Monday, June 29, 2009

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.

Saturday, June 20, 2009

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.

Tuesday, June 16, 2009

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]

Friday, June 5, 2009

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.

Tuesday, June 2, 2009


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.