Tuesday, September 22, 2009

I made it through my first year!

I want to take a moment to recognize all the other Not-So-New Grads who survived the first year with me. You guys are all amazing and wonderful, and I can't think of a better group of girls to go through hell with. Without the support and humor you guys provided, I probably would've done something insane by now. You rock!!!

It's hard to believe a whole year has gone by. I'm sad that some people didn't make it this far, but I wish them all the best in their futures. :)

I've been debating on getting a nursing-related tattoo to celebrate a year, though some tell me I should wait until five years. When I'm *really* sure.

Any thoughts out there in internet-land?

Saturday, September 19, 2009

Sometimes the doctors' notes amuse me...

At our hospital, when the main MD "signs out" for the night and cross-cover takes over, the MD will write a little note with plan of care for reference. I found this little gem the other night:

"If pt decompenstes with generalized respiratory badness, call pulm. Okay to titrate up 02 if necessary. If pt spikes temp overnight, do not re-culture. Don't even *think* about it.... ;) "

Yes, including the winking smiley face. And "respiratory badness" is apparently a technical term now, so that's cool. Now my friends won't give me crap when I describe things as "________ badness" because we know it's officially sanctioned.

Just a little silliness to brighten up the day :)

Friday, September 18, 2009

It's raining crazy at work

So usually our unit just gets little old people with CHF, COPD, GI bleeds. Stuff like that. Rarely do we get anyone under 50.

Tonight we got two, both with psych issues. They came to our unit within 5 minutes of each other (around 2030). One was an admit from ED/PACU, the other a transfer from stepdown.

First one was a mid-40s male who came to ED with "penile pain." I'm thinking, there's got to be something more to this. Penises don't just hurt without a really good story. So here it is:

"Patient placed 5-6 kidney beans in his urethra last night for sexual pleasure. He has been unable to void since 10 PM last night."

Kidney beans? Seriously? I have to wonder at what point it seems like a good idea to place small, irretrievable objects into ones urethra. Didn't he know they make toys for that? Hell, if you want the lumpy feeling, at least use beads on a string or something! Someone should make a PSA (a la Scrubs) about not sticking things where they don't belong.

So the poor guy had to be put under general anaesthesia for a cystoscopic removal of the kidney beans. He must've had some sort of complication, because post-op he ended up with us. Either that or they were out of med/surg beds. *shrug*

Unfortunately, I was just Resource, not his primary nurse. So I didn't get to hear it straight from the horse's mouth. I'm sure it was an interesting story...

Our other crazy patient was in her late 40s. Attempted suicide 4x in the last 3 months or something like that, because she felt like a failure as a wife and mother. (Aside: killing yourself is the *ultimate* in failing as a wife and mother.)

Anyway, she had expressed suicidal ideation, so her husband took her to the ED. While in there, she went to the bathroom. When she came out (after an unknown amount of time) she told one of the nurses that she had taken "about 60 pills" which she had smuggled into the ED in her vagina.

I checked *all* the subsequent notes in the computer. *None* of them mentioned whether the pills were in a bottle, or just shoved up in there. For the sake of "ewwwww" I hope to god they were in a bottle.

Anyway, the woman was a terrible historian, and couldn't remember if they were Cymbalta or Klonopin or what. All the notes had different meds listed. But by my accounting, if you take 60 of *anything* you'll probably get sick.

So they dropped an NG and did gastric lavage, bringing up "no pills or pill fragments." I find that odd, cuz pills take awhile to dissolve fully. So either she took the pills earlier than she said she did, or she didn't take any at all. But she became fairly non-responsive and lethargic, so they brought her up to stepdown for monitoring. When she got a little better, she came to us. She had at 1:1 sitter that came with her, so that was nice.

Both of them are to be evaluated by psych when they're a little more "with it." I wish I could be a fly on the wall for those conversations....

UPDATE: I asked one of the RNs who took care of kidney bean guy, and she said that the reason for the beans is that if they stay in long enough, the body's natural moisture makes them swell, which apparently feels good. So there you have it. :)

Monday, September 7, 2009

Dear pt in rm 60,

Please stop trying to sabotage your own health. It kills me to see you every day, getting better, but not getting better as quickly as you could be. I know it sucks being in the hospital, but combating everything we do is just hurting yourself. Please meet us halfway at least. It's the least you can do for yourself.

Love, PurpleRN

She came in because the swelling in her legs had gotten so bad, she could barely move them under her own power. The unit she was on tried IV lasix a couple times a day but it kept dropping her BP. So they sent her to us for a Lasix drip.

The swelling in her legs caused her considerable pain, so she had Dilaudid on board. She was a clock-watcher. The moment enough time had passed, she'd ring for another hit. And get rather upset if it took more than 10 minutes to get her meds. I understand that being in pain sucks, but we have people circling the drain on our unit. Your legs are slightly less of a concern sometimes.

She's on fluid restrictions because of the edema. Fluid restrictions suck. Imagine some "high faluting" doctor saying, you can only drink 1.5 liters (~6 cups) of fluid today. Period. Well what if you don't budget properly and drink 5 cups of water in the first 12 hours of the day? Screwed, my friend. So she'd been sneaking drinks and not reporting them to the nurses. Her husband/partner-in-crime wasn't helping on that front either, showing up with fast-food meals.

She would go on "walks" with her husband (he pushed her in a wheelchair) a couple times a day, to the atrium near L&D down the hall. We explained that she was going out of telemetry range, and we couldn't monitor her heart out there. She didn't care. And she would come back smelling of cigarettes. Our campus has a strict non-smoking policy, and we told her we could get her the patch while she was in the hospital. She refused, saying it wouldn't work. I hate people who automatically say no without trying.

She threatened to leave AMA if she couldn't smoke, so the doctors let her go off campus with a security guard for cigarette breaks a couple times a day.

What the hell? "THRIVE" my ass! Just because a patient gets whiny doesn't mean you bend over backwards to thwart her recovery!

I bet you're asking, well why not just let her leave AMA? Because she said, "I'll just come back to the ER when I'm done with my smoke," and that creates more work for us. (Aside: I'm of the opinion that if you leave the hospital AMA, you are not allowed to seek medical help for at least 48 hours. If you die from your own stupidity, so be it)

Doesn't advocating for your patients include trying to protect them from themselves? Sure, she's doing better than she would be if she wasn't in the hospital, but she's not getting better as quickly as she could.

Last but not least, we've been very concerned about falls on our unit lately. Our patient population is such that they're mostly too unhealthy to get up unaided, but not with-it enough to realize they need help. Or too proud to ask for help. We even had a recent meeting on how to reduce falls. The only time I took care of this patient was when she came to us from the other unit. I told her that if she needed to get up, she needed to call me first. Obviously, since her legs were so swollen (and she is obese) she couldn't move very well.

My shtick is to say, "I know you don't want to bother me by calling for help, but I'd much rather help you to the bathroom safely than scrape you off the floor when you fall. Plus the paperwork is *insane*. Please don't make me fill out paperwork" Usually it gets a laugh and a promise to call before getting up.

Well she's been with us a few weeks now, and apparently thought she was in good enough shape to get up on her own. She ended up on the floor, requiring xrays and various other tests for broken things.

I know you don't want to be in the hospital anymore. I know you think 3/4 of our nurses are idiots. But you're not doing yourself or anyone else any favours by screwing up your recovery with what *you* think is right. Your treatment team (MDs, RNs, MSWs, PTs, etc) went through lots of schooling and training and hell to know what to do to get you better and get you on your way as fast as possible. Believe it or not, we know what we're doing.

It makes me wonder how we can properly advocate for patients that won't accept it. How can we encourage people to take ownership of their health? Noncompliance increases complications and drives up medical expenses, neither of which are in *anyone's* best interests.

Any ideas?

Update to "Siiiigh"

So after all that silliness about being requested to stay 16 hours, I ended up going home early :)

At about 1730, I get asked if I'd like to leave early, as we will be overstaffed starting at 1900 when the 12s come on shift. Of course I jump at the chance.

At 1900 when I'm giving shift report, one of the 12s comes up and says "If you want to stay, I'll go home and come back at 2300" as if he's trying to do me a favour.

I became briefly worried, "Wait, are you asking me to stay or telling me I *have* to stay?"

"Do you want to stay? Cuz I'll go home. You can stay if you want."

"Um, no thanks. I'm happy going home..."

Afterward, I was told by the nurse I was giving report to that this guy works 2 jobs, and that's why he always looks exhausted, so he probably wanted another 3 hours of sleep. I feel kinda bad about it, but I'm also greedy for time off.

Sorry dude.

Friday, September 4, 2009


So I called Staffing this morning to ask to be considered for the day off if we are overstaffed like yesterday (one of the girls was put on committee and then sent home early). It's rare that they call back, but it's like the best present in the world when they do.

So when my phone lit up with !!WORK!! my heart got very jumpy and excited. A free day off? Yay!

Turns out it was not Staffing, but the BossLady asking if I wanted to plan ahead to work 16 hours tonight.

Ha. Right.

I politely declined.

Guess I'm definitely not getting the day off.

Thursday, September 3, 2009

What is it with little old men?

Two have tried to kiss me in the last two days. Sure it's a little cute and funny, but how do you respond to an octogenarian's inappropriate advances?

The first one was in for breathing problems. He was always up and about, with his heart rate skyrocketing and his O2 sat plummeting. I couldn't convince him to call me before getting up, so I put a lot of extension tubing together so he could get to the bathroom without taking the oxygen off.

Anyhoo, I'd finally gotten him settled in the chair and he was griping about how he couldn't figure out the TV, and really wanted to watch the baseball game. So I flipped through the channels, and found the appropriate game. He said "Yippee" like the cute grandfather in Charlie and the Chocolate Factory and "You deserve a kiss for that! Just one on the cheek"

I politely declined.

The next one in question had just arrived from ED earlier that shift: an unnecessary admission for high blood sugars. Paranoid wife. At any rate, I was finishing up my end-of-shift things and stopped in the room for a last check before report.

I asked, "Do you need anything, or is there anything I can do for you before I go off shift in 15 minutes?"

"Well, I *usually* get a kiss goodnight before bed..."

I paused and said, "I'm pretty sure your wife won't be happy about you kissing a young nurse at the hospital."

"I won't tell if you won't!"

My main question is, "Does it ever actually work?" C'mon guys... give it a rest already.

Wednesday, September 2, 2009

I worked my first (and last) double on Tuesday

Oh what an interesting experience.

I'd been having a really good day on Tuesday. I was Resource (along with L, another not-so-new grad). It was pretty busy, and I had to jump in feet first to get a patient discharged. His family said that if he was not ready to go by 1600 they were not going to be able to get him and he'd have to stay another day.

After that had all gotten settled, it was a pretty smooth shift. Gave people their breaks, helped with fingersticks, did other Resource-y stuff. Nothing eventful enough that I remember it.

But near the end of shift we get word that 2 or 3 of our night shift nurses have called in sick, and they need people to stay double.

Now, I have to say that it's a running gag at this point to ask me to work a double. The Ass.Man. (teehee. thanks to J for the abbreviation) still asks anyway, with a huge grin on his face, knowing I'm going to say no. I'll be the *first* to volunteer to go home early, but I'll be damned if I work anymore than my contract says I have to.

But today I'm thinking, "Well, things are going pretty well. We have 24/26 beds filled, and 6 RNs (we have a 1:4 ratio) so we're full. I guess I'll stick around just to see what it's like."

So I shock the whole world by agreeing to stay double.

I give the boyfriend a call and let him know I won't be coming home as previously discussed, and that if he really loved me he would bring me Starbucks and a salad from Jack-in-the-Box. Not only did he come through for me, he drove miles to find a Starbucks open at midnight, and he got food for L as well. He's so sweet lol.

The first part of my second shift was cake. Potter came a little after midnight, and I took a 15 to show him around the unit and hang out a bit. We ended the tour when one of the pts became confused and his nurse was too busy to re-orient him.

He was a sweet guy who "just felt disorganized" and couldn't figure out where he was. I reminded him he was in the hospital for a bowel obstruction, and that the NG tube was to keep his stomach from filling up with gunk (technical term). He said he knew all that but just couldn't figure out where he was. So I got him up out of bed and walked him to the doorway. Pointed out the main station down one way and the big window down the other. Eventually he got it and was content to try to sleep.

After that, I asked the 3 nurses on my side (there are 2 stations on the unit) when they wanted to take their dinner breaks, offered to help out with anything they needed, and mostly just sat on my butt, slightly bored.

Heck, one of my nurses didn't even tell me when he was going on dinner, or give me his phone or anything. Very different from on PM shift.

Then we found out that ED was OMGFULL and that one of the resources (me, apparently) was going to take an admission. Ok, not a huge problem.

So at about 0330 I decide to take my dinner (mmm southwest chicken salad without the chicken) and relax before I got report. I also have an insane urge to brush my teeth, because this is about the time I go to bed normally. Thank god I keep a toothbrush in my backpack :)

At 0355 L pops her head in and says, "Did you get report yet on 54?" "No, why?"

"Because he's here"

WTF?! Seriously ED. That is *NOT* cool. You do not bring a patient up to the floor without giving report or warning. I understand it sucks being full, but blindsiding a nurse is just not fair.

And this is where the clusterfuck began.

If we had gotten report we would've known that the pt was on droplet precautions (ie, he was coughing and may have something communicable) and we would not have assigned him to one of our 4 double rooms (the rest are singles).

So at 0415 we have to start playing the bed-shuffle game. One patient got transferred to another unit, and then about 5 different patients had to get switched around to accommodate the nursing assignments, because it would suck to have a patient moved all the way across the unit halfway through your shift.

Finally get everyone settled and I try to do my admission the best I can with the few remaining hours of shift. Also trying to be helpful to the other nurses, as I only have 1 pt to their 4.

As the sun came up through the windows I started feeling really exhausted. And when the day shift nurses started streaming in I got the most surreal feeling. It was like I was on the wrong end of time. It was funny watching all the Day RNs' faces register the fact that I was there at start of shift, not end. Barely concealed surprise and shock, and quite a few laughs and "What are you *doing* here?"s

I give report to whoever was taking my patient, then try to give report to the Resource whose side I was on earlier that night.

Got out of there about 0745 and headed out. Immediately, I was confronted with something I hadn't expected to deal with: traffic.

"Oh god. I don't think I can deal with this" I felt the strangest kind of awful driving home, realizing that I had about 6 hours to get home, sleep, and get ready and leave for my normal shift at 1500.

I honestly don't remember much about my regular shift. I responded to frequent statements like "You honestly stayed double? You never stay over! What made you change your mind?" I know that my Resource saved my exhausted ass on a couple occasions. I made promises to patients that I forgot to keep. One of my patients was a retired L&D nurse, and she was very understanding about my situation. Didn't make me feel any better about it, though.

Near the end of my shift I realized that I was getting paid time-and-a-half (or double?) to be a *terrible* nurse. And as much as I'm sure my paycheck will be nice this time around, I can't do that to myself or my patients again. It's not fair to anyone.

At around that point, the Ass.Man (who is becoming cooler these days) comes around and asks people for their Starbucks orders, as he is going on a run and apparently won the lottery. I put in a request for a nonfat vanilla latte (mmm) and go about finishing up my to-do's. I felt a little bad, as I think J may have been trying to just get stuff for the people who were staying double but no questions were asked and, hell, I feel like I deserve free coffee on occasion. And man was it good. Who cares that I was drinking that much caffeine so close to midnight lol.

So I guess if I were to evaluate everything, the only situation I'd work another double is if we were *full* (26/26 beds taken) *and* I was Resource *and* I wasn't working the next day. Because I have better things to do with my life than work myself to death.