From March 22, 2009: I survived 6 months

I'm officially an RN II now. What does that mean? As far as I can tell, it means I get a $2/hr raise simply for not quitting in frustration before the six-month mark. The manager has told all of us new grads that we are fast approaching no-longer-new-grad status, and we need to shape the fuck up before long or else she won't be able to make excuses to the doctors why things get messed up.

I've been trying to think of ways in which I've improved over the last 6 months. Some days I still feel so green, and others I wish people would take me a little more seriously, since I know what I'm doing.

I've learned how to answer the phone without panicking.

I've been working on time management. On that same note, I've learned to just deal with it when time defies managing.

I've learned to take a breathing break every now and then when I am supposed to do so many things that I forget half of them.

I'm learning that nursing is a 24 hour profession, and sometimes you just have to pass things onto the next shift. But it's better for nurse-nurse relationships if you do as much as humanly possible and apologize profusely when things are left undone.

I'm still trying to learn that it's okay to ask for help. Even if you sometimes feel useless for having to do so.

I've learned that listening to music on play.it at work is allowed, and makes me saner while charting.

I've learned that you can't assume that things have been done just because they've been charted as done. People lie on charting.

I know there are a million more things. I'm sure I'll update the list as they come to me.

What about you guys? Any words of wisdom? I'm always looking to learn more....

Nursing Nightmares

They started in nursing school, of course. Sort of the equivalent of the "showing up naked at school" dream, but specific towards nursing.

During school, my Clinical Instructor from Hell featured heavily in my bad dreams. Getting yelled at for not doing procedures I'd never heard of. Or somehow ending up outside the hospital, trying to find my way back in because it was nearly end of shift and I'd been lost for the last 6 hours.

I hadn't had any nursing-related bad dreams since I finished school. But I had one the other night. This job must really be stressing me out. (Don't even get me started on how bad my psoriasis is getting... grrr)

In my dream, J (the assistant manager) came up to me as I was about to give end-of-shift report and said that I would need to stay another 4 hours, until 0330, because they were short staffed and they really needed me. I didn't stop to think that I could say no, so I just sucked it up and went to go see one of my patients. Then I was walking down a reeeeally long hallway (like in one of those creepy movies set in a hospital) and I have a lab req slip in my hand but it's blank, and I know I'm supposed to do a blood draw but I'm not sure what for, so I think about what my patient's in for and what they *might* need (I think I decided they needed an H&H) so I grab a purple-top tube and head on down to the room.

I draw from the AC (which I never do. Squicks me out) and the fluid that fills the tube is bright fucking blue. Like a darker shade of Windex blue. But I get enough to fill the tube and I figure the lab can decide what to do with it; blue blood is above my pay grade to figure out. As I'm walking back down the hall, I see that the tube is not actually full but only has about 1 mL in it. I curse the lab for being able to deal with 1mL of baby blood but 1mL of human blood is not enough to work with.

And then I wake up.


Anyone out there who's reading: Have you had any cracked-out nursing-related dreams?

~~~Floating~~~

I was a little miffed to start my day. I heard one of my colleagues had gotten called off work today and I hoped I would be too. Whaddaya know, I get the call when I walk away from my phone for 6 minutes, and I can't get ahold of staffing to request the day off if they're still overstaffed.

So I keep my fingers crossed that I'll get a call back, while I'm driving to work. I get to work in record time, and manage to find a parking space on the 2nd floor roof, rather than the 4th floor roof where I usually park. Right next to the stairs, too.

Walk onto the unit and look at the census board. Lotta blank spots. And a lot of nurses looking confused. They're still overstaffed, and I get word that I will be floating to unit 135. I did a good chunk of my new grad orientation on 135. I miss 135. I am happy to hear this news.

Then I hear that I'll likely go home when the 7p-7a's show up for their shift. Even better.

I get my patient load. Two MRSA in the nares, and one pt ready to GTFO. And a note that I'll be getting a transfer patient. I hate MRSA. Masks and gloves and sometimes gowns lol.

My discharge patient leaves without a hitch. Although she decided not to wait for the transporter, and was walking down the hall pushing her own wheelchair lol. I hate that they make perfectly healthy ambulatory people leave by w/c.

Then my transfer comes in. Young, only 59. And it's a transfer, not an admission so I don't have to do any long drawn out assessment thingy. Huzzah!

Then I get word that there's a shit-ton of food in the break room for various people's birthdays. And everyone is coming up to me saying "PurpleRN! How are you? What's it like on your unit? Are you doing okay up there? Getting used to being a nurse?" I can tell they're disappointed for me when I tell them how miserable things are, and how 2 of the new grads are ready to quit. One even says I should talk to their manager to see if I can transfer back in. And everyone who sees me finishing up my meds says "PurpleRN! Have you gone to the break room for food yet? Go go go! So I finish up all my stuff in record time - done by 1845. So I take my 15 break till the 7pm shift shows up.

Head back upstairs to my unit, J says I can go home! Wheeee!

It was like a vacation. A little slice of heaven to make the stress go away for just a little bit. Definitely feels like floating

Brief conversation at Karaoke night...

I saw a guy grab a cute blonde's ass, right in the middle. More of a sneaky crotch grab than anything else. She jumped back and glared at him. I made eye contact, grinned, and made the universal "bitchslap upside the head" motion.

She came over to me and said "I love your hair. I've been looking at it all night. I'm a cosmetology student"

"Thanks. I got it cut at Faux, just down the street from here"

"Oh, cool"

"Yeah, it's the most interesting hair at my work. I'm a nurse"

"A what?"

"I'm a nurse"

"You're a nurse? How *boring*"

"Boring?"

"Yeah, totally"

"Has anyone ever died at your job?"

"Huh?"

"People die at my work all the time. When someone dies at your work, you can call mine boring"

"Um. Yeah. I've gotta go pee. See you later" (and then hugs me rather familiarly for someone I've just met)

Granted I bitch about my job a lot, but you can *not* in any honesty call it a boring career....

Call me a sadist....

but I love starting IVs.

I bring this up because my coworker/friend L had a patient whose IV went bad and needed a new one. Poor L... *amazing* at blood draws, but not so good with IVs. She gave it a stab (ha ha) and it didn't quite work out, so she asked if I had some spare time to start it for her.

Luckily I had a sweet and easy patient load tonight (I didn't hate my job today!) so I was totally cool with taking out 5 minutes to give it a go. And everything was set up for me. I just had to do it :)

Found a hand vein pretty easily. I probably could've gotten one higher up the arm in a non-bendy spot but I'd rather get an easy not-as-awesome place in one shot than making 2 attempts at a better location. Plus, as the patient said, she may be going for a procedure tomorrow and they'll probably want to throw an 18 gauge in the AC. I don't know the obsession with 18s in the AC. I hate them. Make the machines beep "Downstream Occlusion" all damn night (grumble grumble)

Anyway, I get it in the vein in one go. It's hard to express the feeling of satisfaction you get when you see the flashback of blood in the catheter. It's an instant-gratification dopamine burst that gives you an "I rule the world" feeling for at least a few minutes.

Conversely, *not* getting an IV site in one go can really fuck with your mood for the rest of the day. And fuck with your IV starting skills as well. Kind of odd.

Anyway, I get it in, everyone's happy. It's taped up and flushes well. Go me!

I remember the first IV I ever started, during my preceptorship in L&D. You can't ask for a better unit to start IVs in. Everyone's full of fluid with beautiful sproingy veins. I was nervous as hell. Tried to remember all my steps from the class. And got it in in one go (thanks to the beautiful sproingy veins).

I remember smiling and telling the patient "Congratulations: You were my very first IV start!" to which she replied "Thank you *SOOOO* much for waiting till *after* to tell me that!"

I got the same kind of joy last week when I started an IV in a patient without being able to see the vein. I know some nurses (like super Resource E from the previous post) who were taught not to look at all, but to only go by feel. But for me, there's a level of confidence I needed to have before trying something blind.

This poor woman's IV had infiltrated while she was receiving a medication, and she waited until there was a definite area of fluid accumulation before telling me that it kinda hurt... C'mon people. If it didn't hurt 20 minutes ago and it hurts now, tell someone!

Anyway, I gave her arm a look-over and didn't see anything. Maybe a shadow of a vein? So i decided to feel around, and felt a good lump by her wrist. Why not give it a go, I thought. So I popped the needle in... nothing. Hmmm. I prodded the vein with the other hand, figured out where I should be aiming, and changed the needle's trajectory slightly. *Boom* flashback. I felt like king of the world, if, again, only for a few minutes till the dopamine wore off.

The first time I felt like a real nurse was when I learned to start IVs. Any trained monkey can pass pills. But starting an IV takes finesse. I hope to one day be like a nurse I met during clinical. She was the go-to gal for any hard stick. I saw her get an IV in an 88lb dehydrated lady in one shot, after 4 other nurses had tried and failed. I want to be her.

Someday.... :)

From March 6, 2009: The worst patient ever

This one is hard to write, because when I start thinking about the various events, I get so angry and stressed out that I forget the order in which things happened. I almost feel like this should be a post of bullet points and general ideas...


I saw his name on the board when I walked in. It was misspelled (wrong first letter) but when I said it to myself I shuddered. And when I saw *my* name next to his, I wanted to dart out of the building and just not return. Having a job isn't worth dealing with *him*.

He spent the first hour or so of the shift in the bathroom. I checked on him every 10 minutes or so. I think I'm glad I don't know what he was doing in there.

When he got out, he immediately got on the call light. "I need Dilaudid (a stronger cousin of morphine) for my pain and Phenergan (an powerful antihistamine that makes you loopy) for my stomach and a breathing treatment right now!"

This is what he says every time. He is a frequent flyer, because he doesn't take his medications and ends up relapsing and making our lives miserable. He rotates around to all the hospitals in the bay area it seems. I bet he hasn't gone 3 months without being hospitalized. He had been transferred to us from another hospital, and claimed that that hospital was giving him everything he wanted.

Well this time the Docs weren't having it. They all got together and decided that, for once, he would not be getting *any* IV pain medication or phenergan. They even listed Dilaudid as an allergy, just to be sure lol.

When it came time to give his meds, I got out the methadone (oral pain med) and he yelled "I am not taking that! They should know better than to give me the pills they don't work and i'm not taking it" "It's better than nothing. If you're in pain you should take it because it's all that's ordered"

"I need to talk to a nursing supervisor and a new doctor i fired my doctor because she isn't giving me what i need and it's my right to fire that doctor so you go get me a new one" (I can't even *tell* you all the random shit he was spouting off)

I was encouraged to write a Responsible Reporting Form (once-upon-a-time known as an Incident Report) to cover my butt and to catalogue his behaviour, as the insurance company was trying to drop his coverage.

I wrote 4 pages of progress notes. I wish I'd made an extra copy so I could give some better examples.

But on with the story. After being harrassed over and over by him I start bringing things up to the Doc, who has decided that if she's "fired" she's not gonna deal with him. Sends up another Doc who's never met the guy before. I wished her luck going into the room.

She gave in a little and wrote an order for intramuscular phenergan. He was happy he was getting at least one drug. But I guess it didn't sink in what "intramuscular" meant.

I drew up the med (in a rather large-gauge needle... I know. I'm bad) and brought it over to administer it. I said cheerfully, "Here's your phenergan!" and started cleaning his arm with an alcohol wipe. Right as I was about to give the shot, he realized what I was doing and swatted my hand away, nearly driving the needle into my other hand. Freaked me the hell out. "What the hell are you doing?" "The doctor wrote an order for IM phenergan. Here it is, I am giving it to you" "It doesn't go in my muscle it goes in my line (he had a central venous access) so you better put it in my line where it goes" "Sorry sir, I have to give it as it was written" "That doctor made a mistake is it that one I fired I don't want that one anywhere near my chart or me or doing anything at all you go back and get the right order" "Okay sir."

I go talk to the doc, who has now had her cherry popped on this patient, and she says "If he doesn't want it IM, he doesn't get it at all. I'm not writing any new orders"

Meanwhile, this asshat is on the call light every 2 minutes, and calling directly to my phone at the same frequency. At one point he calls my phone directly and yells "I don't want that PurpleRN touching me!"

Dude. Why call *MY* phone and then assume you're talking to someone who isn't me? I stopped answering anything after awhile. I just handed the phone to someone else when I saw it was him calling.

I ended up getting off work over an hour late because his jackassery prevented me from doing any charting on the rest of my patients.

Hell, he was scaring his neighbours with his yelling.

There's so much more to say, but I think I'm done with this guy. Unless he dares show up again on my shift....

From March 5, 2009: The best patient ever!

Poor thing. 28 years old, youngest on our unit by at least 30 years. Started coughing up blood one day, and finds out she has lung cancer. Never smoked.

But man was she positive! Always had friends and family in the room. Her mom introduced herself as "Hi! I'm Mom!" It was always a party in the room. Food, soda, balloons. Really upbeat

This particular shift I had gotten a late start out and didn't end up packing myself a dinner. I was in the patient's room and we were talking about food cravings. I said something to her like "Man, a milkshake sounds awesome right now."

"My friend is making a Jack-in-the-Box run. What flavour do you want?"

"Oh, no. I couldn't. I only have $2 and I'd feel weird about it."

"What flavour do you want?"

"Umm... Strawberry? Lol. Dinner of champions!"

"That's not dinner!"

"Well, I didn't pack one tonight, so it is for me. And I'm good with that"

"What else do you want from Jack? Oh right, you're vegetarian huh? Not a lot you can eat at fast food places."

"Yeah. I generally end up with a salad or something" (conversationally)

"That makes sense. Ok. So what's your number? I'll call you when your milkshake is here"

[gives number]"Thanks so much. You really don't have to do this"

[time passes. i get the aforementioned call] "Your milkshake's here!!"

[goes to room] "I couldn't let you get away with just a milkshake for dinner so I had my friend pick you up a side salad too. I hope Ranch is okay?"

"Oh my god you totally didn't have to do that. Here. Take my $2"

"Put your money away. Put it away now. Back in your wallet dammit!"

"You are the best patient ever!"



So yeah. I really hope she gets better. She's way too cool to get fucked by life so badly.

From March 2, 2009: I complain about work a lot, but I had a Fairy Godnurse last night...

Her name was E, and she was the Resource that afternoon. I had a patient who needed a blood transfusion.

The way it works is this: The doctor writes the order for the transfusion. The Unit Assistant (or Nurse, if the UA is unavailable) faxes the order to the blood bank. The blood bank does its thing and calls the unit to let the nurse know the blood is ready. The nurse then fills out a blood retrieval slip and places it in a binder for a runner to pick up and bring to the blood bank. The runner then returns with the blood, the nurse hangs it, and the patient is happy. Yay.

So I fax the order, the bank calls to say the blood is ready, and I say ok. The Resource starts filling out the blood slip and says she'll bring it to the front for me. Very nice of her. I go into another patient's room to do a blood draw. Then I attend to my other patients, waiting for word that my blood has arrived. So I ask the Resource if she has heard anything about my blood. She smiles and says "It's already hanging" and I say "Huh?". "Your blood. I hung it for you" "Did you give the tylenol and benadryl (to reduce reactions in sensitive patients)?" "Of course"

"Oh my god I love you. Thank you *so* much" "No problem. You just have to do the 30-min Vitals (we take vitals before the transfusion, then 15 and 30 minutes after the start) and the ones after it's done."


SO much better than the other Resource, R, who says things like "Why don't you just give your meds after you eat?" rather than offering to give them so I can go on an actual break. And then saying "You want me to give *all* these meds?" That's what a Resource is for, bitch. But I won't dwell on her.

E = Resource FTW

(ETA: R is no longer as bitchy as she was when I originally wrote this. Not sure why, but I'm not looking a gift horse in the mouth)

I sent this letter to the Nurse Educator. He said I should share it. So here goes: the maiden voyage of the blog.

This job is killing me...

I don't know how much longer I can survive being on Tele. Maybe I'm getting melodramatic, but the knowledge that there are no open L&D positions is making me lose all kinds of hope.

Every time I feel a little more positive, like I'm getting the hang of things, I'll do *something* wrong somewhere and get pulled back underwater. Like drowning a little bit at a time.



Today I got in trouble because of an order for a "VIP" patient.

When I got in, we were overstaffed, so I was put "on committee" to do my HealthConnect modules. At 3:30 I was told that one of the nurses wasn't showing up and I was taking his patients. I was also told that I'd likely be going back on committee at 7. So I had about 3 usable hours of a shift to work with after getting report.

The order was written at 12:30pm, for a 5pm CBC draw. It was noted and faxed, so I assumed (stupid stupid stupid) that that meant it was taken care of and would happen as planned.

Apparently lab never came to her, so it wasn't drawn, and the MD came to check the result and it wasn't in. I didn't even know it was an issue until after the fact, around 8pm. And I got dinged. Got two separate talks. And that's how it always goes. I get a talk from T where I hear, "You know, PurpleRN, this doesn't look good for you" and then a talk from J where I hear "So tell me what happened? I'm on your side, and just want to know how we can make things smoother." Pulling a good-cop/bad-cop routine or something.

And I was just pleased with myself for getting my charting done by 7 lol. Whenever I start feeling the slightest bit competent I do *something* wrong. Is the only solution to just assume I'm always on the verge of fucking up? It's not a sane way to manage a job, I think. But I'm not sure what else to do.

Do you have any words of wisdom? Sorry for the long rant but you're the only one I feel that would actually be on my side.