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!