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.

I love that old people seem to lose their filters...

89 year old female, here for GI bleed. Tarry stools. Lots of fun. Anyway, the CNA and I were doing some cleanup.

The CNA had soaked a bunch of washcloths in rather warm water, and squeezed them out over her crotch to help get off some stool.

My patient says, "Oooh. That feels nice. I haven't had anything that hot down there in ages!"

It was all the CNA and I could do not to dissolve into giggles.

Argh. Stupid House...

Episode "Teamwork"

Chase hangs a piggyback but uses the blue extension hook on the piggy, not the primary. It's never going to go in, jackass. Maybe that's why your treatments don't work! Never send a doctor to do a nurse's job....

Never gets old, does it? Kinda makes you wanna... break into song?

I love sundowners
I love the bed alarms
I love old gentlemen
And their eccentric charms
I love telemetry
And its adventures

Boom de yada
Boom de yada
Boom de yada
Boom de yada

I love the C-Diff
I love the GI Bleed
I love CHF
Even COPD
I love telemetry
And all its smells and sounds

Boom de yada
Boom de yada
Boom de yada
Boom de yada

I love AV blocks
I love my rhythm strips
I love new A-fib
And starting heparin drips
I love telemetry
My job is pretty cool...

Boom de yada
Boom de yada
Boom de yada
Boom de yada.....



(copyright by me. written after watching one-too-many youtube videos)


Readers!! I need your feedback, as I'm torn on the very last line. Should it be "my job is pretty cool" or "my job is killing me"? The latter is (much) more accurate, but I was actually thinking of making a video for it that management could someday see...

The V-Fib came out of nowhere....

It had been a slightly rough start to the shift. I found out I had two patients with behavioural issues on either side of the station. Luckily my ETOH W/D had a sitter, but the other one did not.

She was under 50, but had had a recent stroke. Until a couple days ago, there had been no residual. But then she stopped being able to perform ADLs, and her husband brought her in. Now she was agitated, trying to crawl out of bed, and almost nonverbal. Plus she mostly only spoke a foreign dialect that only one of our CNAs (the one who was supposed to be siting with my ETOH) knew, so he was in there trying to keep her calm.

The offgoing nurse let me know that she'd gotten haldol a couple times his shift, and he saved a X1 ativan for me. A little before 1600, the ANM said that now might be a good time to give the ativan so the CNA could go sit with my other patient. Within 10 minutes she was calm and sleepy, all systems normal.

The MDs were concerned about her having seizures because of the location/type of brain damage she suffered, so we started her on dilantin.

I went to go print my strips. She was normal sinus rhythm. I turned to say hi to a nearby doctor, then turned back to the monitor to finish the strips. All of a sudden, V-Fib. For a split second I thought "This can't be real" so I went to go check on her.

There were 2 nurses outside her door, about to go in and do a skin check (THANK YOU GUYS SO MUCH FOR BEING THERE FOR ME!!! YOU ARE AMAZING NURSES!!!) They saw the look on my face when I went into the room, and followed me.

She was slumped over in the bed. It almost looked like an absence seizure or a stroke. Her tongue was protruding, and she was making blubbing noises. We sat her up a little more, did a shake and shout, sternal rubbing, checked for pulse. I had almost hit the code button when she took a deep gasping breath. We felt a moment of relief before we realized that she was probably not going to be taking another breath.

I hit the code button and we started CPR.

From that point, it's a blur of people and activity. Within 10 seconds there were at least 20 people in the room. It felt completely unreal. Like I was trapped in a TV hospital drama, except this was my patient.

I remember people hooking her up to the defibrillator. She was in Torsades de Pointes. The MD yelling for Mag, which was *not* in the cart where it should have been. Finally they bring another tray and we get the Mag for him.

We stop the dilantin infusion, start NS running full blast. Put a compression sleeve on the bag to make it go faster. Starting a central line. CPR still going, intubation in process. Everyone clear for the defibrillator. Still no pulse, CPR continues. I try to clear debris off the floor so no one slips. There is packaging everywhere. Another shock. I took over for chest compressions for awhile. More feeling of unrealness. Drugs are going in. Triple lumen central line in place in the groin. One of the docs stitching the line down to the thigh. That must hurt, I thought, then remembered my ACLS instructor saying "It doesn't matter what you do in the code. The person is dead and not feeling a whole lot" The MD forgetting to let go of the guide wire before the next shock until another doc told him to drop it. Shock again.

The pulse came back. I go give report to ICU who has a bed for her. She's on the unit even before I finish giving report.

From hitting the button to sending her to ICU was around 30-35 minutes. Part of me feels like it lasted so much longer than that. Part of me feels like it was over so fast. I totally forgot I had other patients. It was probably the most in-the-moment I've ever felt. It was also probably the most disconnected from reality I've ever felt as well.

The ANM congratulated us on doing a good job. I was certain I'd get in trouble or something. I must have done *something* wrong to make this happen. Turns out she had an MI related to an LAD blockage. Not my fault. Thank god.

I was pretty shaken so I took dinner early. Went to the garden near L&D. They have lavender and rosemary growing there. I laid on a bench, listened to some music on my phone, watched the clouds, and tried to will my heart rate to go down below 100.

I can no longer boast about never having a patient code on me. But I no longer have to fear it eventually happening. And that's probably the better of the two options.