Thursday, October 27, 2011

10 Ways To Upset Your Nurse

1. Deny a symptom (extra points if its something important like, say, chest pain), then IMMEDIATELY AFTERWARDS, report that same symptom to the doctor, adding that you've "had it for HOURS, and NOBODY treated you!": This will upset your nurse, because she will have been treating you based on the symptoms you REPORTED...and she will be mortified to have "missed" a symptom that could make a difference in your care. She may also want to strangle you a little bit.

2. Attempt to lunge out of bed after your major surgery, while still hooked up to tubes and wires: You might get hurt. Your nurse will have a heart attack.

3. Attempt to and/or actually grope your nurse: Then blame her negative reaction toward your loving caress on the fact that you're missing a limb. Clearly she would LOVE being groped by OTHER patients

4. Refuse hygiene care: We love clean people. We do. They're less likely to get infections. This is why, if you are unable to clean YOURSELF, we will competently do it for you. Head to toe. If you ask nicely, and i have an extra five minutes, i will braid your hair if it is long enough. After shampooing it. REFUSING TO BATHE AT ALL will upset your nursing staff. Also your doctors. What we do to you in the way of surgery, and meds, and immobility leaves NOBODY smelling like roses. please. Bathe.

5. Throw your dinner/lunch/breakfast: We get you might not be hungry. We understand if you dont like our food. But please don't throw it, at us or anywhere else. For one thing, I dont like smelling like miso salmon. For two, if you werent going to eat it, you could have left the cover on the tray, not touched it, and one of the techs would HAPPILY have eaten it. Hell, I might have happily eaten it. But now it's wasted, AND the room is a mess. and i'm probably a little scared of you.

6. Eat Things You Shouldn't: I'm not talking about an extra cookie. I'm talking about the uncontrolled diabetic ordering and eating a large extra-cheese pizza in his room. While on an insulin drip. Your sugars will go crayzee, and I will spend the next dozen hours sticking your finger every 30 minutes and cranking up and down the drip rate. Neither of us will enjoy this, but I'm the one catching flak from the docs for "allowing this to happen"...

7. Push Your Call-Bell every Five Minutes: I understand that you're scared, uncomfortable, and possibly alone in there. But there are five of you, and one of me. Pushing your call-bell constantly to ask for "slightly more ice in this" and then "no! now there's too much ice!" "i need the thermometer up! no! down!" etc. will just make slower at answering your light if i'm in the middle of something. The patients who only call me for things like "help! i cant reach this!" or " this blood?" are the ones who, when their light goes off, I drop other things and scurry in there. Because I know that for the little things, THEY WILL WAIT FOR ME TO POKE MY HEAD IN. I check in on my patients at least every hour, much more frequently on the ones who are immobile. Somehow though, the people who ring for more blankets, for ice, for juice, for LESS juice, for their meds NOW instead of in half an hour? they're generally perfectly ambulatory.

8. Dont let me know when something IS wrong: If you wait until i poke my head in, and you have been bleeding out your eyes, bellybutton, etc. for the past 20 minutes, i will be upset with you. That's a reason to push your call bell. Unexpected bleeding is actually a good reason to not just push your call bell, but to yell "help!" if necessary. Please don't wait until i find you passed out!

9. Take off your oxygen mask, wait until your oxygen saturations drop and your pulse-oximeter alarms like crazy to get my attention. While quite clever, and DEFINATELY creative, it falls into the category of screwing with your nurse. Do this too many times, and we will turn your alarms down, since we KNOW you're okay. Then, what if you're NOT okay? WE WONT KNOW. And that's not good for either of us.

10. Wait until patient services interviews you to tell us we've screwed up: if your room isn't clean, if you feel the docs don't spend enough time with you, if you dont like the way i made your bed, or you feel like your pain meds arent working, DONT TELL THEM BEFORE YOU TELL US. Some things can't be helped, but others can, and i'll happily tell you which are which. AND refer you to the patient services people to help you if i cant. But you make us feel like terrible people when you whisper our mistakes to others. Especially if its somethign that, had we known, we would have fixed IMMEDIATELY.

So...did i miss anything?

Saturday, October 22, 2011

Me? I'm Nobody!

People deal with hospitalization in different ways. Some are patient and forbearing, some have taken that horrible advice from Reader's Digest et. al. ("What Your Doctor Isn't Telling You!" "10 ways to INSTANTLY GET WHATEVER YOU WANT IN HOSPITALS!" etc) and hope that by being the "squeaky wheel" they'll get better "service". Some prefer to take a different tack; or their families do:

I was in a patient's room this morning, my last shift of orientation. The patient was in A LOT of pain. Seems he'd been taking a few more painkillers at home than he had reported initially...oh well, too late to deal with that, it happens. I'm hooking him up to a different opioid for his PCA, and he's moaning in pain, writhing around, refusing to look at/deal with/acknowledge his colostomy (why is it always men who act like someone else is going to change/empty the damn thing forever?), and he says "god i hate people to see me like this!!!!"

Dude...i sympathize. I would rather have all SORTS of pain than have someone LOOK at me while i'm in it- but then his girlfriend (the 50 year old wearing the tweeny bopper sweatshirt)turns and goes "oh's okay...she's not people...she's just the nurse. she's nobody".

And I got just a little pissed off. I know people deal with pain and stress in different ways. Get mad at me. Swear a blue streak. Remind him that I'm pretty much cool about pain- dude had one HELL of a midline incision...he can get whatever he wants to numb that sucker- see it all the time, he's not my first guy in pain. But please PLEASE don't tell him "she's nobody". That sort of thing encourages people to treat us as interchangeable cogs in a wheel. As brainless automatons. As less than the professionals we are. I was in their changing his meds BECAUSE I CHASED DOWN HIS DOCS AND SUGGESTED THEY CHANGE HIS ORDERS TO A MED I THOUGHT MIGHT WORK BETTER FOR HIM.

But hey- who am I to argue- i'm Nobody.

Tuesday, October 18, 2011

They Tried To Make Him Go To Rehab...

I just worked my first two night shifts. They were back to back. At their conclusion I am officially OFF orientation...eek. Also, my "white cloud" status is GONE. Friday night, on report I was given Mr. Detox.

"Mr. Detox is a middle-aged man, who had a lung procedure done. Past history of ETOH abuse...yadda yadda yadda. He's on the Ativan Scale".

For those of you playing at home, the Ativan Scale uses vital signs, plus measurements like "twitchyness" and "sweatiness" plus how much the patient is awake, and how many times he gets out of bed, to come up with a measure of how much he is detoxing. This is done every 2 hours. Ativan is administered accordingly.

"I haven't been giving Mr. Detox very much ativan, because I fear that it makes him MORE loopy"

Alpine: " think the ativan is making him WORSE? how much are you giving?"

Dayshift: " mg every two, but he just keeps getting MORE agitated!"

Alpine: "oh...goody."

Needless to say, Mr. Detox needed a LOT more than 1mg q2hrs. He was literally BOUNCING around the room, pulling on his chest tube, pulling off his pants, trying to "visit other people in their rooms", gnashing of teeth, tearing of hair. By hour 4 I was calling the doc every 10 minutes, begging for more ativan. My preceptor freely admitted that she's afraid of detoxers and of giving too much ativan. Me, I've seen the amounts given in the ED for acute detox, and I knew we could go A LOT higher, considering that 4mg IV Ativan PLUS 10 MG HALDOL all administered AT THE SAME TIME put him out for...5 minutes. Before he started bouncing again.

It was getting to the point where I was expecting a seizure at any moment, and his temp was climbing. I pulled the plug right there: "Night Preceptor? I want a Stepdown Unit transfer. This isn't safe." The only reason we were able to keep it up till 1 am was that there were TWO of us, so we somehow managed to keep everyone else safe while sitting on him.

He's still in Stepdown. So...good call on our part.

Moral of the story: If they tried to make him go to rehab, but he said "no!", GIVE MORE ATIVAN :-p

Wednesday, October 12, 2011

Buddha is my co-pilot (actually, my preceptor)

I may have mentioned this before, but I have the best preceptor in the whole wide world. She actually has me call her "Buddha", because she is, well, Buddha-shaped. Also jolly. She's been a nurse for 35 years, and she knows pretty much all there is to know about surgical nursing. (She also stands up for me to just about EVERYONE- even the manager, the director of surgical nursing, you name it. She doesn't let ANYONE mess with her "babies"'s like the OPPOSITE of nurses eating their young.)

Today we had The Patient Assignment From Hell...

Our floor is a pretty high-acuity med-surg floor...primarily Gen Surg (bowel surgeries, esophageal stuff, the occasional weird pancreas thing), Thoracic (chest tubes! And stents! wheee!) and Transplant (kidneys and pancreases only, ifyouplease, unless you had one elsewhere, and are rejecting...). But when Frozen Northlands Teaching Hospital gets busy...we get everything. Urology. Trauma. Orthopedics. WhateverTheFuckThatServiceDoes. We can to 3 kinds of drips, for the most part: Heparin (per protocol, q5hr aPTT draws...huuuuge pain in the neck) Diltiazem (lots and lots and lots of HR checks, and BP, q1hr or q30min) and...Insulin (q30min finger sticks and rate adjustments. Guess what we had? If you said "ONE OF EACH! PLUS WOUND VACS! AND THE OTHER TWO WERE DIABETIC TOO!!!" you'd be right.

The charge nurse actually APOLOGIZED for putting together the Patient Assignment from Hell, but those were the open beds, because that's who we managed to discharge. I was seriously hyperventilating a few times, even with Buddha at my side, nimbly assessing and cranking drips up and down. While helping me trouble-shoot the 2 blocked JP drains, and the wound vac's low-pressure alarm...

She just says "Easy Tigger (she REFUSES to call me "Alpine")! Take it down to Mach 4! This isn't the ER!" then she smacks me upside the head and tells me to go get coffee before i fall over...

We (I, officially) had a 5 pt. assignment, which is standard.

Mistah Unknown

Night Shift:"Your patient in room 3 is Mister Unknown...pronounced "Unknown""

Alpine: "Um...wait...why doesn't he have a name? Isn't he conscious? Don't we ASK them when they regain consciousness what their names are?"

Night Shift: "Well...yes...but...:sighs: read his chart. He refuses to tell us. Trust me, Alpine, you're going to LOVE this one!"

Alpine: "okaaaaaaay"

So I sat down and read his chart. Mr. Unknown ("Unk" to his friends) is 19ish. As teenage males are wont to do, he gets drunk...and high...and then steals a car...but since this is the rather sparsely populated Frozen Northlands, the cops don't have much to do some evenings. So they chased him. He, naturally, failed to make good his escape. He had LOTSA injuries. A Random Sampling: two collapsed lungs (yeah, that's both of em), bruised spleen, lacerated liver, lacerated kidneys, perforated bowel, and broken leg. He fled the scene on foot, naturally.

So I'm, like, in AWE of this dood- i mean, you have to be at least MODERATELY badass to flee the cops with all your internal organs misbehaving, and a broken leg. But apparently he used up ALL his badassery. Cause in I walk:

Alpine:"Goodmorning Mr Unknown! I'm Alpine, and I'll be your nurse today!"

Mistah Unknown: "fuck you bitch! let me sleep! And give me some pain med'cine!"

Alpine: oh HELL no...he did NOT just say that! "Mr. do not get to speak to the nursing staff like that...if you find your care here to be inadequate, I'll be more than happy to arrange you to be transferred...TO PEDIATRICS!"

Mistah Unknown: "sorry miss...i wont do it again!" (he didnt...btw)

Alpine: "So...would you mind telling me your last name? It's going to be extremely odd calling you 'Mister Unknown' all day..."

Mistah Unknown: "HELL NO! This way the cops wont find me!"

I didn't have the heart to point out to him that he listed BOTH HIS PARENTS as his emergency contacts. With, naturally, their first and last names. I just smiled and went about my day. He spent the whole day asking us to dial outside numbers for him so he could speak to his "friends and his girl"...and then getting pissed and hanging up on them...then immediately ringing the call bell for us to call them back "so they can apologize to him"...seriously, the guy was acting like he was 7!

Friday, September 16, 2011

Please, PLEASE dont do that sir!

The last 7 (yes, 7) shifts have seen me taking a full (5) patient assignment. I'm psyched, and a bit shaky still, but my preceptor assures me that i'm safe to practice. The hardest part has been that ALL SEVEN of these shifts have been with a patient I'm going to call "Doctor Evil". This is because of a physical resemblance. He is not a doctor. This is important. What he IS is a Maunchausen's patient. This man hurts himself to get surgeries by infecting wounds by putting things in them. He is the patient from hell. Usually I'm pretty zen about my patients. I can't choose them, I can't alter their lifestyles, so I just accept it. But this man decided to make ME PERSONALLY a part of his health-care fantasy. And that is not ok.
He has been in the hospital for, cumulatively, several YEARS of time. So he knows the drill. And he knows how the machines work. So as soon as I would leave the room, having hung a bag of antibiotics...the pump would alarm. And for the first TWO DAYS I thought that I was forgetting to unclamp things...or the antibiotic would mysteriously not have run in...necessitating me standing in the room troubleshooting for half an hour.
One of the other nurses finally realized that he was basically gaslighting me to get attention. That was when I decided I strongly disliked my patient.
So he's been making work kind of hellish, with constant demands, and inappropriate sexual innuendos aimed at myself and the other nurses. But, as my preceptor says..."if you can handle Dr. Evil, you can handle ANY patient".

Monday, August 29, 2011

Patient Advocacy

As a nurse, what is arguably one of the most important things I can say in the course of my everyday job?

"This doesn't look/feel/seem quite right!!!"

Two days ago, still on orientation on a busy floor, I had a patient who had come in after Very Bad Things had happened to his esophagus. He was two weeks or so PAST the Very Bad Thing, but he was still "a little out of it" and his cough sounded...funky. It was my first day of two with this patient, and I was reassured on day one that his coughing was related to the Very Bad Thing he had come in for. His diet was ordered as Full Liquids, so when his wife asked for a milkshake in the afternoon, I went and made one (i am fully in favor of making food for patients. They get calories, I get brownie points.)
The problem was, after his wife started feeding him, he started coughing milkshake colored sputum. This was especially worrying, as immediately BEFORE the milkshake, his sputum was NOT that color. "But he's had a swallowing test done!!!" insisted his wife.
So I paged my Favorite Resident (he's not only REALLY good at his job, and highly personable and respectful, he's HOT!) and he came over yesterday morning. "Swallow study? well he's had a test to see if there's a MECHANICAL problem (tumor, obstruction, etc)!"
Me: " mean nobody has done a Speech and Swallow Consult?" (Speech Language Pathology...they RULE- they can evaluate anyone to determine how they can communicate, and if they're safe to be fed)
Favorite Resident: "well damn...I'll order one for first thing tomorrow're right...if this is a result of his Other Medical Problems, this could be something where he's going to need help..."
Me: " more milkshake then???"


Sorry for not keeping up...everything moves so FAST in orientation! I'm up to 4-5 patients, which is a full load. I'm the first one in orientation to carry a full load and get out of work on time. Which kinda scares me- am I doing something wrong to get my work done on time? God I hope not. Yesterday I worked during the Hurricane That Wasn't. The nurse in the assignment next to me and my preceptor had a patient on Comfort Measures. She died. My preceptor thought it would be a Good Learning Experience for me.
Thing is, I've seen dead people before-both in clinical and in the field. This time though, there was a difference- our MD was a brand-new intern. Didn't know the patient, since she was only admitted that morning. And, while well-meaning, he's a bit hesitant (I'm sure it will wear off). He had to certify death. He didn't know how. We had to walk him through it, and then I helped prepare the body for the morgue. The patient had had false teeth. The postmortem checklist specifies that you must replace them BEFORE sending the body to the morgue, lest rigor set in, and cause the face to be stuck without its teeth. I really REALLY didn't want to be the one to put the teeth back- after all, what if the patient rose as a zombie?!? WITH MY FINGERS IN THE MOUTH!!!!
I don't know why, but that really stuck with me. My patient could rise as a zombie, and us without a SINGLE machete on the floor!
It was only after we'd put the toe tags on, and the body IN the bag and zipped it shut that he realized he'd never done the formal LEGAL certification of death. So I went and unzipped the bag, exposing the body. He asked me not to leave the room, and help out. So i stood there, reading an instruction sheet aloud. He listened to the heart for a minute. Then the lungs. Then took the pulse.
"what do i do now?"
"You say The Words!"
"What are The Words?"
"You say 'time of death'"
"Time of Death"
"1901" And with that, the patient was formally dead. Only 1.5 hours after actually passing on. But then, life is strange like that!

I don't think I'll forget this- literally talking a doctor through someone's death. It seemed so silly, since the patient had obviously already passed on. We were the ones screwing around- they were at peace. If I were the patient, I would be giggling in heaven right about now. :-p

Wednesday, August 10, 2011

Hiking Safety (Revised and Edited from Last Year)

Last year I posted on Hiking Safely, and after posting, I spent a month and a half working in the White Mountains with my brother as crew in a mountaintop hostel dealing with LOTS of small emergencies, (plus a few big ones) many of them brought on by simple lack of preparedness. This has applied even MORE to my Wilderness Search and Rescue work. It's dangerous out there, people! I don't just mean the bears (BEARS!) moose, rock slides, etc. I'm talking about darkness, cool temps, drizzle, all the things you don't think of when you think "hazards".

1. Pack an Emergency Bivy. Emergency blankets suck. I've used them on car accident victims, and they blow off in even a light breeze. Invest in a "bivy sack" for emergencies. They're under 20 bucks, and TOTALLY worth it. It's basically a metallic sleeping bag-style sack that's orange with reflective stripes. If you were to be caught out or hurt you could climb in WITH all your gear, and survive the night, or wait for rescue. REALLY WORTH IT.

2. LOOK AT THE MAP BEFORE YOU GO. The main reason people call for rescue in MY favorite mountains (the Whites) is that they overestimate their abilities, and get "exhausted" before they make it back to the trailhead. If you've never done more than a mile or two, DON'T plan on going THREE miles to the pretty waterfall without remembering that it's ALSO three miles BACK. If you DO call for rescue, (and can GET a cell signal) it could be some hours before people can get to you. Rescuers are volunteer, and a crew may have to get out of work, pack their gear, and hike in from quite a distance, depending on where you are. Therefore, MAKE SURE YOU CAN SPEND A NIGHT OUTSIDE. If you're not critically hurt (fell off a rock wall climbing, stomped on by a moose, fell in a stream and broke your leg, etc) you should be prepared to spend a solid night outside before you could be rescued. If simple exhaustion is your problem, think about this- IF you could wait overnight, would you THEN have enough energy to hike out? If this is the case, DO IT.

3. TAKE THAT MAP WITH YOU- this will sometimes be ignored (even by me, and ESPECIALLY by my brother), but if you don't REALLY know the territory, have memorized every trail turning and its approximate distance, and feel comfortable getting yourself back out of that area WITHOUT assistance, BRING THE DRATTED MAP!!! Sometimes a trail has a BUNCH of junctions, and without a map its really easy to get turned around. While we're on the subject, LEARN HOW TO READ A TOPOGRAPHIC "topo" MAP!!!!! Those little lines indicate ELEVATION, and are in increments. Someone who can read a topo map is able to summon a mental image of the landscape, simply by looking at those lines, to identify ravines, waterways, ridges, etc. This helps if you get off-trail, and need to know where you are.

4. has a good list of hiking essentials, but my top gear list would be the following:
NON COTTON clothing (cotton does not insulate when wet, and is heavy)- shorts and teeshirt
-raincoat and pants (dont need to be expensive, but need to keep water out)
-fleece jacket of some sort (the cheap ones work fine)
-iodine tablets (in case you have to be out there a while, to purify water)
-headlamp (seriously, dozens of people every year need rescue because "it got dark out"...BRING A LIGHT! Flashlights tend to be heavier, and you need to hold them, which can screw up your balance. Headlamps can be gotten CHEAP, and are worth it. I carry TWO.
-hat and gloves
-plenty of water

that's the minimum. hike in peace, and enjoy the outdoors!!!

Addendum: I carry a bit more than this, just based on my personal experiences-
A. I carry a very light first aid kit, even when I'm not on a rescue, with benedryl tabs, an epi pen, advil, immodium, pepto, a few bandaids, steri strips, and purell. This is because i can improvise most dressings with clothing, but it's internal complaints that will prevent your walking out of the wilderness. Pain meds, and ESPECIALLY stomach/intestinal meds, will give you the wherewithal to get yourself out.
B. In cooler seasons I carry a softshell, and wear softshell pants. Softshell fabric is water resistant (very) but super light and breathable. It's not necessarily cheap (unless, like me, you religiously keep track of clearance deals), but it's worth its weight in gold. You will be dry, not sweaty, warm (but not hot), and insanely comfortable, because most of these fabrics stretch nicely.
C. WOOL. This is my latest revelation. The new technical marino wools (Smartwool, Ibex, Icebreaker, etc) are, quite simply, the Best Things Ever. They do not stink, even if you are a large man and wear the same shirt for a week. They do not get out of shape. They maintain insulation in driving rain, and you can wash them in the washing machine. I am a complete convert. i even wear wool camisoles or long sleeve shirts under my scrubs. i SLEEP in wool yoga pants in winter. It's not itchy, it's AMAZING- like silk, but durable. If you make one "expensive" clothing purchase for the outdoors, skip the fancy raincoat and go straight for the wool longjohns. Plus, lots of it look PRETTY, and I've gone on DATES wearing my wool shirts, and have gotten nothing but compliments.

Hi, I'm Alpine, and I'll be your Nurse Today!

I still gulp when I say that, because it takes that heartbeat to realize that I'm NOT the student, I'm The Nurse. It has MY name on the whiteboard in the patient's room, just above that of the LNA. I'm still like "woaaaah" when I see it, and half the time I want to erase it, and write in the name of my preceptor, because my name on that board MEANS SOMETHING. It means that I'm actually making some of my own decisions now, (not all, I mean, c'mon- I'm still on orientation) and I go into EVERY patient's room with the thought, deep in my head, that this could be the day I accidentally kill someone, or that someone crumps on me and I have no idea what to do.

Not to say that I wouldn't like to get in on a code one of these days, I just don't want it to be MY patient (again, it's not that I want bad things to happen to people. I don't. I just want to be there if/when they do...because there's nothing that gets my brain going faster than trying to save someone's life in a true emergency).

I have also realized that, by trying to take my dad's advice on Looking Professional, I can wind up looking EXTREMELY depressing- all (ALL) my scrubs (still so excited that I get to wear scrub tops) are either navy, ceil blue, light blue-green, or black. The bottoms are navy, grey, or black. My mother calls me her "little black raincloud", and one of the managers has started to as well. Much as I hate to admit it, this might be a time to get a purple or, dare i say it, PRINTED scrub top (one of those nice Moroccan prints, with solid edging...prints of THINGS make me look like I'm playing dress-up, or that I'm a 12 year old in footie pjs).

But I'm hanging in there. I actually snapped at a neuro-surgical resident yesterday though- I was doing a narc-count for the Pyxis- you know, the ones you have to do after you get a dose out- when he asked if I would pull up a patient's vital sign page in the new electronic record. I held up one finger, trying to maintain my count (seriously, there were something close to sixty pills to count, and i get distracted easily) but he simply didn't get it. He said "NOW if you don't mind, I'm Very Busy!". I kinda snapped- whirled around, told him that I was COUNTING, and had forgotten my number, and now he was going to have to wait while I did it All Over Again. I also pointed out that HE could access the ENTIRE medical record on the computer at his elbow.

After I finished counting, he admitted that he'd never taken the time to learn HOW to use the record. He ALWAYS asked the nurses to pull the page up for him. Somehow this bodes ill for his patients, I think.

Friday, August 5, 2011

I wish I were wrong

This morning I walked into Favorite Patient's room, after a day off. What I saw mildly alarmed me- surely his eyes didn't quite look like THAT on I pulled open all the shades in his twilit room, letting in the full sun. His eyes were...well...yellow. Ran LFTs. Total bili of 9. Yeah...the mets ARE in his liver, and they're hitting the bile ducts. I don't think his self-prognosis of "6 months to live" is going to work. I think he's got WEEKS.

He was angry with me for the rest of the day, since it wasn't "real" until I documented it. Apparently HE was hoping it was a trick of the light too, when he saw it yesterday, and never mentioned it to the nurse.

He still can't put weight on his left leg, because the spinal mets make it hurt too much. Radiation hasn't helped him, and it's been a week. I give it a 50/50 shot that he gets out of our hospital alive to make it to hospice in Florida...

I'm not an outwardly emotional person, but I had to work hard not to cry when I explained that he really WAS jaundiced.

Then I went home, and explained to Man-Friend (who is a whole NOTHER level of weirdness), and got a hug (did have to explain what Bili means)...but he did make it a bit better. He, at least, doesn't turn pale and get upset when I talk about work.

Wednesday, August 3, 2011

In Which it is the Small Things That Count

Just worked two 12.5s, back to back, with the last shift ending half an hour late because our relief nurse was late. Had a fascinating patient who kept desatting every 10 the point where i was literally hovering over her bed going "BREATHE...DEEPLY...NOW" and watching her sats drop lower, lower, lower. I bit my thumb and watched.

While I blush and stammer while trying to program a Patrol or Sigma pump, I KNOW how to treat a desatting patient. You give them oxygen. You give them O2, page their intern, and pray they stabilize. The thing is, the patient already has 2 PEs. We just don't know where the big problem lies- we scanned her legs, no clot...scanned her head, no clot. This means that the problem may lie in her pelvis. Her radio-opaque pelvis. That's like...deadly emboli waiting to happen.

And so I hovered...for HOURS. And then shift changed, and I went home.

And I just got a text saying "got stuck helping with a coworker's thesis...can I come over late and snuggle?"

Yes. Because snuggling is never EVER too late.

Monday, August 1, 2011

In Which Life is HARD

Worked my first two back-to-back 12s on the floor as a New Nurse. Woah. Surgical floors are INTENSE. We had two patients pre-AAA surgery (pressures at 100 systolic? sure sir, i can try to maintain wait...she's back up at 140...give metoprolol...recheck...ok, now she's back up...fuck)

At the same time, we in the Frozen Northlands were involved in a rather large search and rescue. As a result I am exhausted. And it wasn't a good outcome either way, though lord knows we tried...and we didn't miss the subject where we were looking, they were simply elsewhere.

On the bright side, I haven't screwed up yet.

Sunday, July 24, 2011

Hot Enough For Ya?

Yes, even here in the (often) Frozen Northlands, the Heatwave From Hell has taken its toll: I personally don't function particularly well over 85 degrees, nor can I sleep if it's over 80 in my bedroom. BTW, the roommates and I have no AC in our otherwise charming house- the vast majority of the time YOU DON'T NEED IT: for the 5 or so days it's really stinking hot up here, we gently perspire and drink iced tea. The rest of the time we open windows, and deal.

Just to make this more fun, I have caught a summer cold from The Man-Friend. In his defense, he DID warn me he was sick, but being a compassionate human, and trying to be nice, I took care of him, bringing him iced tea, and backrubs, and pretzels, and movies. Naturally, I caught it. On the bright side, he is Very Brave (probably helps that he knows damn well he won't catch it from me :-p ) and is being quite nice about me being all sniffly and gross.

Probably will have to wear a mask at work tomorrow...

Friday, July 22, 2011

Cannon Fodder

Yesterday, as I was getting a tour of my new floor, my two partners and I were referred to as "cannon-fodder", as well as "fresh meat". My preceptor is on vacation, so today, my very first day on the floor, I was precepted by a nurse who is leaving the floor for another unit in two weeks.

I felt like cannon fodder. I was supposed to be "observing" today, just watching to see how the floor worked. But our patient care tech was "tired" and taking personal calls, and our call bells kept going off, so...patient care it was! It was quite a steep curve- i haven't done med-surg in a year and a half. 3 out of 4 patients had colostomies. the 4th had a chest tube. OMG. Plus, now that I'm an RN, i can do IV push. First time. Today. As far as I know, everyone lived :-p

Wednesday, July 20, 2011

Woah...we can DO that?!

Today we were walked through "competencies"- aka, with another nurse watching me the first time, I'll be able to do IV push meds, and...give blood. This is new. Never been able to do it before. SUPER intimidating.

But know what I wont be able to do? IVs. There's an IV team. While I totally understand that, in the interests of having experts do it, and reducing infections and such, I really REALLY wanted to be able to start my own IVs. After a year on my floor though, i can transfer to ER/ED or critical care. THERE you can do IVs. In the meantime, I'll have to ask nicely to practice on my friends.

Man-friend (yes, i have one now) is sick. Sniffling, coughing, not-running-a-fever sick. I am treating him with tea, backrubs, and only occasional sarcasm. If i catch it from him, I'll still have to go to work, but i'll be seriously guilt tripping him :-p

Tuesday, July 19, 2011

Times they are A'Changin

Since I last posted, I have gotten not one but TWO jobs- first as a part time school nurse, and now as a Nurse Resident at the North's Best Hospital. I am SO proud. I'll be on a med-surg floor, but it seems pretty high-acuity, and like a great place to learn.

My fellow interns are AMAZING- over half have a non-nursing degree, just like me, and the skill sets are kind of alarmingly high. We have an electrical engineer, a fly-fishing guide, several former financial gurus, etc. The hospital has been nothing but welcoming. In fact, this hospital has kind of a reputation for being super nice to everyone. Doctors smile and hug nurses in the halls, transporters will high-five you, it's a great climate to learn in.

But it's not, naturally, all hearts and roses, and kittens: what with the budgetary crisis all over the Frozen Northlands, it looks like we're going to have a serious budget issue- our jobs are, for the moment, safe (we're cheap, we nurse interns) but...who the heck knows about the future!

I have yet to treat a patient- the first week is all orientation classes, and sim labs, but tomorrow i'm actually shadowing my preceptor on my unit. My two fellow interns on our floor are The Fisher, and M. They're nice, smart, funny, and are going to be a pleasure to work with.

One problem: I haven't had a med/surg patient in...something like a year and a half. Steep learning curves? I has them.