Why I am not moving to Montreal....

I love visiting my family up in Montreal. There's something about Christmas in that city that feels different from any other. So when I was there last week for the Holidays, I thought about what it would be like to live there.

I've been saving my pennies to buy a house; it's really expensive where I live, to the point of extreme frustration. Yet in Montreal, many of my cousins (some younger than me) are already homeowners. You can get a beautiful brand-new construction there for the price of a fixer-upper here.

So the question came up - Why not move to Montreal? "We really need nurses here!"

But I don't think I could be a nurse anywhere but California. I have never known life before the mandatory patient ratios took effect in 2005. I don't know what I would do with 8 or 10 or 12 patients, apart from lock myself in a bathroom and cry. And to have to keep an eye on a colleague's 8 or 10 or 12 patients when she takes dinner... I can't imagine.

I've never once had to work mandatory overtime. I've had to deal with annoying phone calls begging me to come in on my day off and desperate managers scouring the floors for anyone who wants to stay over. But if I say no, that's it. No repercussions.

I've never shown up and been told to go home because they didn't have enough patients to go around. They will find *something* for me to do around the unit and pay me for it. But I can volunteer for a day off if I want (and I usually do!)

I've never had to float to a unit that I am unprepared for. They can't just send me to Pediatrics out of the blue because they're short staffed; I have to be oriented to and trained for the unit.

I've never had to rotate my sleep schedule to accommodate revolving shifts. If I am hired to Nights, I work Nights. The only time I have to forgo sleep for something work-related is if we have a Skills Day, since those start at 0800 (grumble grumble).



If I had to deal with those situations as a possibly daily occurrence, I don't think I'd make it. Maybe I'm spoiled, who knows. And I suppose the kicker is that if I were to live and work in Montreal, I'd get paid 1/3 to 1/2 what I do here. And the cost of living isn't *that* much cheaper.

So, no, I don't think I'll be relocating any time soon.

Plus, my French skills are dismal.... :)

This site has the most imaginative pictures!

http://www.fubiz.net/2010/07/27/milas-daydreams/

You must go to the site to see the rest! Super cute and super creative!




(I know this has nothing to do with my work other than it is baby-related, but such is life *grin*)

Forgot to post this when it happened, but now's as good a time as any...

This is back when I was on Tele (Sept 7), but pretty near the end of my sentence there.

I was Resource, or maybe Committee. Regardless, I didn't have patients of my own. My task was to help discharge a patient who'd been admitted for CHF. I knew pretty much nothing else about him lol.

So the discharge paperwork has a lot of instructions and education on it, so patients don't have to try to remember every little thing. The CHF paperwork is probably our most common; I can quote chunks of it from memory.

So I'm going over the instructions with the patient, his wife, and his son: "Start taking these medications, this one has changed dosage, stop taking this one, etc" Then we get to the lifestyle habits that are essential for controlling CHF.

"Try to cut as much salt out of your diet as possible. Penzey's (a spice company) has some amazing salt-free seasoning mixes that really help make up the flavor. And make sure to weigh yourself every morning, after you pee, but before you eat anything, wearing similar clothes every time." At which point the patient looks rather confused. I said, "Oh. Is this a new diagnosis of CHF? Someone from the CHF team should've come to see you at some point." "No, I got diagnosed last year." "And no one has mentioned weighing yourself?" "I don't even have a scale." Ohhh boy....

So I got to explain how salt and water work to balance in the body, and increased salt makes water stick around longer. It makes the heart work harder to move around the increased volume, and the fluids tend to leak out of the vessels causing swelling in the legs and difficulty breathing. Fluids can build up pretty quickly, so weighing yourself is the best way of telling if things are getting bad. If you gain 2lbs in a day, or 5lbs 5 days, it's likely to be water, not real weight.

"Trust me on this one thing: cutting the salt and checking daily weights are the easiest way to avoid ending up back in the hospital. I *know* you don't wanna come back here. It's much better to catch it early, and just go to the doctor for a med adjustment..."

Apparently no one had explained this to them in the way they could understand, let alone told them *why* they should make these lifestyle changes. I made little extra cheat notes on the instructions to help them remember the basics.

Eventually the runner came to wheel the patient out, and I wished them luck and headed down the hall. The son called me back for a moment, smiled, and said "Thank you so much for all your help, you should at least have dinner on me." He pressed a $20 bill into my hand. I thought about protesting, but he looked so genuinely, sincerely happy that I figured I'd just keep my mouth shut.



I never thought being a nurse would involve getting tips :)

In which I am mistaken for a Stepdown nurse...

So I had this patient.... Came into ER with headache and nausea, and BP 200s/100s. 33 weeks pregnant. Stat C Section for pre-eclampsia. I took care of her her first night on the floor. Her SBP was still on the higher side (140s), but coming from Tele that's really nothing to write home about. Baby was in NICU. Mom was recovering fairly well. Sort of. Turns out she developed HELLP syndrome and her blood counts were not pretty. Still, she was pretty stable and seemed to be doing okay.

Then I had her the second night. Apparently during Day and Eve shifts, her kidneys started failing. Her urine output was scant, and she was starting to get a bit swollen. They gave a small dose of IV lasix (20mg) but no luck. By my shift, we were during hourly urine outputs (ugh) and labs q6 hrs. Lungs were starting to get a little diminished, and the slightest bit coarse. She was on nasal cannula and continuous pulse ox, with frequent vitals. Honestly, it was kind of refreshing getting some of what I was used to.

Until I realize that I was not dealing with Med/Surg doctors.

I text-paged the doc to let her know that urine outputs for the various hours was very low (totaling about 70mL for the entire shift) and mentioned the lung sounds. Asked if maybe we try a larger dose of lasix or something (would be the first course of action on tele, since it can sometimes prevent renal failure from worsening). The doc said they'd decided she had Acute Tubular Necrosis and that we should encourage PO fluids and keep the IV running.

Yes, doctor. We should keep pumping fluids into someone who is not processing them or excreting them. That sounds like a great idea. Fast forward to change of shift when we have to cut off her ring to prevent it from impairing circulation in her very swollen hands.

When I came back the third night, I was incredibly relieved to hear she'd been transferred to ICU (apparently there were no available SDU or Tele beds) and set up to start hemodialysis.

She finally recovered enough to get back to the mom/baby floor, and with any luck should be going home this morning. :)

Explaining circumcision

As a Mom/Baby nurse, it's my unfortunate duty to ask parents if they want their boys to be circumcised. The "circ trays" are prepared during the night shift, so we need an accurate count so we can be ready, and the docs know how many need to be done.

I do not believe in the circumcision of infants. I don't believe in doing cosmetic surgery on a person without their consent. So this part of my job kinda sucks.

I found myself in an interesting situation with some parents who were Indian. From what I've seen, most people from India don't circumcise. But these two had no idea what I was talking about; I don't think they'd ever heard the term.

So I tried to explain it as unbiasedly as possible: "Circumcision is the removal of the skin at the tip of the penis for cultural or cosmetic reasons." Nice and simple. And judging by the looks on the parents' faces, completely horrifying.

You could see the question in their eyes. "Why would someone do that?!"

I then went on to say that most Indian parents choose not to circumcise, and they looked relieved and said, "No, I don't think he will be wanting it."



Just another day in the life....

Quick charting funny....

Reading through the doc's notes last week, and one of them wrote this gem:

"Pt tolerating regular diet, passing flatus and chicken and soup."

I wonder how often people actually proofread their notes for clarity....

Adventures in my first week flying solo!

I'd originally planned to write this after the first night solo.... and then I decided to make it the whole weekend.... but I got lazy and am only now writing, since is it 6:30am on a Sunday and I am Very Not Tired.

The first night on my own was slightly surreal, I guess. When I started off as a new grad, the orientation seemed to last forever. I might as well be a new grad again when it comes to Mom/Baby skills, but here I got three weeks. Which, all in all, is still pretty nice to get a feel for a place and to hone the skills I hadn't used since nursing school. By the end of orientation, I was actually kind of itching to be on my own, and to stop having someone looking over my shoulder all the time.

The first night, my patient load was split fairly far across the unit. I was a little nervous, because I like having my patients close to each other so I can hang out nearby in case of trouble. But none of my rooms were really near a station, so I just hoped for the best.

Nothing terribly exciting happened that first night, for which I am grateful.

The second night, I got a taste of Tele, just to remind me I guess. One of my patients had had a failed induction, ended up c/s. Had some hemorrhaging afterwards, as well, so I was a little worried it'd start up again.

I guess she was still a little numb from the spinal or something, because when I was assessing her, I found that she... needed some cleanup. It'd been a month since the last time I needed to do incontinence care, and there are no CNAs on this unit. So I take care of all that, which was fun since she had a little trouble moving her legs still.

After I finish, I ask her to let me know if she notices any change in bleeding, including any gushing feelings.... So I get a call about 10 minutes later saying, "Uh, I think there was some gushing...."

Nope. Not blood. Sigh :(

So I clean her up *again* and start feeling like it's that animated video where the patient craps the bed because it's the nurse's job to do pretty much everything. (see video here; the bit in question starts around the 2-min mark)

Luckily, no more code browns that night. Though I did have to deal with missing antibiotics, so that was fun. And at the end of the night/first thing in the morning we got back her post-delivery CBC. Her H&H was something like 7/20.

Now this is something interesting, I find. If one of my patients on Tele had that kind of lab result, I'd be slightly panicking. If it was an 87 year old dialysis patient with CHF and UTI that was CTD, they'd pump a couple of units of blood in ASAP and do serial H&Hs q6 hrs. Apparently if it's a new mom after major abdominal surgery, they prescribe PO Iron, TID. I guess they're the experts, but it seems a little weird to me. I mean, if *that's* not the cutoff for transfusion, what is?

(Apparently I can answer my own question by doing some Googling...)

The next three nights I actually got most of the same patients. One of them had the cutest baby ever. She was born at 37 weeks, c/s early for IUGR and a bad-looking monitoring strip. Mom was pretty young, with twins at home that also had health problems r/t extreme prematurity, and a history of substance abuse with a currently-using boyfriend/FOB. On the second day she kicked him out of the room, and he never came back. Which is very very good. Anyway, this baby was only 2000g at birth, and had tiny little pointed ears like an elf. I could've fit her in my scrub top pocket and taken her home with me. I really hope things go well for her.


I'm finally starting to feel tired now (cuz the Benadryl is kicking in), and I have to get some sleep since I'll be working tonight; I'm very bad at napping, so I should get as much as I can now :)

More adventures to follow, I'm sure....