Saturday, August 22, 2009

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.

Tuesday, August 11, 2009

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."


Sunday, August 9, 2009

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...