Monday, May 18, 2009

"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.

Saturday, May 16, 2009

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.

Thursday, May 14, 2009

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.

Wednesday, May 6, 2009

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 :)

Saturday, May 2, 2009

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....