Thursday, April 30, 2009

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."


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.

Sunday, April 26, 2009

Woo unexpected day off!

Yesterday we were overstaffed. Really overstaffed. Our 26-bed unit had 16 patients but the nursepower for 24. Therefore L and I were put "on committee."

Our tasks for the evening:

Get people signed off on the new way of printing EKG strips for when we go computerized.

Have people sign an attestation that they have read and understood a new law regarding medical record privacy (inspired by the Octomom fiasco) that says if we look at stuff we shouldn't be looking at we are subject to immediate firing and a fine up to $250,000 for each person's record that gets looked at.

Watch people pass meds and document if it's been done correctly.

Watch people give reports and document if it's been done correctly.

Check the new transfer patients' skin to make sure that if a pressure ulcer is already present that it's documented so we don't get blamed for it, and see if nutritional and wound care consults have been made.

Find out from our "fall risk" patients if they've been offered help with toileting or activities. The main issue with this was finding fall risks who weren't confused because they tend to forget that they've been up to the bathroom etc.

Restock the grey carts that are in the rooms on the B-side of the unit with useful things like saline flushes and 2x2s and IV-start equipment.

Restock the mobile rolling carts with the same.

This is all fine and entertaining for maybe half a shift. After that you start to get antsy. Especially with the paperwork audits. Those feel very useless.

So this morning when I woke up I called Staffing and said "We were rand ather overstaffed yesterday due to low patient census, and if the census is still low today I'd like to be considered for a day off".

About 20 minutes later my phone rings and my heart skips a joyous beat. Turns out it's just a friend of mine, calling to ask about some food she left at my place. Siiiigh.

Then I get a call about an hour later. It's Staffing! Yippee! They ask if I still want the day off. Hell Yeah! They asked if I wanted to use it as a vacation day (meaning I get paid for the day off). I don't need the money as badly as I need spare vacation days so I decline. (I'm enjoying my days of low expenses... not sure how much longer that'll last so I'm making the most of it)

My energy level went up immediately. From the weariness of knowing what's in store for me later in the day to the bounciness of an extra day with limitless possibilities.

Went for lunch with a friend, went to the mall to get bathstuffs, went hottubbing with some other friends, late dinner. Oh so glorious!

I'll always take a day without pay over a day on committee.

Friday, April 24, 2009

Another one bites the dust.....

We all hear about the statistics that 1 in 5 (possibly more) new nurses quit within their first year. It's understandable, really. It's a high stress job that no amount of preparation prepares you for. It's easy to get overwhelmed. And when your management seems to be working against you at every turn....

One of the new grads who started with me finally put in her two weeks' notice. She's a really smart cookie and definitely competent as a nurse. But the pressure got to her and she snapped.

She was working 32 hours a week, and trying to go to school to get her degree in biochemistry. Back in March she asked the managers if she could cut her hours down to 24 per week so she could sanely go to school. Biochemistry is *not* exactly a light subject. They said no, it wasn't possible. They needed everyone to work more hours since we're short on people.

So she slogged along for a couple more weeks and finally said screw it and put in her notice.

When I used to see her at work and give her report, I could see the heaviness in her eyes, and feel the stressed-out aura around her. I can feel the same thing in almost all the new grads.

But this week when she came in you could tell there was a difference. The look in her eyes was positively zen, and the aura was serene. Having the end in sight seems to have boosted her spirit remarkably.

And I am jealous.

I want to feel calm again.

I wish I had the balls to say, "Fuckit, this isn't worth it." I think a lot of us do.

I was talking to another one of the girls about it yesterday and she said that she is learning to just say "Whatever" when something bad comes up. We discussed that the only way to survive this job on this unit is to just give up. Sigh, shrug your shoulders, and just keep on plugging away. Stop hoping for anything better because it's just depressing when better never comes.

What a way to view your job.

Just keep swimming, just keep swimming....

I love my job. I love my job.


Friday, April 17, 2009

Nursing Nightmares 2

I had a rough shift last evening. I ended up staying an hour and ten minutes overtime because I hadn't gotten a chance to do a single word of charting. Everything just came at me nonstop all shift. So I got home around 0100, fell asleep a little after 0300. I had given my cell number to the oncoming nurses to let me know if I'd missed something or if there were questions.

Well at 0839 I get a call from one of the nurses letting me know that I'd somehow mislabeled the tube for a stat troponin draw that happened right around change of shift. I honestly can't believe I did that.

Anyway, I managed to fall back asleep and had this lovely dream...

I'm on the B station, waiting to get report. For some reason I'm sitting on J the Nurse Educator's lap, kinda leaning on him. He's a pretty snuggly guy. Talking to a couple of the nurses there, waiting for S to come give me report. She was a little ways down the hall so I flagged her down from outside rm 62 saying "C'mon, let's get this moving. It's already 1510 and I haven't gotten any reports yet." Someone unidentified said "Good job encouraging bedside report" so I felt happy someone noticed me doing the right thing.

Then S told me to follow her and suddenly I was driving to Santa Cruz (or at least the dream-equivalent). I think it was somewhere on campus. Anyway, I end up rather lost and at this rundown-looking shack, with a low wooden-post fence. I wander through the house looking for S, becoming more worried that I won't get through report on time.

I get back in my car and start driving around, and end up going through this large square archway in a wall, and what I see *looks* like ground, maybe with some water on it. I drive towards it and it apparently *is* water and I'm up to my chest in it in the car. But the car turns into some sort of floaty thing, like the kind you put babies in in the pool. The water is moving and I'm spinning around, trying to find my way back to the cement walkway near the arch.

I finally get out of the water and head back to the hospital so I can finish getting report from other people, assuming that I'll just figure out what I need to know about S's patients while I'm there.

I get lost a few more times on my way back, but I can't figure out what time it is an how late I am. At that point something in my brain says "Y'know, this seems awfully unrealistic. Are you sure you're awake and that this is happening?" I get back to the hospital and I try to ask MH and L if I really left the hospital and if any of this was real.

While waiting for an answer, Mom comes to wake me up so I can take her and Dad to the airport.

My most vivid/realistic dreams always happen when I have to wake up and interact with reality and then go back to sleep afterward. I'm sure this dream means something lol. I especially like the not-so-veiled reference to drowning....

Here's hoping for a calmer shift today.... [knocks all available nearby wood]

Thursday, April 16, 2009

From April 15, 2009: Wonder of Wonders, Miracle of Miracles!

Somehow, I managed to spend 80% of my shift with only *TWO* patients.

Let me tell you it was *heavenly*.

Our census was rather low to begin with (18 out of 26 beds) and I was given 3 patients. One of my patients was in for a lower GI Bleed and had it fixed up in the AM, and wanted to know what the plan was. Apparently the plan was a rather unexpected discharge! So he was gone *poof!* by 1700. I didn't even have to do anything, thanks to the ninja-like powers of the Resource, MH. So many things got magically done while I wasn't looking. Kinda crazy.

So that left me with 2 patients. They were on opposite ends of the unit, of course, but only having 2 of them left me with *plenty* of time to make the journey back and forth.

I kept expecting to get an admission or transfer, but somehow I stayed under the Charge's radar. So with my free time I helped L with her admission assessment and took other people's patients to the bathroom.

It was really awesome. Here's hoping for another good day, but I'm not holding my breath.

Monday, April 13, 2009

I had a good day today.

Report was thorough yet concise. I didn't have any immediate pressing need-to-do's at the beginning of shift. I actually got a chance to make my to-do lists and properly assess my patients and even do my PCHs (Patient Care Hours, which are used to determine staffing for next shift).

My patients were all A&Ox4, ambulatory (though some with assist) and none of them needed 2-hour turning. They all smiled, even though one was pretty bummed about being in the hospital, and everyone said thank you. A lot.

And every time I asked the pt in room 60 if there was anything I could do for him he'd say "Just keep smiling, hon. Smiles are free." He was a good guy.

I had such a good day that I didn't mind that it took a little extra time to get the pt in 62 tucked into bed properly. She was so sweet and cute about getting the little adjustments made so it was *just right*.

The biggest problem I encountered during shift was a BP of 77/43 on pt60, and all we did was turn off his Lasix drip for an hour and keep an eye on him, because he was asymptomatic. The doctor I called about it was clear and understandable; even spelled his name out without me asking him to.

I didn't have time to pack myself a dinner for tonight, but one of the girls brought in cupcakes for easter. Dinner of champions. Someone else had brought doughnuts, so I feasted on sugar. It was glorious.

I listened to old 80s/90s music online all shift, and no one even looked at me funny when I was singing along.

And I got out early. All my everythings done on time, and report was quick. Out of there by 2318. I decided to just clock out because I'd rather have 12 minutes of freedom than 12 minutes of pay.

Here's hoping for a lot more of these to come.

Friday, April 10, 2009

From April 3, 2009: Nursing is a 24 hour job....

The way our unit works, there are 2 different kinds of shifts. You have the new grads working 8 hour shifts (0700-1500, 1500-2300, 2300-0700) and everyone else working 12s (0700-1900, 1900-0700). Therefore there is often an overlap where for 4 hours (1900-2300) you have way too many nurses for the number of patients on the floor. On these days, *someone* has to go "on committee." Often it's the 12s, and for 4 hours they become extra Resources for us. Other times it's us 8s, and we end up doing audits (checking to make sure things were done correctly) and other boring paperwork-type activities. Or, like me, you can beg to go home early if you're not doing anything of actual importance. This means you have 4 hours to do all the need-to-do's that may arise.

So I had the opportunity to put in a half-shift, and I was pretty jazzed about it. I started off my shift with 3 patients, one needing to be discharged ASAP. I did my damnedest to get him off the floor, and off he was at 1615. Down to 2 patients. Yay. Oh but what's this? I get an admission at 1630. Admissions take *ages* to get in order, between the initial assessment with all its questions and the new orders and the MAR that shows up 2 hours later, etc etc etc. Luckily I had a resource to do the initial assessment because I had to get meds into my other patients. I'm also told that one of my patients needs to be transferred to a lower-acuity unit because she's no longer on tele.

While I'm working on my med pass, my manager walks by and says "By the way, Mr Worst Patient Ever will need a sitter." "Huh? When did you plan on telling me I was getting a transfer?" "He's being transferred to our unit and he's yours."

He gets to our floor at 1830 and I thank god he's a transfer, not an admit. I then find out that the other unit didn't do *any* of his 1800 meds before sending him my way. So I scramble to get his meds in him before I have to hand him off at 1900. The only thing missing is his pain med. Luckily he noncomplianted himself so badly he wasn't quite the same pain-in-the-ass as usual and didn't say a word. I just told him that one of his meds wasn't in the system yet and the next nurse would take care of it.

Somewhere in this time I manage to get some of my charting done. I don't know how.

Right around 1900 I get the MAR for the new admit but it's time for shift change. I apologize to the oncoming nurse (always apologizing... sigh) for not getting more done in my paltry 4 hours. I let her know about Mr WPE's missing med, and tell her that I didn't get a chance to go through my new admit's orders because the UA *just* finished with the chart, etc etc. She said "Well, I don't mind so much, just go through the med orders and sign them off so I can give the meds."

It's 1930. I'm supposed to go home. But I am green and don't want to rock the boat and alienate the seasoned vets, because they are all that stands between me and complete failure as a nurse somedays. So I sigh and start going thru the MAR.

I'm grumbling slightly to myself about not getting my stuff done on time when R leans over and says "You're choosing to be here." "Eh?" "You got to put your foot down. You're here because you want to be not because you have to be. Nursing is 24 hours. You got to remember that."

But the way some nurses look at you when you dare suggest that you ran out of time in your shift... It's enough to make you stay overtime so you don't have to see that look again.

Someday I'll put my foot down. Maybe.

Thursday, April 9, 2009

What I do with my shift (in an ideal world....)

1450 - Arrive on the floor. Put backpack in break room, glance briefly at notices on the board

1455 - Go to the station to get my assignment. Construct my "brain". Paper folded into quarters like a book, Room #s in the top left corner. Swipe patients' cards at the top of each quarter so I have their name and MR# easily accessible later in the day.

1500 - Get report, ideally at bedside so the manager doesn't get grumpy. If the patient has some private-type issues or the leaving-nurse doesn't want to say something in front of the pt we'll do it outside the door. Go meet patients, put my name and phone number on the board in the room. Tell patients I'll be back in a bit to check up on them and make sure they are still alive.

1530 - Claim an "office" space at the station. Print EKG strips and put in chart to analyze later. Go through the Medication Administration Record (MAR) and RAND (I still don't know what that stands for....) for each patient and make an hourly to-do list of their meds and dressing changes, if they need turning and tape the paper to the grey binder housing the MAR and RAND.

1600 - Assess patients. Deal with simple pressing needs like new grippysocks or a refill on water. Wish that we had more CNAs on the floor to do stuff like this. Turn the patients who require it.

1630 - Analyze EKG strips, chart patient assessment info.

1700 - 15 minute break

1715 - Check fingersticks (blood sugars), check vital signs to see if I should skip certain blood pressure/heart rate meds. Start pulling out medications for all my patients.

1730 - Begin administering meds to patients. Ideally this is done without interruptions.

1830 - Done with meds, time for dinner so the resource who leaves at 1900 can go home on time.

1900 - Dinner's over, back on the floor. Check in on my patients, attend to needs. Turn the patients who require it, which should've been done at 1800 but I can't give meds and turn people at the same time...

1930 - Print out 2nd batch of EKG strips, put in chart.

2000 - Chart again (our unit is q4h charting). Write progress notes where applicable. Turn patients who require it

2045 - 15 min break

2100 - Fingersticks for before-bedtime sugars. Start pulling out 2200 meds

2130 - Med pass. There are generally fewer this time of night, so it doesn't take as long. Thank god.

2200 - Turn the patients who require it. Finish up and close out charting. Do 8-hour orders checks. Make sure vitals have been entered in the chart.

2230 - Check on patients, make sure they don't need anything before change of shift

2300 - Shift change. Give report to the ladies of the night (ok. there's one guy too lol.) Say g'night to patients

2330 - Freedom!!!!!

I just realized that I made my ideal schedule without putting in my hard-won 15 minute breaks. I totally forgot that I am supposed to get them. I don't know where they would go since i rarely get them, so I put them in where it seems like they might work lol.

Stay tuned for the "real world" shift breakdown! Full of confused patients, disappearing charts, missing medications, and doctors who don't call you back!

Wednesday, April 8, 2009

Little old men are horrible flirts....

Yesterday one of my pts (88yo) asked if I was married while we were walking in the hallway. I told him no. Today he said "If I were a younger man I'd ask you to marry me." I told him I was more trouble than I'm worth.

Other patient (72yo)was in for safe alcohol withdrawal. He said "I was drinking for 60 years straight. I could outdrink your husband (gesturing to me) and her husband (to the CNA sitting for him)". Jokingly I said "I don't have a husband, but could you outdrink *me*?" and laughed. He said "When I get out of here I'd like to take you out for a drink." I told him I didn't think it was a very good idea....

Friday, April 3, 2009

PSA: What "Full Code" really means for your loved one

I received a transfer patient from another unit. 87 year old female, baseline A&0x1 (A&O = Alert and Oriented, to Person, Place, and Time) and barely verbal. Diabetic with history of ulcers and multiple toe amputations. Wheelchair bound at home. End Stage Renal Disease with dialysis 3 days a week. Almost blind. Here for sepsis and pneumonia. Quality of life? Not so much.

So she comes to me and I start doing my assessment. She requires a "shake&shout" just to get her to open her eyes. When I go to check her name band, it is stuck to her skin, which is thin as tissue and nearly tears when I try to separate the band from her wrist. She moans with pain but doesn't open her eyes.

The doctors are at the desk going over her chart to figure out if she needs any new orders on this unit. I mention that she does not look good at all, and that I was told in Report that she was "full code" but it didn't seem right to me at all. One of the doctors said he'd seen her before, last year, and that she was DNR/DNI (Do Not Resuscitate/Do Not Intubate) and that he was pretty sure she still was. We go through the chart to look for the "code status" paper. There it is. "Full Code".

The doctor sighs and I say, "I don't think people really understand what full code means in real life context. They see a code on TV. There's some CPR, there are paddles, maybe some drugs given. And 30 seconds later the patient is back, right as rain. If they knew what it really meant, I think a lot fewer people would choose this for their loved one. Are the risks of resuscitation really explained to people when they determine status?"

The doctor agrees. If someone tried CPR on this frail little old lady, her ribs would shatter. He decides we should call the family member to confirm code status. The doctor finds a half-assed "Advanced Directive" paper in the chart that says the patient doesn't want to be kept alive on machines. But doesn't specify if she wants to get put on the machines in the first place. He tries to take this angle when he talks to the family member. The family member insists that she would've wanted to be full code. The doctor acquiesces and makes a note of it in the chart. I look at the clock to see how much of my shift is left. Less than an hour. I hope she doesn't code on me.

If you are over 70 years old your chances of coming back after resuscitation are less than 15%. This doesn't mean "back to normal". This just means "no longer being technically dead". Your chances of surviving increase to about 50% if your death is witnessed by medical personnel, but only about 20% of *all* resuscitation survivors (from young to old) live long enough to be discharged from the hospital. Compare that to the survival rates from TV: CPR brings'em back 75% of the time, and they're usually fine afterwards.

As you age, your bones become more brittle. Your cartilage loses its springiness. During chest compressions, we have to use about 100-125lbs of force to get to your heart. Over and over and over. 100 times a minute.

Think about your grandmother for a minute. How well do you think she'd do if she was hit in the chest with 100lbs of force more than once a second? Imagine being 85 years old, having died temporarily, waking up with fractured ribs that cause a stabbing pain with each breath. Now know that there's an 80% chance that she will spend the rest of her short life in the hospital, in pain.

Then there's intubation. If for some reason grandma's airway isn't open enough, they'll stick a tube down her throat into her lungs so they can ventilate her that way. Have you seen what they use to get the tube in there? That thing is made of metal, and if the person's mouth is small, or jaw doesn't open enough, or the doctor *can't quite* see the vocal cords, there's a good chance grandma's gonna end up with chipped/broken teeth. If grandma survives long enough to be extubated, there are other problems. The tube has to go between the vocal cords. It'll be very hard for her to talk. Very bad sore throat. And if it stays in long enough, the muscles may be impacted. This means difficulty swallowing.

Difficulty swallowing could mean a couple things. If it's really bad, like everything she tries to swallow goes into her lungs, we won't let her eat. Because food in the lungs = pneumonia = death. Not good. So we'll keep testing her swallowing every day, to see if it gets better. If it doesn't we'll put a tube down her nose to give her liquid nutrition. She will hate the tube. If the trouble swallowing isn't too bad, we'll put her on "aspiration precautions" and she will need to be fed by someone. If family is there, good. They can help out. If not, it falls on us.

These days on our unit, we're short staffed. We have one CNA on the floor trying to do everything for everyone. We have one UA (unit assistant) trying to get our orders entered into the system in a timely manner. This means that a lot of the little things fall on the RN's shoulders. I'm not saying that we shouldn't have to do this stuff. These people are here to help. If they can't, then it's our job. And that's ok. But there's only one of me and if I'm trying to pass medications and start a blood transfusion and make sure my confused patient doesn't get out of bed and fall and trying to get one patient off to CT while taking report for an admission... you can see how something like feeding a patient might get pushed off for a little while. I always try to make sure my patients get fed during my shift. But it's not uncommon to see unopened trays of food sitting on tables in front of people who can't feed themselves.

So now grandma has pain with every breath, a crazy sore throat, maybe some chipped teeth, and hasn't eaten for 2 shifts because she's either NPO or her nurse didn't have time to feed her.

Oh. And then there's hypoxia. It only takes a few minutes for brain cells to die from lack of oxygen. A patient would be very lucky to have medical personnel in the room at the moment of coding. It dramatically increases immediate survival rates. But a nurse isn't going to spend the entirety of a shift in a patient's room just in case. It's just not possible. So the more likely scenario is the nurse comes by the room while rounding, or during medication time. Sees grandma lying there unresponsive. Checks her "brain" (paper used to write down report info) to confirm the code status and goes "oh shit oh shit oh shit what do i do?"

We don't know how long grandma's been unconscious/dead. Two minutes? 10? There's no way of knowing. But we call a Code and start CPR and do everything we can to bring her back. If it's been too long without oxygen, maybe we won't succeed. But maybe we will. Miracle of miracles, we get a pulse back, she starts breathing again. However, the lights are on but nobody's home. She's gone without oxygen for too long and she's in a coma. Or a vegetative state.

The grandma you knew is gone. She can't talk, can't move, can't open her eyes. Now she's definitely getting a tube for nutrition. And she needs to be turned every 2 hours to prevent pressure ulcers from forming. And that's going to hurt because her ribs are broken from CPR. And she has an 80% chance of dying permanently anyway during this hospital stay.

All because you decided that grandma should be full code. If grandma has had a good full life then please, let her slip quietly into the night. Think about her current health. Think about the pain this could cause her. Think about the quality of life she'll have if she does manage to survive. Being Full Code doesn't guarantee a good outcome. If you love your loved ones, let them go when it's their time.

Making your relative DNR doesn't mean we stop giving care. We still treat their diseases, provide for hygiene, prevent pressure ulcers, and try to make them better. But if it's their time to go, we let them go peacefully.

The next day when I came for work, I asked how the patient had done overnight and through the day shift. I was told that the doctor talked to the whole family, and they agreed that the best course was to put her on End Of Life Care (EOLC). This means we no longer try to treat her diseases. We make her as comfortable as possible and allow her to die on her own time. Thank god the family finally saw reason. I like to think the doctor told them what Full Code really means and that a little education went a long way.

From March 23, 2009: Assignment Woes

I will always volunteer to take a day off. Or take a half-shift. I'm at the point in my life where I enjoy the free time substantially more than I need the money. All the other nurses marvel at my nonchalance about income. I'm sure someday when I have a family and a home to pay for and no longer live at my parents' I'll care. But for now, I'm livin' life :)

So I show up to work as usual, and they're working on putting the assignments together. The Charge tells one of the nurses, C, that she will give me her patients, and then go "on committee" to work on her computer training modules. C says "To work on the computer for only 4 hours doesn't make sense. I am so slow I won't get anything done. I want to keep my patients."

Of course, I chime in "Wait, if C won't give me her patients, then you don't really need me here, right? Because if she stays till 1900 then one of the 1900-0700 nurses will take over her patient load. Can I just go home?"

The charge looks over the assignment sheet and says "Sure, have a good day." So, happy as a clam, I go back to the break room, grab my stuff, and get the heck outta dodge.

I get to my car, I head on down the road, make plans to go hang out with some friends and am [this close] to getting to my friend's house. Sitting in traffic on the freeway, one exit away and my bluetooth thingy starts ringing at me. I answer, assuming it's my friend. It's not. It's work.

Apparently the Charge thought another girl was scheduled to work that day, but she wasn't. I was needed after all. It's 1518 at this point, and I am still very much stuck in traffic. I take the next exit and dipsydoodle through side streets to get back to the other freeway that gets me to work faster. I don't actually get to work till 1600. The Charge gives me report and I start hauling ass to get all my ducks in a row so I can start actual patient care.

Everyone asks why I'm back. Everyone says "Why the hell did you answer your phone? Never answer a work call once you've left." They have little sympathy for the fact that my phone was in my pocket and I was driving and didn't look at the caller ID.

I don't know how I did it, but I managed to actually get *everything* done my shift and get off on time. I'm gonna give credit to my amazing Resources. They make life so much better on the unit.

I guess I've learned to screen my calls better...