This has been a glorious week!

Of the four days I was originally scheduled to work this week, I've only done one and a half.

I was unexpectedly called on Wednesday to see if I wanted the day off. Hell yeah!

On Thursday, I was given the opportunity to go home after 4 hours. Hell yeah!

And today, I called to see if there was any chance they were overstaffed and didn't need me. Ask and ye shall receive!


Thursday was a fuckwad of a hard day. We only had 4 RNs on the floor because our census was low. According to Papa, that means that we technically only need one RN to be both Charge and Break Relief. I dunno if he's ever tried to do both at the same time, but it is *not* safe.

As Charge, you're the one who does the assignments and works with the house supervisor to figure out beds and nurses for incoming and outgoing patients. As Break Relief, you are to take over a nurse's patients during her scheduled breaks, and care for them as if they were your own.

This is nearly impossible when you've go the House Sup calling you every 10 minutes asking if you have a new bed available. Especially when you technically don't have any nurses to take patients yet, but you will after 1900 when the Night crew comes in, so you have to try to plan for the future. Meanwhile one of the patients is desatting to the mid 70s and the alcohol withdrawal pt with a history of seizure is complaining of a headache and needs pain medication. And the calls keep coming in. 84 year old with syncope from ED. Transfer of small bowel obstruction from stepdown. Pt coming from post-op who had an anaesthesia complication.

I dunno what dumbass came up with the rules, but he obviously hasn't ever tried to do 6 things at once, safely, before.

By the time 1900 rolled around, I was ready to throw my phone out the window and rip off the head of the next person who asked *anything* of me. Technically everyone got their breaks, and the assignment did get done (3 times.... every time I thought I was done, I got the call for another pt coming in). But it was more stress than the extra 5% an hour is worth.


When I got today off, I decided not to be a lazy bastard and went on a 9 mile bike ride with my boyfriend. It was awesome. I think my goal is to go on a ride at least 2x/week. One of the girls at work is 3 months pregnant and still skinnier than me... this must be dealt with.

Wish me luck!

Our Easter Miracle....

Today was an aberration to be sure. I woke up at 0700 to go to Easter breakfast at a friend's house. Then I got in trouble at home for missing Easter brunch with the family. There is nothing worse than disappointing my Mom. I was feeling pretty down and guilty when I got to work.

Imagine my surprise when I saw the board: the gods saw fit to reduce our census considerably. We were at 14 (I was kinda pissed off at the beginning, as I'd called to see if I could have the day off and didn't get a call back...) beds filled until near the end of shift when we went alll the way up to 16.

The miracle is that were actually appropriately staffed. More than expected, really. Not only did we have a Charge, I was Resource, and we had *two* CNAs. With only 14 patients lol.

And the RNs on the floor seemed to have everything under control, and most of them refused their 15 min breaks saying they didn't need them. I practically had to beg to take phones away at least so they could do things uninterrupted.

I ended up busying myself cleaning the med rooms and restocking the IV start kits, which were in a horrible state of disarray. Dear Unit: MRSA swabs are not part of the IV start kit. Tele stickers are not part of the IV start kit. Suture removal kits are not part of the IV start kit. Also, urine specimen tubes do not go with the blood draw kit. Just saying... Please try to keep them nice for at least a little while!

I got to take someone down to CT, didn't get lost, had a nice chat with the Radiology Tech downstairs. I figured it would make the most sense just to stick around during the scan rather than go up and have to come back down again later.

There's not much point to this post, I suppose. I hope I get patients tomorrow so I can be in my own little world...

That is, if I can't get the day off... :)

Dear Grateful Patients and Family Members...

We, your nurses, love knowing if you appreciated our care. There is nothing that gives me the warm fuzzies like a little old lady saying, "You're so sweet and caring. Such a wonderful nurse." Makes me forget that I hate my job sometimes.

But I have a favour to ask of you. I know I probably don't speak for the majority, but for myself, I have this tiny request.

Stop it with the baked goods already!!! Why does "I enjoyed your nursing care" automatically have to translate into piles of cakes and cookies in our break room? I'm trying to lose weight for god's sake!!

I can turn down a box of chocolates, or distribute them among coworkers. But I am powerless against homemade lemon squares, or chewy chocolate chip cookies. And nothing goes down quite so nicely after a hard shift like a cup of tea and an almond biscotti that just happens to be sitting on the break room table.

It's instant dopamine gratification, and it needs to stop. You will make me diabetic, I am sure of it.

If you want to show your appreciation, I'd love it if you filled out one of the comment cards we have at the nursing station. My boss sees those, and I need all the good words with her that I can get.

Thanks,

PurpleRN

The ugliest rhythm I have seen so far in a person who wasn't actively trying to die...

I had a patient yesterday who was 81 (but looked much much younger) who was A-Fib brady (in the 40s, 30s when sleeping) with a bundle branch block and a long QT interval.

Needless to say, pacer pads were nearby....

It always happens at shift change, right?

So after a busy but not-too-hectic evening, I finally sat down around 2245 to finish up my charting.

I had a lot to catch up on, because of a new admission to 63. He showed up on the unit around 1800, but was immediately whisked off to dialysis before I had a chance to do any assessment beyond "He's alive, A&Ox3, and doesn't look like he should be in the hospital." He came back to the unit around 2130. I did my admission sheet, got him dinner, and brought him his (late b/c of dialysis) meds in record time, done around 2230. He was doing just fine all through it.

So at 2250 his wife comes up to the desk with a worried look and says, "My husband is not acting normal at all. I need you to come take a look right now." She said it with such calm and straightforwardness that I was immediately terrified. When people come at you with histrionics it's usually something stupid like needing a repositioning. When there's an eerie calm, you know there's trouble.

I popped my head into the room, and he's staring off to his left, with a right-sided facial droop that I didn't recall seeing 20 min earlier when I was last in the room. We asked him to say his name, and his speech was slurred and unintelligible. He was able to lift his left arm on command, and give my hand a good squeeze, but we couldn't get any response from the right hand side. Couldn't even get him to turn his head that direction.

"Well, shit" I thought.

So I called the on-call doc and asked her to get up to us to check him out. Resource came in to check his vitals, which were fine. We decided to call RRT to get a little extra help.

Doc showed up a little before 2300, we called a Stroke Alert about a minute later. This involved doing an assessment on pronator drift, and getting a bunch of blood samples.

The lab had been in not too long before and said he had "slippery" veins. They weren't lying. Luckily, he had an 18g in his forearm with brilliant blood return that we were able to get samples from. Thank god.

He was off the floor and down for a head CT by 2313, which isn't too bad, timing-wise. Things seemed to move much more quickly, and I was always surprised when I looked at my watch.

His poor wife was rather shocked, because this wasn't what she expected at all. Hell, they were going to send him home from ED earlier that day. Got him dressed, took out his IVs, everything. Then they changed their minds and sent him up to us.

So after the CT they sent him to ICU, and I had to wait awhile to give report to the nurse who would take him. Hooray for overtime!

I was told by Pappa that they did find a couple blockages on the CT and he was eligible for tPA.


I'm curious to see how it all ends up when I go back to work today.


Addendum: So apparently they didn't do the tPA after all, owing to the severity of the stroke and how many areas it involved, as well as the fact that the pt was a Jehovah's Witness. If there were bleeding side effects from the tPA, it would be very problematic if he didn't accept transfusions. He is stable now, transferred to our neuro unit, already able to swallow safely and working on his communication skills. Apparently they called an erroneous code blue on him yesterday when he had a seizure post-dialysis. Luckily he's still okay.

Well, okay as can be expected....

Forget designer knock-offs.... here's the product I really want to see...

So going back to Hypoglycemia Girl and "I Need My Pills" Lady from a couple posts ago...

At one point during the shift I was chatting with Hypoglycemia Girl and her boyfriend, and had apologized a couple times for not checking in on her more often. I explained (without compromising confidentiality) about the issue with INMP Lady and how I wished there was something I could give her.

HG said, "Can't you just give her something else, like Tylenol, and tell her it's the right stuff?"

I explained that most of our patients (especially the older folks) know their pills by look more than by name or what it does. I said, "I've had patients refuse certain medications because at home they take two little green pills not one pink pill, even though I explain to them it's just a different manufacturer"

Together we came up with a fabulous idea for a business, creating Placebo knockoffs that look just like the real thing. That way if your patient is demanding Ativan but isn't allowed it for whatever reason, you can give the appropriately sized and colored placebo. Of course, they should be kept separate from the full-fledged medication, and be available only in hospitals.

But wouldn't that be damn helpful for confused folks who can't understand that if we give them Ativan when they're already having trouble breathing, they might stop breathing altogether....


I know we shouldn't be out to deceive our patients, and that we should educate where people don't understand. But some people are apparently ineducable and just giving *something* would reduce stress on everyone's part :)

Dear Hospital Management,

My birthday is coming up in May, and I thought I'd let you know ahead of time what I'd like so you can get working on it.

I would like my unit to be appropriately staffed all the time. I don't want it to be an unexpected surprise when we have two CNAs on the floor, or when I get my 15-minute breaks.

Last night we were dangerously understaffed considering the complexity of our patients. We had all twenty-six beds filled. Three of our patients are worth *at least* the work of two our three patients themselves. We've been good. We are doing our PCHs as diligently as we can.

For a full house, we are supposed to have a Charge, two Resources, and two CNAs on the floor. There was one Resource and one CNA.

This is just plain wrong.

One of my patients last night has CDiff, is incontinent, and has a Stage II pressure ulcer on his coccyx. I cleaned him 5 times in my 8 hour shift. Each time I had to spend *at least* 20 minutes just trying to find someone, anyone, to help me clean him up. That much feces near that severe of an open wound for that long is just *screaming* to brew a massive infection. On top of that, this pt's wife is *very* involved in her husband's hospital stay, and not in the good way. This guy is doing his best for a TTJ and we just keep putting in new corpaks (Don't even get me started on the corpak adventure. Let's just say that after as many X-rays he got, I wouldn't be surprised if he started glowing in the dark.) and turning him every 2 hours and doing dialysis and putting restraints on so he doesn't pull things off.

I spent at least four hours of my eight-hour shift just on him, nevermind my other three patients (two of whom were mentioned in my adventurous last post) who thank god didn't do anything exciting.

So much time could've been saved if there'd been more help around. I had to rush to check on bed alarms because there was no one else. And bed alarms are only effective if there's someone to hear and react, much like the tree falling in the wood.

I know we're going through a lot right now, what with our realignment nonsense. I know you don't want to hire any new outside people until you figure out where all of us inside are going. But just because you're planning for the future doesn't mean you can ignore the present. When you are in the hospital, the present is all you have. If you don't take care of it, you don't have a future to worry about.

So, Management, if you have any shred of love for your faithful employees, you'll give me this one little thing I'm asking for. You still have two months to get it together.

Thanks for your time,

PurpleRN