I'm still hoping for my TriCorder...

but these wireless innovations seem pretty damn cool. I especially like the "smart bandaids." Definitely worth watching.

Dear Patient in 63,

I know it sucks being in pain and being stuck in the hospital. However, using your call light literally (and I do mean literally; I kept track) at least once every two minutes will *not* increase your level of care. You seem alert and oriented, so we're assuming it's not that you're confused, you're just insane. When you call that frequently, especially for things you can do yourself, we start ignoring you like the boy who cried wolf. I don't care how much your shoulder hurts; if you can reach the call light that often you can reposition your arm a couple inches to make yourself more comfortable.

Ma'am, if you behave today like you did yesterday, I am going to take the call light away from you and read you the Riot Act like nobody's business. We have 25 other people on our unit, and 95% of them are in more serious condition than you are. You are jeopardizing their health by monopolizing our time and attention.

Knock it the fuck off!

Sincerely,
Purple RN

(After she whined "I'm just so miserable!" for the umpteenth time, I did say "Ma'am, we're *all* in the hospital and we're *all* miserable." She laughed a little, which I suppose is better than calling my manager...)


In my perfect world, I would invent a call light with a built in electric shock. If you use the call light more often than, say, 20 times in an hour, you get zapped every time you hit the button after that. I think it would encourage much more judicious use of the call light, and in an emergency situation I think a person would withstand a little zap to get real help. Until they perfect the Ativan mist or Ativan nebulizer treatment

A compliment a day does wonders for the self-esteem...

"You're a nurse." She said it in a somewhat awestruck way, as if it were something she hadn't encountered yet during her 4 days of hospitalization. She was in her mid 80s, here for sepsis and trouble with breathing. Standard-issue patient on our floor.

"Um, I try to be..." I said confusedly, worried that she was sundowning.

"No, I mean it. You're a real nurse. No one has done that for me the entire time I've been here." I was busy tidying up her bed, and untangling the phone and call light cords while she sat on the commode after finishing her business. "Huh? Fix your bed up?"

"No. Cleaned me."

I had just come to help her off the commode, and I noticed some old soiled toilet paper stuck to her backside, and various other substances that needed addressing. So I got a warm washcloth and some soap and gave her backside a decent scrubbing while she balanced holding onto my other arm and shoulder. Really basic nursing school stuff. Patient is dirty? Clean her up.

I was a little shocked to hear it, so I clarified. "No one has helped you clean up after the bathroom since you got here?" "Nope," she replied. "Yesterday I called for help and no one came for 45 minutes. I was watching the clock"

I apologized profusely on behalf of whatever nurse was responsible for that incredible lack of care. Personally, if I can't be there to help my patient within 5 minutes, I send someone else. And if that person can't be there, I will make myself un-busy to help (barring an emergency situation, of course).

"Don't worry about it honey. You're doing a great job, and you're a wonderful nurse. Thank you."


It made my day. And the next few days, I got compliments from patients and family members each day.

"You're a good nurse."
"I'm glad I have you as my nurse again."
"You're kind and efficient. You're good at what you do."


One of my friends recently commented that the way I write this blog, it sounds as if my job always sucks. I told him that the shitty things make for better stories. No one wants to hear, "I did my assessments, passed my medications, charted, wrote a couple notes, and made sure my patients were comfortable." Crazy people and wacky adventures are where it's at.

But when something good and uplifting does happen, dammit I'm gonna share it :)

First day back after a week off...

It was a hell of a week off (family emergency/drama), not relaxing in the slightest, and my first day back was a fucking doozy.

The central issue was a young (<65 is young on my unit) man who had melena in the morning and came to ED to get checked out. He went for an EGD on his way up to our unit, and got to us right at the start of shift. Upon arrival, we found out that the room he was slated for had not yet been cleaned (previous occupant was out 6 hrs prior) but was listed as clean. So my patient is hanging out in the hall, not looking one bit sick. His H&H was 13/37.9, probably better than anyone else on the unit including mine lol.

He flags me down and asks if there's a charge nurse he can speak to. I ask what the problem is and he says that after the EGD, they told him they didn't find any active bleeding. He said that he couldn't afford to spend the night in the hospital, and that his copays had doubled recently. I told him that we'd need to get a doctor up to the floor to discuss the issue with him, and that if they decided on it, he could leave AMA.

The room gets finished, he hangs out in there, and the doc comes to talk to him. Meanwhile, I avoid releasing any orders, just in case he decides not to stay.

Apparently the doc figured that if he took one of the meds PO instead of IV, they could keep him here for observation instead of admission, thus bypassing the cost of a hospital admission. Everyone was happy. Yay. I do my new-patient questionnaire, get his orders going, and things go smoothly for awhile. (At least with this patient. One of my other ones had hospital-induced loss of hand function. Could always reach the call light, but not pour her own damn drink)

So I go off to dinner feeling pretty positive about things. Nice easy patient.

I come back from dinner and find Resource Ninja and one of the other RNs in my patient's room. Apparently while I was gone, he threw up 200mL of blood. They put in a large-size NG tube, and sucked another 500mL out of his stomach. They were total rockstars. They drew labs, started 2 new large-bore IVs, and got an NGT inserted in like 5 minutes. The doc decided to start him on some IV drips, and get him sent to stepdown for more acute care and a stat EGD.

We seemed to have a completely full house. Trying to figure out the bed issue with the boss-man was a nightmare. First I hear we have a bed in stepdown, but we have to take one of their patients in exchange. Then we don't have that bed and there are no other available beds. So I get told he's going to ICU. I call ICU to try to give report, and they have no idea who this person is. I find out I was given the wrong room number and that he's going to a different ICU. Make up your fucking minds people!!!

I go to check on him while I let the management figure out where he's going. Poor guy threw up again. It looked like cherry pie filling. Huge globs of coagulated blood that had no chance of going through the NGT. The pt had been sitting on the edge of the bed, so he could vomit more comfortably. However, with this new advance, and the slowly increasing amount of blood in the suction canister, I decided he'd be best off lying back in the bed just in case of passing out.

I go out to the station, finally find out where my patient is going, and give report as they're wheeling him down the hall on the bed. I could hear him arrive on the other end of the phone. The portable monitor's PING is unmistakable.

I finish up my notes (though it occurs to me now I forgot to chart the hematemesis on the I&Os) and try to catch up on everyone else. Later on I find out that he has a huge gastric varix that somehow got missed the first time, or just decided to open up while I was at dinner.


The best part is that the very next day, right at the beginning of shift, I'm told I have an admission. "He's easy" they said. "It's just a GI bleed, and he's a walky-talky. Nothing too exciting." Never been so terrified of that diagnosis before...

I wish the BBC would allow embedding of video

You must go watch this video. It's about an outdoor maternity "hospital" and the nurses who are trying to help out. I wish I was down there. I have a year of almost-critical-care under my belt and put my name on the Registered Nurse Response Network list. You can donate at www.sendanurse.org to help fund much-needed supplies.


Anyway, here's the video

http://news.bbc.co.uk/2/hi/americas/8471326.stm

Today I got the punishment for something that was not my fault.

I got a patient yesterday from ICU. Meningitis, had a rough time of it but was pulling through. Very sweet lady who was an L&D nurse for over 20 years. Her family was at the bedside, a little anxious but generally kind and friendly. I joked around with her sons, we made each other laugh. They even gave me a recommendation for a local Middle Eastern restaurant with excellent food and low prices. Things were going swimmingly.

I was excited to have her as a patient again today. But there should have been alarm bells early on in the shift when the pt and her friend (another retired RN) asked when she was going to be moved to the other unit.

Now, I hadn't heard anything in report about a downgrade to Med/Surg, or an upgrade to Stepdown, so I said "I don't think you're going anywhere." Then I got busy enough with the start of shift that I pushed it to the side for a little while.

Then at about 1630 I got a phone call from the manager of our sister unit, who is covering for our manager while she's on vacation. She said that my pt was going to be transferred to her unit as part of a "customer service recovery" issue.

I couldn't get many details, but the gist was that the family was unhappy with her care on our unit during the NOC and AM shifts. The AM shift RN told me that one of the sons was grumpy with her, but I didn't think much of it since he has sort of a sarcastic sense of humour.

I can't imagine anyone being so upset that they request a whole new unit. Plenty of people request not to have certain RNs again, and we're very accommodating to that. But to change floors?

The manager of the other unit said "The family is happy with you. Don't worry about it too much" but wouldn't give me more than that.

So a little time passed, and the family showed up to help the pt get to the other unit. I knew it was bad when the manager was personally escorting the patient. Her son asked if he could fill out one of our "above and beyond" cards about me (we'll see if it happens; it'd be my first one!), and said that he emailed people saying that he was glad to have my care. He even asked if I could get transferred with the pt or if she could stay through the end of my shift.

So one of my best patients gets taken away from me for something other people did/didn't do. It sucked, and I was furious. But my anger doubled when about 15 min later I learned that since I now had an opening (the only free spot), I was getting a new admission from ER.

Luckily it was a pretty easy pneumonia case, walky-talky A&Ox4. Sweet older guy. Thank god.

The worst part about all this is that our unit looks bad. We've spent a lot of energy trying to get the unit's reputation out of the mud, and this is just one more stone weighing us down. "Look at Tele! People are begging to get transferred out!" When our manager comes back, we won't hear the end of it for awhile.

I hope the patient continues to recover well, and that something like this never happens again.

One of my patients was put on comfort care today, about 2 hrs before my shift started. They had called RRT on her for non-responsiveness and trouble breathing. When I got her, she was on the CPAP and pretty much nothing else.

I tried to be as comforting and supportive to the family as possible. I think I was doing a pretty good job of it.

Until ED started wanting to send people up, and we had no nurses to take them. Since comfort care doesn't require tele monitoring, she was to be moved to the next unit over.

The family was *not* happy.

I apologized profusely, and tried to explain that I was needed to take a patient who required monitoring. Really, there's no good/nice/easy way of saying "We need you out so someone else can come in." No matter how lightly you try to put it, you sound like an asshole.

So I asked the family to try to get their things together, as there were a lot of them there with a lot of stuff.

I saw the bedside table get shoved angrily out the door into the hall. There were a lot of reddened eyes and scowls. I assured them that the transfer would be quick and painless. One of the sons was concerned about her breathing, so I hooked her up to the portable O2.

Things were not made better when we got to her new room and there was no O2 hookup in the wall. I had to run down the hallway and steal one from an empty room. More glares.

I tried the best I could, and still felt like a jerk. I hate feeling like I have no control. I tried to ignore the guilty feeling so I could continue with my shift.



Then about an hour or so later, the two sons came to the unit looking for me.

They apologized for being so harsh. It really made my day, because I was not looking forward to trying to sleep tonight with a guilty feeling.

I hope all goes well for them, and that the patient's transition is peaceful.