demanding to know why Ms Sundowner is getting a sitter and wondering what medications I could have given her instead and asking why I am not rounding more frequently on a patient that I know will be sundowning because she has a history of dementia and what isn't she getting something around the clock for her dementia and I nearly yelled at him to STFU.

I told him that I went by her room about twice an hour and she was sleeping the whole shift. She had no PRN anti-crazy meds and nothing around the clock. The only thing she was taking for Alzheimer's was Aricept. He then starts badgering me about what the MD said when I called (but I hadn't gotten a chance to call) so then I got questioned on why I didn't call. I told him that I knew nothing of the sitter because I asked the Resource to take over so I could give report, and that anything that happened between then and now was something she initiated. I told him I was trying to do an EKG and got off the phone as quickly as possible.

I apologized to Mr CrazyPacer (who was awesome btw) and did the EKG as best I could. The machine decided to hate me and I forgot which button printed out the kind of strip the MD wanted. Eventually got it and then got the hell outta Dodge.

The last thing I wanted was to run into the Ass.Man. on my way out.

I did the best I could, and all I got was him taking out frustrations on me at end of shift. AAARRRGHHH!

I made it through my first year!

I want to take a moment to recognize all the other Not-So-New Grads who survived the first year with me. You guys are all amazing and wonderful, and I can't think of a better group of girls to go through hell with. Without the support and humor you guys provided, I probably would've done something insane by now. You rock!!!

It's hard to believe a whole year has gone by. I'm sad that some people didn't make it this far, but I wish them all the best in their futures. :)

I've been debating on getting a nursing-related tattoo to celebrate a year, though some tell me I should wait until five years. When I'm *really* sure.

Any thoughts out there in internet-land?

Sometimes the doctors' notes amuse me...

At our hospital, when the main MD "signs out" for the night and cross-cover takes over, the MD will write a little note with plan of care for reference. I found this little gem the other night:

"If pt decompenstes with generalized respiratory badness, call pulm. Okay to titrate up 02 if necessary. If pt spikes temp overnight, do not re-culture. Don't even *think* about it.... ;) "

Yes, including the winking smiley face. And "respiratory badness" is apparently a technical term now, so that's cool. Now my friends won't give me crap when I describe things as "________ badness" because we know it's officially sanctioned.



Just a little silliness to brighten up the day :)

It's raining crazy at work

So usually our unit just gets little old people with CHF, COPD, GI bleeds. Stuff like that. Rarely do we get anyone under 50.

Tonight we got two, both with psych issues. They came to our unit within 5 minutes of each other (around 2030). One was an admit from ED/PACU, the other a transfer from stepdown.

First one was a mid-40s male who came to ED with "penile pain." I'm thinking, there's got to be something more to this. Penises don't just hurt without a really good story. So here it is:

"Patient placed 5-6 kidney beans in his urethra last night for sexual pleasure. He has been unable to void since 10 PM last night."

Kidney beans? Seriously? I have to wonder at what point it seems like a good idea to place small, irretrievable objects into ones urethra. Didn't he know they make toys for that? Hell, if you want the lumpy feeling, at least use beads on a string or something! Someone should make a PSA (a la Scrubs) about not sticking things where they don't belong.

So the poor guy had to be put under general anaesthesia for a cystoscopic removal of the kidney beans. He must've had some sort of complication, because post-op he ended up with us. Either that or they were out of med/surg beds. *shrug*

Unfortunately, I was just Resource, not his primary nurse. So I didn't get to hear it straight from the horse's mouth. I'm sure it was an interesting story...


Our other crazy patient was in her late 40s. Attempted suicide 4x in the last 3 months or something like that, because she felt like a failure as a wife and mother. (Aside: killing yourself is the *ultimate* in failing as a wife and mother.)

Anyway, she had expressed suicidal ideation, so her husband took her to the ED. While in there, she went to the bathroom. When she came out (after an unknown amount of time) she told one of the nurses that she had taken "about 60 pills" which she had smuggled into the ED in her vagina.

I checked *all* the subsequent notes in the computer. *None* of them mentioned whether the pills were in a bottle, or just shoved up in there. For the sake of "ewwwww" I hope to god they were in a bottle.

Anyway, the woman was a terrible historian, and couldn't remember if they were Cymbalta or Klonopin or what. All the notes had different meds listed. But by my accounting, if you take 60 of *anything* you'll probably get sick.

So they dropped an NG and did gastric lavage, bringing up "no pills or pill fragments." I find that odd, cuz pills take awhile to dissolve fully. So either she took the pills earlier than she said she did, or she didn't take any at all. But she became fairly non-responsive and lethargic, so they brought her up to stepdown for monitoring. When she got a little better, she came to us. She had at 1:1 sitter that came with her, so that was nice.

Both of them are to be evaluated by psych when they're a little more "with it." I wish I could be a fly on the wall for those conversations....


UPDATE: I asked one of the RNs who took care of kidney bean guy, and she said that the reason for the beans is that if they stay in long enough, the body's natural moisture makes them swell, which apparently feels good. So there you have it. :)

Dear pt in rm 60,

Please stop trying to sabotage your own health. It kills me to see you every day, getting better, but not getting better as quickly as you could be. I know it sucks being in the hospital, but combating everything we do is just hurting yourself. Please meet us halfway at least. It's the least you can do for yourself.

Love, PurpleRN



She came in because the swelling in her legs had gotten so bad, she could barely move them under her own power. The unit she was on tried IV lasix a couple times a day but it kept dropping her BP. So they sent her to us for a Lasix drip.

The swelling in her legs caused her considerable pain, so she had Dilaudid on board. She was a clock-watcher. The moment enough time had passed, she'd ring for another hit. And get rather upset if it took more than 10 minutes to get her meds. I understand that being in pain sucks, but we have people circling the drain on our unit. Your legs are slightly less of a concern sometimes.

She's on fluid restrictions because of the edema. Fluid restrictions suck. Imagine some "high faluting" doctor saying, you can only drink 1.5 liters (~6 cups) of fluid today. Period. Well what if you don't budget properly and drink 5 cups of water in the first 12 hours of the day? Screwed, my friend. So she'd been sneaking drinks and not reporting them to the nurses. Her husband/partner-in-crime wasn't helping on that front either, showing up with fast-food meals.

She would go on "walks" with her husband (he pushed her in a wheelchair) a couple times a day, to the atrium near L&D down the hall. We explained that she was going out of telemetry range, and we couldn't monitor her heart out there. She didn't care. And she would come back smelling of cigarettes. Our campus has a strict non-smoking policy, and we told her we could get her the patch while she was in the hospital. She refused, saying it wouldn't work. I hate people who automatically say no without trying.

She threatened to leave AMA if she couldn't smoke, so the doctors let her go off campus with a security guard for cigarette breaks a couple times a day.

What the hell? "THRIVE" my ass! Just because a patient gets whiny doesn't mean you bend over backwards to thwart her recovery!

I bet you're asking, well why not just let her leave AMA? Because she said, "I'll just come back to the ER when I'm done with my smoke," and that creates more work for us. (Aside: I'm of the opinion that if you leave the hospital AMA, you are not allowed to seek medical help for at least 48 hours. If you die from your own stupidity, so be it)

Doesn't advocating for your patients include trying to protect them from themselves? Sure, she's doing better than she would be if she wasn't in the hospital, but she's not getting better as quickly as she could.

Last but not least, we've been very concerned about falls on our unit lately. Our patient population is such that they're mostly too unhealthy to get up unaided, but not with-it enough to realize they need help. Or too proud to ask for help. We even had a recent meeting on how to reduce falls. The only time I took care of this patient was when she came to us from the other unit. I told her that if she needed to get up, she needed to call me first. Obviously, since her legs were so swollen (and she is obese) she couldn't move very well.

My shtick is to say, "I know you don't want to bother me by calling for help, but I'd much rather help you to the bathroom safely than scrape you off the floor when you fall. Plus the paperwork is *insane*. Please don't make me fill out paperwork" Usually it gets a laugh and a promise to call before getting up.

Well she's been with us a few weeks now, and apparently thought she was in good enough shape to get up on her own. She ended up on the floor, requiring xrays and various other tests for broken things.

I know you don't want to be in the hospital anymore. I know you think 3/4 of our nurses are idiots. But you're not doing yourself or anyone else any favours by screwing up your recovery with what *you* think is right. Your treatment team (MDs, RNs, MSWs, PTs, etc) went through lots of schooling and training and hell to know what to do to get you better and get you on your way as fast as possible. Believe it or not, we know what we're doing.


It makes me wonder how we can properly advocate for patients that won't accept it. How can we encourage people to take ownership of their health? Noncompliance increases complications and drives up medical expenses, neither of which are in *anyone's* best interests.

Any ideas?

Update to "Siiiigh"

So after all that silliness about being requested to stay 16 hours, I ended up going home early :)

At about 1730, I get asked if I'd like to leave early, as we will be overstaffed starting at 1900 when the 12s come on shift. Of course I jump at the chance.

At 1900 when I'm giving shift report, one of the 12s comes up and says "If you want to stay, I'll go home and come back at 2300" as if he's trying to do me a favour.

I became briefly worried, "Wait, are you asking me to stay or telling me I *have* to stay?"

"Do you want to stay? Cuz I'll go home. You can stay if you want."

"Um, no thanks. I'm happy going home..."


Afterward, I was told by the nurse I was giving report to that this guy works 2 jobs, and that's why he always looks exhausted, so he probably wanted another 3 hours of sleep. I feel kinda bad about it, but I'm also greedy for time off.

Sorry dude.

Siiiigh

So I called Staffing this morning to ask to be considered for the day off if we are overstaffed like yesterday (one of the girls was put on committee and then sent home early). It's rare that they call back, but it's like the best present in the world when they do.

So when my phone lit up with !!WORK!! my heart got very jumpy and excited. A free day off? Yay!

Turns out it was not Staffing, but the BossLady asking if I wanted to plan ahead to work 16 hours tonight.

Ha. Right.

I politely declined.

Guess I'm definitely not getting the day off.

What is it with little old men?

Two have tried to kiss me in the last two days. Sure it's a little cute and funny, but how do you respond to an octogenarian's inappropriate advances?

The first one was in for breathing problems. He was always up and about, with his heart rate skyrocketing and his O2 sat plummeting. I couldn't convince him to call me before getting up, so I put a lot of extension tubing together so he could get to the bathroom without taking the oxygen off.

Anyhoo, I'd finally gotten him settled in the chair and he was griping about how he couldn't figure out the TV, and really wanted to watch the baseball game. So I flipped through the channels, and found the appropriate game. He said "Yippee" like the cute grandfather in Charlie and the Chocolate Factory and "You deserve a kiss for that! Just one on the cheek"

I politely declined.

The next one in question had just arrived from ED earlier that shift: an unnecessary admission for high blood sugars. Paranoid wife. At any rate, I was finishing up my end-of-shift things and stopped in the room for a last check before report.

I asked, "Do you need anything, or is there anything I can do for you before I go off shift in 15 minutes?"

"Well, I *usually* get a kiss goodnight before bed..."

I paused and said, "I'm pretty sure your wife won't be happy about you kissing a young nurse at the hospital."

"I won't tell if you won't!"



My main question is, "Does it ever actually work?" C'mon guys... give it a rest already.

I worked my first (and last) double on Tuesday

Oh what an interesting experience.

I'd been having a really good day on Tuesday. I was Resource (along with L, another not-so-new grad). It was pretty busy, and I had to jump in feet first to get a patient discharged. His family said that if he was not ready to go by 1600 they were not going to be able to get him and he'd have to stay another day.

After that had all gotten settled, it was a pretty smooth shift. Gave people their breaks, helped with fingersticks, did other Resource-y stuff. Nothing eventful enough that I remember it.

But near the end of shift we get word that 2 or 3 of our night shift nurses have called in sick, and they need people to stay double.

Now, I have to say that it's a running gag at this point to ask me to work a double. The Ass.Man. (teehee. thanks to J for the abbreviation) still asks anyway, with a huge grin on his face, knowing I'm going to say no. I'll be the *first* to volunteer to go home early, but I'll be damned if I work anymore than my contract says I have to.

But today I'm thinking, "Well, things are going pretty well. We have 24/26 beds filled, and 6 RNs (we have a 1:4 ratio) so we're full. I guess I'll stick around just to see what it's like."

So I shock the whole world by agreeing to stay double.

I give the boyfriend a call and let him know I won't be coming home as previously discussed, and that if he really loved me he would bring me Starbucks and a salad from Jack-in-the-Box. Not only did he come through for me, he drove miles to find a Starbucks open at midnight, and he got food for L as well. He's so sweet lol.

The first part of my second shift was cake. Potter came a little after midnight, and I took a 15 to show him around the unit and hang out a bit. We ended the tour when one of the pts became confused and his nurse was too busy to re-orient him.

He was a sweet guy who "just felt disorganized" and couldn't figure out where he was. I reminded him he was in the hospital for a bowel obstruction, and that the NG tube was to keep his stomach from filling up with gunk (technical term). He said he knew all that but just couldn't figure out where he was. So I got him up out of bed and walked him to the doorway. Pointed out the main station down one way and the big window down the other. Eventually he got it and was content to try to sleep.


After that, I asked the 3 nurses on my side (there are 2 stations on the unit) when they wanted to take their dinner breaks, offered to help out with anything they needed, and mostly just sat on my butt, slightly bored.

Heck, one of my nurses didn't even tell me when he was going on dinner, or give me his phone or anything. Very different from on PM shift.

Then we found out that ED was OMGFULL and that one of the resources (me, apparently) was going to take an admission. Ok, not a huge problem.

So at about 0330 I decide to take my dinner (mmm southwest chicken salad without the chicken) and relax before I got report. I also have an insane urge to brush my teeth, because this is about the time I go to bed normally. Thank god I keep a toothbrush in my backpack :)

At 0355 L pops her head in and says, "Did you get report yet on 54?" "No, why?"

"Because he's here"

WTF?! Seriously ED. That is *NOT* cool. You do not bring a patient up to the floor without giving report or warning. I understand it sucks being full, but blindsiding a nurse is just not fair.

And this is where the clusterfuck began.

If we had gotten report we would've known that the pt was on droplet precautions (ie, he was coughing and may have something communicable) and we would not have assigned him to one of our 4 double rooms (the rest are singles).

So at 0415 we have to start playing the bed-shuffle game. One patient got transferred to another unit, and then about 5 different patients had to get switched around to accommodate the nursing assignments, because it would suck to have a patient moved all the way across the unit halfway through your shift.

Finally get everyone settled and I try to do my admission the best I can with the few remaining hours of shift. Also trying to be helpful to the other nurses, as I only have 1 pt to their 4.

As the sun came up through the windows I started feeling really exhausted. And when the day shift nurses started streaming in I got the most surreal feeling. It was like I was on the wrong end of time. It was funny watching all the Day RNs' faces register the fact that I was there at start of shift, not end. Barely concealed surprise and shock, and quite a few laughs and "What are you *doing* here?"s

I give report to whoever was taking my patient, then try to give report to the Resource whose side I was on earlier that night.

Got out of there about 0745 and headed out. Immediately, I was confronted with something I hadn't expected to deal with: traffic.

"Oh god. I don't think I can deal with this" I felt the strangest kind of awful driving home, realizing that I had about 6 hours to get home, sleep, and get ready and leave for my normal shift at 1500.

I honestly don't remember much about my regular shift. I responded to frequent statements like "You honestly stayed double? You never stay over! What made you change your mind?" I know that my Resource saved my exhausted ass on a couple occasions. I made promises to patients that I forgot to keep. One of my patients was a retired L&D nurse, and she was very understanding about my situation. Didn't make me feel any better about it, though.

Near the end of my shift I realized that I was getting paid time-and-a-half (or double?) to be a *terrible* nurse. And as much as I'm sure my paycheck will be nice this time around, I can't do that to myself or my patients again. It's not fair to anyone.

At around that point, the Ass.Man (who is becoming cooler these days) comes around and asks people for their Starbucks orders, as he is going on a run and apparently won the lottery. I put in a request for a nonfat vanilla latte (mmm) and go about finishing up my to-do's. I felt a little bad, as I think J may have been trying to just get stuff for the people who were staying double but no questions were asked and, hell, I feel like I deserve free coffee on occasion. And man was it good. Who cares that I was drinking that much caffeine so close to midnight lol.

So I guess if I were to evaluate everything, the only situation I'd work another double is if we were *full* (26/26 beds taken) *and* I was Resource *and* I wasn't working the next day. Because I have better things to do with my life than work myself to death.

In April I wrote a post called "Nursing is a 24 hour job"

This, I suppose, is somewhat of a corollary.

Two days in a row, I have gotten patients from the same nurse. Rumor has it that she used to work ICU/Stepdown. You'd think she'd be able to handle some measly Tele patients.

Two days in a row, I started receiving report 10-15 min late, because she is running around crazy trying to finish things. I *know* day shift has a lot more going on. But when you give report late, you steal 15 minutes from my shift. I have my day carefully calibrated, and even 15 minutes can screw things up sometimes.

Now that we are computerized, the first thing I do when I get on is set up my eBrain. I still have a paper brain, but this one keeps my patients where I can see them quickly on the computer. Yesterday, I set things up to find that one of my patients has 6 overdue meds that were scheduled for 1330 & 1400. The nurse is aware of one of them, some IVIg (an immune factor), is late because the pharmacy needed to send up special tubing. That's fair. But what about the other 5? I know that I have a 2200 med pass (one hour before end of shift) and I plan accordingly, trying to get them all in starting at 2130. But she didn't even realize they were there. Today, there were 2 overdue meds each for 3 patients.

This blows my mind, because she should have an "Overdue Med" column on her eBrain. I see mine every time I use the computer, multiple times an hour.

Usually her excuse for not being up-to-date with everything is that she got an admission. I know the day shift is more used to discharges than admissions, but come on. It's not like you have to wait for the UA to take all your orders off and put them in the chart. Or you have to wait for the pharmacy to receive all your med orders and get them into the computer. It's all done instantly. Click click click click click. Acknowledging new orders takes seconds. The admission interview, granted, is a little longer than before, but it's still mostly the same. And charting is another set of clicks.

I wonder if she forgets she has Resources. Or if Resource is too busy on Days. I know that the moment I found out about all the overdue meds, I let my Resource know that I'd need help catching up with my day or I'd be way behind. And my Resource went over and passed the meds so I could assess my patients and start my shift properly.

Apparently I'm not the only one complaining, because the manager asked me to write up specific instances for an employee performance review. And she got a talking-to. I feel really bad about that, because I know what it's like to get a talk from them. But I also hate having to clean up after people who should know better.

A compliment last night

I had a pretty easy load after one of my patients was DC'd @ 1600, leaving me with only three. So when one of my pts complained about her gown being wet (not sure if it was incontinence, a spill, or her gown got dunked in the bedside commode) I figured I should take care of it. Nothing better to do, so why bother a CNA?

I got her gown changed, and decided she should go for a walk. So we took a slow 1/4 lap around the unit. When we got back, I noticed her bed was also a little wet, so I set her up in a chair and got fresh linens.

A little after my return, one of the CNAs (a tiny little lady who used to be a schoolteacher) was in the room doing her 2000 vitals. I start remaking the bed and she remarks, "You're doing *my* job"

I reply, "Well, *you're* also doing your job right now. It needs to get done so I'm doing it."

"You sure you don't want any help? I can take care of it when I'm done with vitals."

"No, I got it. Don't worry"

She looked a little shocked.

Then she pushed the vitals machine to the side, smiled, and stood on tiptoe and stretched her arms up to give me a hug.

"You're a good nurse. Thank you."


:)

I originally started writing this one at the beginning of July. Apparently I suck at follow-through...

We switched over to computerized everything on Saturday June 20.


It's been 2 weeks. In that time, I've worked 8 shifts, which is just about enough time to become comfortable analyzing the system.

The first few days were insane. Everyone was freaked out. Our shift especially, since we were the first to do *everything* paperless. The tail end of the day shift caught the beginning of the "cut-over" so they had done a couple things, but they were mostly on paper. Since we didn't have access to the paper charts, a *lot* of things were missing. It was hard to find the previous assessment info. The UA was confused about where things were supposed to go, and kept forgetting that there was no paper.

Thank god they only gave us 3 patients instead of 4, so we could spend some extra time getting acquainted with the system. We had roving experts to help us figure out where certain things were located when we were panicking.

I managed fairly well.

The 2nd day I got my first admission. It came at a very inopportune time, right around 1800 med pass. Not only that, but dialysis wanted her to come down right away. I barely got the admission work done and sent her over. She came back 10 min before end of shift, with all her meds flagged as "overdue" on the computer. I didn't want them to get forgotten by night shift, so I didn't resolve them. Because when you resolve them they go *poof* I still don't quite know how to reconcile the situation.

Since then it's been fairly smooth sailing. I'm still a little sketchy on sending people to procedure. I had the honour of figuring that one out during the first 30 minutes of my shift yesterday when one pt had to go to the cath lab. Apparently there's a procedure protocol or something. I hope I did it right. I haven't heard anything back, so I'm guessing it's all good.



And now, for your enjoyment: A list of good stuff and bad stuff!

The Good Stuff

• Time Saving! My shift assessment goes like lightning, just clicking through the applicable items. And I can finally click "No change from previous" for my 2nd assessment of the day without looking lazy like I did on paper.
  
• New Orders in Real Time! I can call a doctor and ask for an order, and it will be put in the computer within minutes. No scanning/faxing things. It's just there. *poof* like magic
  
  
• No More Annoyed Calls to Pharmacy! If there's a problem with a medication, I can click on the med's profile and sent them a note about it. Like "He got this medication in ED. Please change administration time to reflect" or "Med not in either Pyxis or cassette. Please send." Missing medications are figured out much more quickly
  
  
• Orders don't get "thinned" out like they did on paper. If it's still active, it's still there to see. So if you're wondering "Is there really an order for this?" you can look through for it.
  
  
• 
  

The Bad Stuff

• The Amazing Capacity for Mis-Charting! You should *not* be able to put the charting for a chest tube's output in the same flowsheet as the results for fingersticks. But with this system, you can add a "Line/Drain/Airway" anywhere you damn well please. I think a lot of people go "Oh right! He has a ______" and then add the thing, no matter where they are charting at the moment. And people, for the love of god, if it's a piggyback medication, add the Piggyback/Bolus group! Not Maintenance fluids! Same goes for actual boluses of fluid. Makes me crazy when it looks like maintenance fluids have been charted, but the MAR says it was a one-time fluid bolus. AAARRRGH!
  
  
• Dealing with Labs! Say a bunch of labs have been ordered over the course of the last day or two or three. They all show up in the "Lab Orders" section of the report. Even if they've been drawn and sent days ago, they still show up. So it makes you wonder if it's been done, so you have to hunt thru the lab results to see if there's evidence of its existence, or call the lab to see if they've received the sample but the lab's not done with it yet. There needs to be a "complete" button next to the lab orders. I've been adding notes at the top saying things lik "MRSA swab sent 7/3 @ 1900" just so the next people have an idea what I've done and haven't done.
  
  
• Dealing with Lab! If the doctor puts in the wrong kind of order, it looks like we are supposed to draw routine scheduled labs when it's actually more suited for the Lab to do. And I haven't figured out a way to switch things from unit-drawn to Lab-drawn. And man do the Lab people get annoyed when you come up to them with a label asking "Can you pleeeeease draw this for me?" Sometimes the stickers print up on the unit, sometimes down at the lab. I still haven't figured out how the Lab clipboard works in terms of getting things drawn in a timely manner. Bad blood is brewing, I think.
  
  
• Having to constantly leave the area you're working in to find other things! Doing an admission is a pain in the ass. You go through this "Admission Navigator" which makes you switch out to other parts ("Go to Orders," "Go to Patient Plan," Go to MAR") of the program, then come back to where you were. Can't they just make it show up all in one spot?
  

But really, it's all been pretty positive. As I go along, I'm sure I'll get even better at it and it'll feel like I never used paper charts to begin with. Fingers crossed... :)

Not quite sure how to title this one....

Tonight I was at a party at a friend's house. One of the guests was transgender, MTF. She told me that she'd graduated with a degree in kinesiology/sports medicine about 10 years ago, but never did anything with it.

She told me she'd just been accepted to the BSN program at the local university. I congratulated her and wished her the best of luck.

I hope to god she is tough as nails.

Nursing school is hard enough even when you look/act like everyone expects you to. The patients and their families *do* judge you. You can be the most kind, knowledgeable, and professional RN on the planet, but some people will see your nose ring and decide you probably don't know what you're talking about.

I know a couple guys in my nursing school who could not complete assignments during their L&D rotation because the new moms wouldn't allow them to meet up for a follow-up visit. A lot of people still don't trust the motives of male nurses. They assume they're gay, or weren't *quite* smart enough to be MDs.

I don't even want to think of the hell she might go through, just to get her degree. Let alone get a job.

If she survives it all then I think she wins for most tough RN ever. Here's hoping...

Weird ass dream about a patient....

There was a patient on our floor recently for a GI bleed. The docs were giving him Colyte to clear him out for colonoscopy, and every time he had a BM it looked like a murder scene. Soaked through the bedding, dripped on the floor. Really bad.

Yesterday someone finally said "You can give him all the Colyte in the world, it's an active bleed and he's not getting any better" and he was moved to a higher level of care unit.

Because the guy is in his late 80s, the docs are very wary of doing surgery. And this is where my dream begins...



I'm talking with another nurse about the crappy situation this guy is in. "Either they do surgery and he likely dies from anaesthesia, or has to have an ostomy for the rest of his life, or something like that. Or, they do nothing and he bleeds to death. Every bag of blood we put in comes right back out"

I start asking around if anyone knows what eventually happened to this guy, and came across a whiteboard with patient names on it (not unlike the one in our station, but a little different). Next to this patient's name it said "Dead."

I got very freaked out. Oh man, I just took care of this guy, and he's gone already? Craziness! So I go walking around some more and come across the patient's family members.

I ask them what happened, and they start talking about how this has been a difficult time for them, but no, he's not actually dead.

What happened in reality was that after all the bleeding from between his legs, he decided he was supposed to be a woman, and that he was just on his period. And had a sex change operation. The old "him" was dead, but "she" was alive and well.



And thus ends my dream. I wish to god I knew what to make of it.....

I think there's something wrong with my brain.

It's official. My manager hates me.

She came up to me yesterday and said "Purple, I've volunteered you for a new project. It's about keeping the care boards updated."

Care boards are in each patient's room. They have the date, room number, room phone, MD's name, RN's name and phone number, and the "plan of care" for the patient's stay.

It is to be fully filled out and updated daily.

And she wants me to be in charge of making sure it's done for "maybe 5-8 rooms" every shift I work.

Note that. When I am *working* on the floor with with *patients of my own*, she wants me to go around and check other people's rooms to make sure their boards are filled out.

We *have* people that do this, when they're on committee and don't have anything better to do. I have better things to do, dammit.

And what's this BS about volunteering me? That's not how volunteering works, *especially* when it's something that could adversely affect my patient care.

I don't know what she's trying to pull here, but I don't like it...

One last important thing....

Today I received in my work email a very urgent notice from the head of all computery-stuffs.


Apparently we are *not* to be using hospital computers to stream Michael Jackson's memorial service from the interwebs tomorrow, as it ties up bandwidth required for critical patient care applications.

They *really* deemed it necessary to send out an email? Even if I *did* give a crap about the memorial, I don't have time to sit and watch *anything* during my shift.

Brilliant.

And sometimes it ends up okay...

At 1900 they switched me to committee, where I had time to write that last entry. I also ate dinner, helped reposition a patient, delivered some lab labels to a new admit, helped reinsert the NG tube, called pharmacy about a missing medication, did a fingerstick, started an IV (one shot! gorgeous forearm vein. probably coulda gotten a 16 in it), and showed some people how to find a certain report on the computer system.

Felt way more useful than when I had patients.

And then, afterward, I went to Denny's with four of the best friends a person could hope to work with. Nothing soothes frazzled nerves like a strawberry milkshake and some bad-for-you food, mixed with an enthusiastic gripe-fest.

Thank god for my coworkers. Sometimes they're the only thing separating me from a 5150 hold :)

Assignment Despite Objection

A Day Shift RN filled out a form that documented her objection to her pt load, because it was unsafe. She encouraged me to do the same.

My load was way too heavy. I cried for the first time in a month or two. Sigh.

One pt was here on suicide watch. No reason for her to be here. Heart is just fine, needs to be in a psych facility. She has a sitter for 1:1 observation. Waste of a sitter. Very tearful, but not very demanding. Not really a problem.

One pt was here for an possible infection in a dialysis port. He's mostly healthy and wants to go home. But he's on a heparin drip, which is a high-alert medication that also requires monitoring thru frequent labs. And he's been bleeding. One of his IVs yesterday, and his dialysis catheter today. And one of his IVs was starting to annoy him, and it had to be DC'd and replaced.

One pt came from ICU th'other day. Part of her intestine ruptured, so she had surgery to clean it out and make a colostomy. She has a colostomy bag, a line of staples (which were removed too early by a med student) and a few drains. She was in ICU for respiratory arrest, and is on high-flo O2. She hasn't been eating, so she's on CPN, food thru the veins. This means fingersticks q6hrs. She also doesn't swallow well, requiring meds to be crushed in applesauce. Her family is concerned about her recent mental fuzziness. She has a PICC line. All labs are RN drawn

One pt was also in ICU in the past for respiratory arrest. He had a PEG tube placed, which he pulled out a few days back. This means there is a hole in his stomach and abdomen. To prevent infection, there is an NG tube to suction to make sure nothing stays in his stomach. He has been pulling his tube out at least once a day every day. He's been on restraints, but his day shift nurse decided he was doing okay enough to have them off. Not the brightest of ideas. He also has CPN, requiring fingersticks. He has a PICC line, and I got orders at the beginning of shift to hang 5 extra bags of medication, which I have to juggle with his ABx and anti-seizure meds. He was doing ok until 1900, when (surprise surprise) he pulled his NG tube. The Dr has now said that *no one* is to take off his restraints for at least 3 days, because repeatedly jamming a tube down his nose is rather bad for the tissue. He's also on contact precautions.


I know on paper it doesn't seem so bad. But it's too much for a person to handle. I only survived because my resource did a bunch of meds and lab draws for me, and because one of the RNs who wasn't even supposed to be doing pt care did meds for me.

I barely had time to assess my patients before having to work on the meds.

I tried not to get overwhelmed but I couldn't stop it.

Hooray for crying in the breakroom. And bathroom. And almost on the floor.

I am so glad I have the next 2 days off. If not I'd probably call in sick.

Fun with the Scale

While walking down the hall at work today, I decided to pop on the unit's scale, just for a kick.

I weigh a good 5-6lbs more at work than I do at home.

Why is this?

Pocket-stuff, my friends.

In my everyday life, I carry many things in my pockets. The front left pocket gets my wallet and a pen. The front right pocket gets my chapstick, pocketknife, and cell phone. The right belt loop gets my keys.

At work, I have much more required stuff, and so many pockets to put it in! I continue to carry the standard stuff, sans keys.

The front left scrub-top pocket gets a sharpie, a highlighter, a dry erase marker, 2x2s (gauze), and adhesive-removing wipes (best thing ever invented for removing tape from hairy people).

The front right scrub-top pocket gets my work phone (which I have the habit of occasionally taking home with me), my alcohol wipes, and my brain. Also, near the end of shift, my flushes for IVs.

The back left pants pocket gets my "Non Interruption Wear" sash, which is "road-crew reflective" yellow, and rarely gets worn because I am so busy I forget to take it out of the pocket. I also find that it does not work. Nurses/Doctors are so focused on whatever question they have to ask you that they don't notice what you're wearing, and patients/family members stop to ask "What's that about?".

The right knee pants pocket gets my stethoscope and my scissors (it even has a scissors-shaped mini pocket!).


Yup. That seems like about 5lbs of stuff to me. No wonder my knees are starting to give out already.

I assure you I'm fully qualified.....

As many of you know, my goal in life has never been to be a Telemetry nurse.

No, my friends. My true love is Labour & Delivery. My ultimate desire is to be a midwife. Someday it will happen. Siiiigh.

The topic came up today, when a friend pointed out a very pregnant music teacher at a jazz concert and said "Haha. Don't you wish you had to deal with that?" I think I surprised him when I said "Kinda yeah..."

I told him there were many reasons, but one of them sticks out.

When I was in Nursing School during my rotation and preceptorship in L&D, each labouring woman would ask the same thing. "So do you have children?"

And when I said no, they'd each get this fleeting look that said "How do you expect to take care of me if you've never been through this?"

Granted it was only split-second, and no one ever *said* anything, but I could tell it was there.

I don't have to have gone through it to be a positive, supportive, sympathetic, attentive nurse. It's part of the job, no matter my life experience.


And it's only in L&D that you get the question.

My CHFers never ask, "So, have you ever had fluid build up in your lungs because your heart pumps inefficiently?"

My GI bleeds never ask, "So, have you ever had blood gush out your anus in terrifying amounts?"

My Diabetics never ask, "So, have any of your toes died and turned black because you weren't careful with your diet and medication?"


How many surgeons get asked if they've had a total knee replacement? How many dermatologists get asked if they've had skin cancer? How many physical therapists get asked if they've had to relearn to walk up stairs?"

It's irrelevant if it's a yes or a no. Fully trained and fully qualified is just that. You don't have to have suffered from it in order to take care of it.



Still, I look forward to the day where a labouring woman can look at me and ask "So, do you have children" and I can say "yes" and see a look of relief instead of concern, and they believe that I am actually fully qualified.

I got complimented by a doctor!

Also, had another really good day :) I like that they're getting more frequent.

So it's the very beginning of shift. I had just finished report (which was thorough yet concise and only took 15 mins instead of 30. yay!) and was sitting down to get my ducks in a row for the shift.

The Dr came over to my "office" and asked about a pt's diabetes teaching. Apparently he'd been refusing insulin teaching, or people said it'd been done when it hadn't. Regardless, he needed to learn the difference between Regular and NPH insulin, and how to draw it up, and how to inject. His wife was learning as well.

The Dr was telling me about this and what things needed to be done for the pt to go home tomorrow, and then said:

"I'm really glad you are his nurse. You always get things done."


YAAAAAAY! Someone notices and appreciates the things I do! Happy Dance!


So I got cracking on the teaching, spent at least a half hour in the room making the pt and his wife both practice drawing up and injecting insulin. I have some worries, but I think they'll do okay.

Beyond that, I only had 3 patients until 1900. Diabetic guy, girl my age who is steadily falling apart worse than my sister, and quiet old guy with urosepsis.

No one had any emergencies. There were no missing medications. No accidents to clean up. Beautiful.

And then at 1900 I picked up one of the 12hr nurses' patients, a younger (for our unit) guy with cancer. All he wanted was some quiet and sleep. I'm *always* happy to provide that.

I finished all my med passes early, did all my charting early, and even got to take all my breaks.


I love the days where it finally feels like I'm getting the hang of being a nurse.


Here's hoping tomorrow is just as smooth.




[knocks wood]

Results of the meeting I mentioned a few posts back...

So apparently Manager T got an email a little before I went on vacation, complaining about some of my behaviours and my negative attitude. She decided we needed to have a "heart to heart" in order to clear things up. We had a Union Rep present as a witness, but she didn't technically have to be there as the meeting wasn't related to disciplinary action.

The first thing T mentioned was about the phone. Going back a couple weeks, one of the higher ups (resource? charge? I forget) said "You should put the cover back on the phone. Those things are really expensive, like $1000 if they break."

I hate the covers. Everyone hates the covers. They are bulky, the material feels weird, and you can't quite help but feel like they never get *quite* clean the way the hard plastic of the phone does.

So I said, "If I break one of the phones when it's out of its case, then I'd be happy to pay for it. I've got the money."

I smiled and laughed. Everyone else laughed.

Well, I thought it was everyone else. Apparently someone didn't think it was amusing, and decided that T should know about it.

The Union Rep asked, "Um, is this *really* all the meeting is about? Because that doesn't seem like grounds for a meeting."

T said "No, there's more"

"The perception of you is that you are very negative, and it is bringing morale down."

"Huh? I try to be friendly and professional"

"I'm not saying it's true or not true. It's a *perception* and this perception is making people unhappy."

"Can you tell me who, specifically, said this? Because I've asked around to see if I've been doing anything to make people mad and no one can figure it out."

"J has more details, and I'll ask him when he gets back."

At this point I'm thinking "Bullshit". Maybe it's T's perceptions that she's passing off as someone else's.

She then continued on to say that she knows that Telemetry wasn't my goal unit. And that none of us were hired by her, that she prefers to interview her own staff, and we were thrust upon her as much as she was on us.

Also, apparently, one of the Resource nurses came to her in tears because of how unhappy the new grads are.

At which point the Union Rep asked "Are all the new grads unhappy?"

"No, not all. Just most. I've had 4 people from the evening shift and one from the day shift say that they are happy here."

The Union Rep asked, "And what actions are you taking to make the rest of them happy? How are you trying to fix moraled on the unit?"

T more or less brushed that one off, saying that because we're switching to computerize charting soon, the higher-ups aren't listening to anything she says. I wonder if she realizes that's how we feel a lot of the time.

There was a lot more blah blah blah about how I am very vocal about not being happy on the unit and then the Union Rep asked if T had anything *good* to say about me. Which I appreciated.

To which T said "You're very smart, and you have good ideas. Like at the last staff meeting where you brought in pictures of things on the other unit"

Now, I don't want to sound cocky, but it's going to come off that way and I'm sorry: I *know* I'm smart. I've been smart my whole life. To tell me I'm smart is akin to telling me my hair is brown. Ok, that's nice. But it's how I am, not something I had to work for. I wanted to hear something like, "Her patients are happy with her care," or, "She's willing to help her colleagues when they need her." Something that I have control over.

Then she says something way outta left field that I didn't expect, "We could use more strong nurses like you on Day Shift. Some of the new grads aren't quite strong enough nurses and need more Med/Surg experience, and some of the transfers from other units are too stuck in their ways and unwilling to adapt."

"Would that be something you'd be interested in?"


Uh, bwah? So I'm negative, and I talk back, and I bring morale down, but you think I'm strong enough to bring a shift up?

I politely decline, stating that I am not a morning person, and would be useless till 1100. Meanwhile in my head I'm thinking, "You want me to wake up at 0500, work a shift that is *crazy* busier than PMs, *AND* take a $5/hr pay cut? Hell no. You must be on drugs."

Then she switched gears and told me that, more than anything else, this is like a conversation she'd have with her son. When she knows that he isn't living up to his potential, and she needs to spur him on a little bit. "Not that you're like my child or anything, it's just that kind of conversation." (She also mentioned wishing that other people would come to her when they are unhappy, rather than letting it get worse until the unhappy nurse's performance starts declining)

She said that I have a lot of influence on the unit because I am so smart, and that I have the capability of helping turn the unit around. She mentioned the suggestion box, and that no one had put anything in it.

Which isn't true, because the *day* I noticed that it was up I put in a suggestion to lower the box, which is high enough that I can't see the slot on top without standing tiptoe. I wonder if she even looked in it. I told her to check again.

She said that she wants me to be in a position like M and MH, training to be Resource/Break Nurse. I told her that they tried once, over a month ago, and pulled me after 45 minutes to take admits.

She told me that I need to be careful, because bad perceptions of people have a tendency to float around the hospital, and that all the units talk to each other. And if I want to have a chance at L&D, I have to make people like me and think positively of me, otherwise L&D won't want me.

And of course I'm thinking "The only reason I'm negative and miserable is because I'm *here* not *there*. AAARRRGH"

I tell her that I'm trying my best and that some days are better than others. As I wrote earlier, I actually had a good day recently. But I think one of these meetings with her takes away the equivalent of at least 3-4 good days, if that makes any sense.

So yeah. That's pretty much what I remember of it. I need to get better at keeping my mouth shut when I'm unhappy. And just keep swimming.

From June 3, 2009: Damn I'm clever sometimes....

A mind-blowing *third day in a row* with the same patients.

One of them has the mother of all sinus infections, and is on some pretty strong antibiotics. Other than the infection, nothing's wrong with her.

In cases like these, we often set the patient up with a PICC line, which can stay in for up to a month or so (compared to 4 days for a regular IV line), so they can administer the strong antibiotics at home rather than being trapped in a hospital.

So she has signed the consent for the PICC but has a few questions. I re-explain what it is, and how they do it at the bedside (here is a great video of the insertion process) and that it's pretty quick and they numb you up, etc etc.

Judging by her reaction to the information, I'm not so sure they gave her all the information when getting consent. She said, "Maybe I don't want it after all."

And I'm thinking "How do I get her to understand and realize that it's not so bad after all?" and the little lightbulb goes off. One of my other patients has had a PICC for awhile now, and seems like a big fan of it.

So I excuse myself briefly and ask pt 72 if she'd mind giving a testimonial to pt 50 and her family. She says yes, so I grab 50 and her friend/sister(?) and bring them across the hall.

72 explains that it's really fast, and once it's in you can't feel it at all, and you can move your arm just fine. And the best upside is that you don't need to get poked for lab draws; they just take it from the port.

Pt 50 appears very relieved, and pt 72 wishes her good luck. I usher 50 back to her room, and pat myself on the back for a job well done.

From June 2, 2009: I had a surprisingly good day.

It was one of those days where you amazingly get the same patient set twice in a row. And that particular patient set isn't terrible. Nothing short of a miracle.

I did all my pre-assessment setup (going through meds, printing telemetry strips, doing my PCHs) without any interruptions from patients needing a pitcher of water.

I managed to do my assessment and my charting by 1645. This is practically unheard of.

I actually got to take my first 15 minute break, and all my fingersticks were done when I got back. One of my patients was turned for me.

When I went off to dinner, labs were sent off, including a swab-up-the-nose I really didn't feel like subjecting the poor little old lady to.

When I got to take my *second* 15 minute break I thought I was dead and in heaven. It's rare to get one of my 15s, let alone 2.

Nothing exploded, there were no frantic calls to the doc for a medication that shows up from the pharmacy 4 hours later, and, this is the kicker:

I finished giving report 10 min before 2330.

That's right. I clocked out early.


It's days like this that I start feeling comfortable and happy with what I'm doing. I'm getting better at it. Just keep swimming.

Worrying....

Before I went on vacation (which is why I haven't posted in so long) one of my managers took me aside and said "We need to have a meeting, so you should call the Union Rep."

I asked him what it was about and he said, "Don't worry. It's not a medication error." Ummm.... okay. I didn't ask what it's *not* Sigh. I ask for a little more information and he says that someone sent him an email about my behaviour. I'm very confused at this point. I have never had a patient seem to dislike me, and I am friendly and professional with my coworkers.

He says that I should try to arrange the meeting for before I leave. Hah. I have work every single day before leaving, and my flight the day I leave is at ass o'clock in the morning.

So I put it off.

I got back yesterday, and the other manager says, "We need to have a meeting about your attitude and behaviour. We need to have a heart-to-heart." Why does a heart-to-heart require a Union Rep? So I call the Union Girl and leave her a message.

I haven't gotten confirmation yet that she's coming. We're supposed to meet at 1515, so I have to call her again on my way in.


I've never had to deal with "office politics" before. I've never had anyone not like me enough to talk to a manager about it.

I've asked around a bit to see if anyone's overheard something. I wish I knew who it was and what s/he said. It's not so much that i want to confront the person, but it'd help me analyze my own shortcomings and improve on them.

Siiiiiiigh.

"Too many indians, no chief..."

This was said by someone on my unit today, describing our management, and their poor leadership and communication skills.

I had an odd day today.

I get on the unit, see that I have 3 pts. Two are slated for DC, one is staying and is generally stable.

I am told that when I am down to one patient, I will take 3 pts from M so she can work on the computer training stuff for when we go electronic in a month. This makes little sense to me, as we all need to practice, so why not give my 1 to her, and then the next day she can do computer training. But whatever.

Pt 54 has had all his paperwork done and signed off, I just have to write the DC note and get him gone. He is getting picked up by Notoriously Late Transport Service. They give me a window from 1548-1618 that he will be picked up. He's anxiously waiting in his wheelchair in the hallway. I can tell he wants to GTFO. Around 4 I call the runner, and she comes to get him. She needs the CNA's help to bring his stuff, which includes a full prosthetic leg. Apparently the CNA also needs to hang out with 54 until his ride comes. But he's off my unit and I'm down to 2.

Pt 70 is waiting on his son to come get him. He is forgetful, and keeps asking about when he's coming and when he's getting his IV out. I've been told the pt can stand on his own long enough to pivot into a wheelchair. His son will be bringing his powerchair from home. Son finally comes around 1605 so we can go over the DC paperwork. I find out that he forgot to charge the powerchair enough to get it up to the unit, back down to the car, and back into his house. I assure him we can get a normal wheelchair to get him down to the lobby. We go over paperwork. Everything's all signed off, and I tell the son he should drop by the pharmacy on his way to the car to get his dad's meds. The son doesn't seem to believe me, though I tell him it'd be the best in terms of efficiency. I call the runner to come get the patient, and am told that since it's early enough, I can call the volunteers to wheel him down.

Volunteer comes up and I ask the patient how much help he needs in standing. He tells me he can't stand. I hate it when people misinform me in report. Argh. Frustrating. The volunteer tells me to call Lift team, and she'll come back when he's in the chair. So I call Lift for some stat help, and he shows up pretty darn quickly. Nice. I <3 Lift team. I should make a button for it. Anyhoo

We try to stand him up and get him in the chair, and Lift Guy notices that, sometime in the 15 min since I last saw the pt, he has had a lovely loose C-Diff stool. So out come the full gowns and I get to do a last-minute cleanup. To all you non-medical-professionals out there, pray you never have to deal with C-Diff smell. It's bad. Very bad.

Finally we get 70 into the wheelchair and call the volunteers again to get him gone. I think he left my floor at 1650. And then there was 1.

Going back in time slightly, I was hanging ABx for 71 at 1630, and overheard the MD talking about a small bowel obstruction, and possible surgery "tonight". So I file that into my head and go about my business. Not an hour later I'm getting a call from OR asking if I'm ready to give report on her. Ooookay.

I give report, and get going on the pre-op paperwork. Her daughter wants to be there before she leaves for surgery, but, in common fashion on my unit, she is whisked away before I have a chance to get things fully in order. And her daughter shows up about 3 minutes after the pt is wheeled down. I try to direct her to where the pt has gone. I have to assume she made it. I apologized profusely.

So now I'm zero. I'm seriously wondering at this point if I'm getting M's patients or not. it's about 1800 at this point. I ask J and he says I'll switch with M at 1900 so I should go eat dinner. I start getting cleaned up, and he changes his mind. I'll go on computer training instead. So I start on that. Something b0rks so I pop out to ask J about it, and Resource M says "You're getting patients! One admit, one transfer"

"Uh, bwah? J said I was on computer duty. Can you talk to him and figure it out?"

I hate having conflicting info from various sources. Kills me.

So we finally figure it all out, I'm on computer duty. Wheeee. As is M, whose patients are being taking by the 7-7 crowd. Mostly we complain about how dumb the system is.

I'm dreading the day we switch over to electronic charting. It's going to be disastrous.

Two half-days in a row....

No real interesting stories lately, as I have been unexpectedly given the option to go home early two days in a row.

I know I shouldn't be taking so much time off. The reduction in pay will eventually catch up with me. And my patients weren't actually all that bad these last two days. I almost feel bad about leaving them after only 4 hours.

But there's still a part of me that goes "HOLY SHIT YEAH I'M GETTIN' OFF EARLY" whenever the Charge says "Hmmm... we seem to have 11 nurses on the floor at 1900, and only 21 patients."

On our unit, we're a mix of 8hr and 12hr shifts. So 1900 is a magic time, when a bunch of 12hr shift nurses come on, and the 8hrs who started at 1500 are still around. So I scramble to get all my ducks in a row in the 4 hrs I have to work with.


I guess this is really more of a non-post, as nothing of interest has happened so far this week. Though I am thinking about a Diabetes PSA in the near future. Stay tuned, I suppose.

We get a lot of patients who have fallen or are at risk for falling on my unit...

So I am kind of intrigued by this article and video (sorry I can't embed the video directly, it's an ABC thing I guess) about a study done on women over the age of 62 to see what they do during the course of a slip/trip/fall and how to prevent from doing so in subsequent fall-risk situations.

From May 5, 2009: A New Personal Record!

From start of shift to tears in less than an hour!

I'm getting *way* more efficient at this. lol.

The day started off rather well. Went out for lunch and margaritas to celebrate B getting the fuck off our unit-of-doom and going back to school. We'll miss her.

I get to work, get a rather half-assed report from a new traveler who I don't really know yet. One of the things I learn is that one of my pts is confused, came from ICU, and just pulled her IV when she got to the floor at 14:30. They managed to clean up most of the blood, though.

This is another situation where I can't accurately express all the crazy that was going on.

I go to the patient's room to assess, and she asks for a Diet Coke. We don't normally have soda on the unit, but I told her we could ask the kitchen to send some up with her dinner. She seems ok with this. I move along, but not long after hear her hollering down the hall. I go into the room and she is freaking out. Frantically trying to get her gown off, pulling her telemetry wires, etc. I tried to reorient her and calm her down, and keep her clothed. I told her we could take off the wires and everything but we should try not to give the whole unit a free show. She starts talking about her babies, and so I try to get in contact with her son, who isn't answering the phone.

I call the Dr and let her know what's going on, and she comes miraculously fast. She gets into the patient's room right as she's trying to pull her foley out. We manage to make her hold off for 30 seconds so I can grab a syringe to deflate the bubble. The last thing we need is her bleeding from the urethra...

Foley is out, Tele is off, IV is out, SCDs are off, and gown is barely covering her up. We get a sitter into the room while we try to get in contact with the family members. At some point while I'm at the desk the lady starts walking out of her room and BMing on the floor.

Then I get a rather miffed-sounding woman on the phone. Her father (another patient of mine) is back from ultrasound and has been on the gurney for a rather long time, and is getting uncomfortable (big guy....) and wants to get back in bed.

What the fuck is wrong with the runners? This has happened quite a few times. One of my patients is back on the unit and *NO ONE TELLS ME*. I can't read your minds, people.

So I was all kindsa frazzled from crazylady, and I made the mistake of looking at my watch. It was 1600 and by this time I usually have all my meds figured out for the shift, my to-do list is updated, I've done my PCHs, and am starting to assess. None of that's been done and I feel like I'm drowning.

That's when the tears start.

I feel like a dumbass because I know it's nothing I did, and crazy just happens sometimes. But I can't seem to calm myself down. So I high-tail it to the bathroom where I splash my face with cold water and try to look professional, with middling results.

So I get lift team to help me move big guy onto his bed. He barely speaks English, and I can tell he's going to be a needy sort. Sigh.

I scramble around trying to assess my patients and make sure they're comfortable, and by this time it's medpass time.

After I get done passing meds, I am standing at my "office" trying to figure out what to do with myself next. Big guy needs a blood draw, hip fracture needs to be turned, and little old asian guy needs 2 nasal swabs for flu/MRSA.

Then manager J comes and does something that completely surprises me.

He asks me what needs to be done (luckily I've just made a to-do list) and then says "Go on break. Take 45 minutes to relax, and get some of your charting done."

It was the shortest 45 minute break ever, but I got to decompress and catch up on my paperwork, and when I got back, *everything* on my list was done.

I managed to get all my stuff done on time, and transferred my hip fracture to the ortho floor. Well, I was told she would be transferring, and J decided to move her along without me finishing all my stuff (it was 2230 at this point) and brought her by the room I was in so she could say "bye" and I could wish her luck. I hope she does well. She's a sweetie.

And crazylady calmed down rather well once her family was there, and would likely be sent home in the AM if she remained stable. Happy to hear that...

The only crazy people I should have to deal with in the hospital are my coworkers :)

From May 1, 2009: Cool Dialysis Nurse and a Brief Update

I was lucky last night. Out of my 4 patients, 3 were walky-talkies that didn't require too much care. 2 of them were set to go home tomorrow, so I pretty much just had to pop in every now and then to ask if they needed anything. My 4th patient, however, is a bit of a sad story. Little old lady, last year fell and broke her hip. They patched her up, and sent her back to the SNF (Skilled Nursing Facility) she lived at. While at the SNF the wound became infected. Badly. MRSA and P Vulgaris and one other bug I can't remember off the top of my head.

She'd been in a few times to get it treated with strong ABx but it didn't help. She was in ICU for awhile, and a couple days ago had an I&D and a revision, which took about 9 hours in the OR. It was like re-doing the whole hip surgery again.

Naturally she's in a bit of pain.

This woman moans if you so much as move her arm, which is odd cuz her arms are *fine*.... But I feel bad for what she's been through. She just wants to rest.

It came time for me to check her before-bed blood sugars ("HS fingerstick"), and she was in the middle of her first round of dialysis (kidneys not doing so well anymore). That can take a lot out of a person... literally lol

The dialysis nurse says "Wait, you don't need to poke her again" and grabs a TB syringe and pokes it into one of the ports on the "outgoing" dialysis tubing and draws me up a bit of blood.

I really appreciate him doing that. The patient was extremely grateful not to be stabbed again and I didn't have to do any finger-squeezing to get a good amount of blood out. Smiles all around.



On the Update side of things; I ran into the Union Rep in the hallway. She apologized again profusely, and said that she was really freaked out by what happened. After the meeting she went to one of her higher-ups and said "I'm obviously not cut out for this job, I didn't protect PurpleRN the way I needed to" and tried to quit. I think he talked her out of it, as well as told her that the stack of RRFs that J&T are painstakingly going over aren't their problem. They shouldn't have a single on on the unit. They should all be sent down to "Quality" for *them* to determine what's important enough to follow up on. It would be nice if they got a little payback....

I am Tired of Crying at Work -or- How Roughly $13 of This Paycheque Will Be From Sobbing Uncontrollably in the Bathroom

So awhile back I screwed up. Hung a bag of D5W with 20K instead of NS with 20K. Pt wasn't diabetic, nothing bad came of it. Got written up as a med error. Had a nice long chat with the managers with a Union Rep present, did some crying for making a stupid mistake. Then nothing came of it and I moved on.


About 3 weeks ago I made another mistake. Pt was put on End of Life Care, and I'd never dealt with those orders before. I was being pushed to get the patient off our unit, since we don't deal with EOLC patients. The family member was pushing me to make the pt comfortable.

So I screwed up. Didn't do the orders right. Screwed up on med dosing. Made the patient comfortable though, and didn't overdrug. The family member thanked me for making him comfortable so quickly.

But it was another med error. So another meeting with the managers, with a Union Rep present.

These meetings are supposed to be short investigations into what happened. 15-20 minutes to get the full story. Instead I end up with a 45 minute interrogation, literally cornered in a tiny conference room. I wish I could remember all the things that were said.

I wish I could convey the tone in which they were said. The manager let J, the assistant manager run the investigation. He should not be allowed to do this ever again. The way he looked at me, the way he talked to me, it was like I was dirt. Why was I there, contaminating his Unit?

The first time I lost it was when he was demanding to know how I would avoid making the same screwup in the future. But it wasn't a simple "Now that this has happened, how are you going to avoid making the same screwup in the fuure?". It was a long, convoluted diatribe that ended with making me feel like there was no hope for me to do things right *ever* Man, I wish I'd recorded this. I know it's not coming across right and I'm sorry for babbling about it. But it's my blog, so there ya go.

I ended up having to call a time-out to cry for a little bit and get myself back together.

J and T ask a few more loaded questions, and babble about inconsequential shit for a bit, like the chain of command for various things. I'm pretty sure they just like hearing themselves talk, as they tend to say the *same damn thing* over and over in different ways. And they had the audacity to ask if I felt like I was being supported by them while on the unit.

But the kicker. The one that killed me.

It feels like the meeting of doom is finally almost over. And J says, "And you've got to remember, that with all of the orders and everything, the one thing you *should* be caring about is the one in the bed"

Something in me catches his tone, so I ask, "Are you telling me that I don't care enough about my patients?"

"That's what it looks like to me."

WHERE THE FUCK DOES HE GET OFF TELLING ME I DON'T CARE ABOUT MY PATIENTS?

I felt like I'd been kicked in the solar plexus. Every molecule of oxygen was sucked from my body and all I could do to get it back was sob. I have never cried like this in my life. My chest was tight and I was gasping, nearly shrieking, with every breath. All I could get out was "What the fuck? I am out of here. I can't handle this shit anymore. Fuck this. I'm out of here."

The Union Rep ushered me out of the conference room and into the bathroom so I could pull myself together. I felt bad for her. I am usually pretty stoic. But there are a couple things that really set me off. One is telling me that I am incompetent. The other is claiming that I don't care about something that I put my whole heart into doing.

She said she couldn't believe he said that. That she should have stepped in and stopped him in his tracks, but she didn't think he'd actually *say* what he said; she didn't think it was possible.

She said she'd talk to the Union higher-ups about what happened.

We have to go back in to officially finish the meeting. I ask if I can just go home, as I am, once again, "on committee".

J looks like he will say yes, but T says I am needed here for Very Important Work. But if the census stays the same then I can go at 1900.

The very important work of the day? Going thru everyone's charts to see when they had their last BM. I am dead serious.

1900 rolls around, and I am ready to GTFO. But no. The census is changing, and I will be the admit nurse. So at 2015 I get a new admit, and at 2130 I get another. At least they were easy admissions, and MH the Wonder Resource really helped me out on them. Sigh. Sorry MH for crying at you in the copy room. I'm working on keeping my shit together.

Everyone asks me when I'm transferring out of the unit. Trust me guys, I'm just waiting for an opening. Anywhere but here.