Thursday, September 23, 2010

Time to compare and contrast!

So I've done 5 shifts on Mom/Baby so far. The first day I shadowed on the floor. The next two I was in the Well-Baby Nursery (shadowing/helping out). Fourth day I took one patient, and the fifth I took two.

So I feel like I'm getting the hang of this place.

The Good

-No more demented old men peeing on my shoes and then asking if I'd get in bed with them! The only poop I have to deal with is meconium, which comes in small amounts and has no smell. Bye bye CDiff!!

-Night shift is very chill. I thought it would be a real issue adjusting to the schedule, but so far so good. I've even got the start of a daily pattern. Get report, do vitals and assess, and then the first cup of coffee (3/4 coffee, 1/4 milk). Then chart and wait for something interesting to happen. Maybe give a pain med here or there. Remind moms to breastfeed, then take "dinner" around 0300 or so. Before 0400 I have my second coffee (1/4 coffee, 3/4 milk) just to keep me going. I've been warned that coffee after 0400 can be detrimental to sleeping when you get home. Then just sit around waiting for something to happen until 0600 pain meds. So far, so good :)

-Management actually cares! The NOC shift ANM comes around every couple hours to do a "wellness check" to make sure the nurses aren't drowning, and that people have gotten their breaks, and to see if anyone needs a hand. Sometimes the ANM did that on Tele, but it was more like, "Why is this med overdue? What's going on? What do you mean you haven't taken your break?" Very different approach lol...

-Management does things to make the unit better. Apparently the nurses were complaining about having to get snacks and ice water for patients, and it would be nice if the patients' families had access to the kitchen. For infection control purposes, the kitchen is code-locked. So the management brought it up with the Powers That Be and they are working on a "family snack station" so people can serve themselves. I didn't even know you *could* complain about having to get food for people. I spent at least an hour each shift running back and forth to the kitchen lol.

-High quality frozen yogurt at the staff meeting. Plus the meeting was interesting and interactive in an organic sort of way, not in the kind of way where your manager calls on you like you're a student and expects you to answer a question like you'd been paying attention. Apparently they do a 2-hour meeting every other month rather than a 1-hour meeting monthly. Saves on the boring lack of news. It went well enough that I didn't mind staying three hours past shift, and that's saying something.

The Bad

-The (perceived?) lack of autonomy. One of my patients had an order for Norco (5/325) q6h around the clock. Makes sense, s/p c-section. So I gave it. The nurse I was working with said "Oh no, you have to verify with the anaesthesiologist first. Look here:" and then showed me on the computer system, where the orders said "No narcotics via IV or IM route for 18 hours after Duramorph. Said nothing about PO. Plus the patient had a stronger PRN Norco (10/325) ordered by anaesthesiology, so obviously it's not contraindicated. Another example: if a patient on Tele has antibiotics ordered, but no continuous fluids running, we set up our own primary line so we can piggyback the various meds without having to start from scratch every time. Standard practice. When the med is done, we run saline long enough to flush the line and then disconnect. No biggy. One of the nurses I was working with actually called the doctor to get an order for a primary line at TKO so she could piggyback the med. If I did that on Tele, the doc would probably yell at me for wasting his/her time with a stupid question.

-Apparently the various medical teams (mainly OBGYN and Anaesthesia) don't talk to each other. One patient had three separate orders for PRN Norco (10/325). That's just *asking* for a mistake, people...

-No CNAs on NOCs (dunno about the other shifts) and there aren't enough dynamaps to go around. People stake them out before even getting report and then treat them like private property; I've seen names labeled on them! But that brings us back to "the good" and that the manager has ordered a few more machines.

The Weird

-People will bring their patients' babies into the nursery, and ask the nurse on duty there to do their assessment and charting on that baby. WTF? I can't even *imagine* asking someone to do that with an adult patient. The assessment is the cornerstone of nursing care, and passing it off to someone else just blows my mind. Vital signs and weight, sure. But I wanna *know* that my baby's lungs are clear and that he has normal heart sounds, not just take someone's word for it.

That's it for now, more stories to follow, I'm sure :)

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