nighttimenursing

Doing the right thing

2011-10-25T17:24:00.002-04:00

I had a patient come in the other night............drunk with a head injury. As typical of us jaded ED nurses we kinda rolled our eyes and figured he was one of our regulars who had slightly bumped his head while intoxicated. That was not to be......

This man was someone who had only had 1 previous ED visit with us. He came in the ambulance doors with snoring respirations and his face covered in blood. He was immediately intubated and rushed to CT. Unresponsive throughout it all.

His CT scan showed a LARGE intracerebral bleed with a shift. Not a subdural bleed but intracerebral. His pupils were uneven too. We headed back to the ED and by then neurosurg was there to see him. After an exam and look at his CT it was evident that his prognosis was terminal. He was, in fact, brain dead in less than 24 hours. The only good thing that came of this is that his organs were harvested.

So...........you may be asking why the post is titled "Doing the right thing" with such a sad story?? Well, it gets sadder. This man was drinking at a friend's house that night and decided he was too drunk to drive home (he was, as his etoh level was 2x the legal limit) so stayed at the friend's house. He then got up at some point that night and fell causing his fatal head injury.

Just sad, so sad. He was only doing the right thing. I only hope that he is resting in peace at this time.

Resurection?

2011-10-24T21:43:00.002-04:00

Perhaps it's time.............

For a resurection!!

Of this blog that is. I'm not gonna make any promises but I'm gonna give it an honest effort. Now that I'm an ED nurse I have TONS of great stories!! I have been an ED nurse for almost a year now. I think. Ha ha. I honestly cannot remember if I transferred to the ED in Nov of last year or January of this one. I could find out I'm sure, but honestly I don't care that much!!

I'm still on the fence as to whether ED nursing is for me too. I said I would give it a year and then reassess but closing in on that year I'm just not sure. Some days I love it and some days I utterly hate it. And then there is the in between ones too :-) Perhaps it is just the 12 years of inpatient nursing I did and how different the ED is. It could be any number of things, many of them which I could name but will just leave alone here. For now though, I'm staying put. Really where else would I go? I've done most of what my hospital has to offer......floor nursing, critical care, MET nurse and now ED. All that is left is NICU as our pediatric floor is a combined adult/pedi floor so holds no interest for me. And I think I'll save NICU for later in my career when my back is gone :p

Next post I won't just mutter along absently but will actually give you a story!! See ya then.

Guest Post by Jennifer Johnson

2010-11-17T16:41:00.009-05:00

nuTop 5 Ways to Stay Awake

Might as well call you a Vampire— while the rest of the world sleeps, you’re awake, transporting bodies and dealing with blood. You are 12-hour night shift nurse. And while the rest of the public might not be able to do what you do you, you love your job because of the higher pay, no traffic during your commute and you get to chime in on a family event every now and then. And oh yeah, you save people’s lives. But you’re not really immortal, you’re human— and a lack of chronic sleep can and does take a toll on you. Here are the top 5 ways to stay awake during your shift without caffeine—because even though you’re go-to choice of drink may get you over the occasional slump, it’s bad for you and dehydrates your body. You know this. You’re a nurse.rse.
1. Drink tons of Water.
Dehydration reduces your blood volume, which makes you feel tired. Drinking plenty of water will also, in turn, make you want to go to the restroom more— a feeling that can help you stay awake. Try drinking the standard 8 glasses a day to keep your brain and body functioning properly. It’s not scientifically proven but mints are also supposed to stimulate a sense of alertness. Try mint-flavored water, it’s a two-in-one kind of deal.
2. Exercise. It moves oxygen through the bloodstream and stimulates cells, which is vital in keeping the body alert. While it might look strange to do jumping jacks and squats down the surgical unit, you can excuse yourself for a moment and do a couple of lunges outside. Even doing some basic stretches will help. Take a couple of huge gulps of fresh air while you’re out there too. It’ll also help you stay awake.
3. Eat. Fruit, such as apples, keep energy levels high because they are more easily digestible than many other foods and give the instantaneous fuel you need to keep going. Don’t really feel like carrying a huge apple inside your pocket? Opt out for a fruit smoothie instead of a Starbucks frapp during your break.
4. Turn on the lights. Your body responds to changes in light. Though it is the sun that contains the highest levels of short wavelength blue-light—the energizing light that activates our brains—bright lights around you can also help. Most hospitals are already highly illuminated, but if it is unnaturally dark in an area where you are working, flip on a light switch or go someplace that you know is filled with an excessive amount of light, like a bathroom.
5. Laugh. Not only does laughter reduce stress, but it also stimulates the feel-good chemicals that boost up your energy levels. Ask some of the doctors, other nurses, staff members or even some light-hearted patients to tell you a good joke. It’ll help you feel better mentally and physically and prevent you from falling asleep during your shift.

By-line:
This guest post is contributed by Jennifer Johnson, who writes on the topics of Nurse Practitioner School. She welcomes your comments at her email Id: j.johnson19june@gmail.com.

The NICU

2010-03-14T08:06:00.001-04:00

I came in last night and the nursing supervisor asked me if I had ever worked in the NICU. Uhhh.....nope, the regular newborn nursery but not the NICU. But hey, I'm up for anything as long as they understand that I can only do so much.

I get over there and they are greatful for the help. They have only 3 nurses on and have a total of 5 babies with 2 on the way. A drug withdrawal baby that screams a lot, a set of feeder & grower twins that were born at 33 weeks, a bruiser of a 10lb baby that aspirated meconium at birth and a set of 29 weeker twins that were born yesterday and were quite unstable (1 of who was about to be shipped to a tertiary hospital). The two on the way are a set of 34 week twins on CPAP.

While they worked I got to do the fun stuff....sit in a rocker and feed!! I ended up being there 5 hours and fed the drug baby twice and the feeder & grower set of twins once. What a joy to sit there in a chair and feed a baby for a job!! It felt like I was at a different place. I had to remind myself I was even at work!!

At the end I got to watch them give surfactant to the other 29 weeker. A pretty neat experience since I had heard about it lots of times but didn't really know how it was given. Also my nephew was given it at birth, so now I know what he went thru. He's quite the sick little boy (the 29 weeker, not my nephew) so hopefully he will do well, though I have my doubts I'm sad to say.

All in all it was a pretty neat experience. One I'll do again if asked!

Chief complaint

2010-02-15T07:12:00.001-05:00

I get to spend quite a bit of time in our ED doing my job as our resource nurse. The other day I was down there for awhile and happened to notice the chief complaint of one of the patients:

Having a bad day

I was named to....50 Best Blogs for New Nurses

2010-02-14T20:13:00.001-05:00

I got an email the other day letting me know that I was named to a list of 50 Best Blogs for New Nurses. I love being named to these kinds of lists! Especially lately when my blog has taken a back seat to other things in my life!!

To check out the entire list check out: http://nursepractitionerschools.org/50-best-blogs-for-new-nurses/ She does a wonderful job describing each blog too. Thanks Jennifer!!

Please Stop....

2009-11-26T06:55:00.001-05:00

The other night I was helping in the ED and we got this patient that was showing signs of an acute stroke. She arrived talking though she had some expressive aphasia. Then all of the sudden she went unresponsive. As the doctor started getting the intubation supplies ready I shook her shoulder and yelled her name. Not responding to that I did the next step....a sternal rub.

At this she started posturing. Never a good sign. But, then she suddenly awoke again! I rushed her to CT for a head scan and we all expected her to have a head bleed. Nope! In CT she had another unresponsive episode though. Again, shake the shoulder....nothing. Sternal rub....posturing. Then a minute or so later she awoke again. Very strange!

Back to the ED and she had 2 more of these episodes. Always the same. Then no more. After that she was more awake but just kept complaining of being "so so tired" and just wanting to go to sleep. Explaining to her that she really needed to stay awake until we could get more information on what was going on with her she looked at me and said:

"Can you please stop doing that thing to my chest because it really hurts"

I was shocked that she even felt it since she postured each time I did it. She went on to say that she was quite tired and that she heard me and that she was trying her hardest to open her eyes for me but that it was just so hard. So then I would push on her chest and that hurt so much. Could I please just stop doing that!!! I felt so bad!! The poor thing. I promised her that I would stop as long as she stayed awake. It was a deal!!

Everytime I went into her room after that and she saw me the first thing she would do was point to her eyes and say "see they are open"!!!!!!! She was quite the cutie!

Lions and Tigers and Nurses....A Review

2009-09-17T08:02:00.002-04:00

Awhile back I did a post on Amy Glenn Vega's Nursing Novella titled Lions and Tigers and Nurses. You can find that post here. If you remember (or just read) I was a bit skeptical when first asked to be involved with these nursing novellas on my blog but then opened the press release and figured I'd give them a try. I'm glad I did. I received a copy of this first novella and was excited to read it. Unfortunately I haven't had the proper time to sit down and review it properly on here. So here it is:

This story is a classic "nurses eat their young" story. The two main characters are Haylie, the new grad and Miriam, the preceptor. Haylie starts and Miriam immediately treats her like she knows nothing instead of taking her under her wing and teaching her how to be a great nurse.

The book then goes on to tackle lateral violence which is rampant in healthcare today. In the book Haylie, Miriam and their nurse manager Donna attend a class on it to help deal with the way they are treating each other. Amy is very thorough in this class in describing lateral violence using the "Lateral Violence Top Ten Among Nurses" list.

By the end of the book everyone has learned quite a bit about each other and how to treat each other. And there is even a bit of romance!! Does Haylie leave Miriam's floor due to the way she was treated? Now, that would be giving things away!! Read it for yourself and get the CNEs. To get them you have to answer 15 questions on what you learned about lateral violence.

Amy's second novella Broken Heart is out now too. It deals with coping with change and loss. It is next on my reading list. Thanks to Ken, Amy and Pritchett & Hull for giving me this opportunity.

Code 8 where?????

2009-09-08T21:10:00.001-04:00

Not too long ago we had a person (that wasn't a patient or employee) however was in the hospital building try and hurt themself. In the process of doing this he set off a smoke alarm. When a security guard and the nursing supervisor went to check the status of the alarm this person was found. The injuries were not life threatening but he was badly injured at the same time so to get the right people there for immediate help it was decided to call a Code 8 which is our hospital's Code Blue response. This is what was heard overhead:

Code 8 Morgue, Code 8 Morgue, Code 8 Morgue

What????? No, the person wasn't acutally in the morgue but just outside so security and the nursing super figured it would be the easiest landmark to call the team to. But can you just imagine????

Travel Nursing

2009-07-15T16:27:00.001-04:00

Do you use travel nurses at your hospital? We used to use them all the time and they were great to fill in the gaps. We got some great travel nurses in--some that I am still friends with in fact. With our new senior leadership we hardly get travel nurses anymore which is hard on us and unfortunate for them. What a great way to start out your career and see where you may want to settle down or way to end your career by touring the country while working those last few years.

I have never been a travel nurse and due to being married and having 3 wonderful kiddos it won't be an option for me in the near future. If you are a travel nurse or have thought of being one here is a company (www.nurse.tv) you should consider checking out and what has been said about them:

Let’s be honest about a fact here. As a travel nurse, you are one of the few professionals who are in demand in America today. Not only are you in demand, you are paid the best salaries and benefits that are on par with the ones offered in similar professions. Now it is also a known fact that you are not in this profession just for the money. You want adventure and exposure too. You know one way of getting the adventure and the exposure you seek is by traveling. As a travel nurse, you can travel the length and breadth of the United States and sometimes overseas too. This is the profession you always wanted and now that you are in it, are you actually happy working in the profession that you dreamed of pursuing?

There are many travel nurses who would say that they made a mistake of taking this up as a profession, and that they don’t earn enough or don’t get to travel that much. The truth is, the problem is not with the profession, it is how you’ve chosen to pursue your career. It all starts with the travel nursing companies. Selecting the right one is paramount to your happiness. Actually, many travel nursing companies give negative signs right at the time of your applying for a job. They can torture you with very cumbersome paperwork when applying, and annoying phone calls or mailers after you sign up. It’s like you are on their watch list for all the wrong reasons. Good professional nursing companies don’t do that. They will hire you without any needless paperwork, provided you are qualified for the job. They will assist you in information regarding licenses and give you a choice of three destinations to choose from. Most travel nursing companies don’t do this.

The better nursing companies work for the benefit of both the hospital and you. Even the interview process is quite simple and they can set up an interview (mostly telephonic) with the hospital that in most cases last only 5 minutes. The hospitals are the final authority on your recruitment, but the job is as good as got because the good travel nursing companies know where to present your profile to your maximum advantage. Their job doesn’t end there. They see to that your accommodation needs are met and can even help you with stuffs like cable, telephone etc. Good travel nursing companies can get you wages between $22 and $50 per hour and they will deposit a direct check into a bank account of your choice at the end of the month. They will send you W-2 at the end of the year and your 401k plan starts the very first day you join the job. Compare this with travel nurse companies that don’t pay their staff even their salaries for months together.

The benefits of joining a professional travel nursing company are endless. Lots of things like travel reimbursement (flight, rail or road), insurance, bonuses and incentives, general housing subsidiaries- the list could go on! Good salaries, minimum work hours guarantee and choice of destinations, what more could a travel nurse want? And they just don’t stop at that, they offer you support -24/7 support, 365 days a year! That’s what the best travel nursing companies do, they look out for you!

Is your travel nursing company giving you all this? If the answer is no, then don’t you think it’s time you looked at better options now?

Happy Birthday CoS!!!

2009-07-10T07:44:00.001-04:00

Change of Shift has completed 3 successful years and will now be starting year 4!! Hard to believe. I don't get into it too often because I tend to forget to submit my posts........oops! Not intentional just too busy to remember. Anyway I'm in this one so check it out. You can find it at: http://www.emergiblog.com/2009/07/change-of-shift-begins-fourth-year-volume-four-number-one.html

Thanks Kim for creating and continuing such a great thing!!

Lifesaver

2009-07-06T07:03:00.001-04:00

A few years ago I took care of a patient with pneumonia. She also had a history of aggressive breast cancer. She quickly went downhill and ended up intubated. She was at death's door for well over a week. Her husband spent everyday there and was so devoted to her. In making small talk with him many of us nurses commented to him multiple times on her toenail polish color and how unique and pretty of a color it was. It is hard to describe the color but it is a shade of coralish orange.

When she finally got better she didn't remember any of her intubated period or realize how sick and near death she was. Her husband told her several times how sick she had been and how us nurses had saved her life. She kept saying that she couldn't have been....

In doing her care we mostly did small talk or talked about how devoted her hubby was or her breast cancer etc. But at least once a day someone mentioned her toenail polish to her. She would just laugh and say that it was her favorite color but that she desperately needed a pedicure!

She finally after several weeks made it out of our unit, went to the respiratory floor and got better enough to go home. Several weeks later I came in at 7pm for my shift and there was a basket sitting on the counter with a note attached. It was from her and her husband thanking us for our efforts in saving her and getting her well again. The card stated that she had gotten her pedicure and that she felt that all of us nurses deserved one too so she had sent us all bottles of her favorite nail polish. Sure enough it was the color she had had on her toes! The most touching part of the entire thing was that the card went on to say that she had never really noted what the exact name of the color was until she was preparing the basket. She had turned over one of the bottles to look and smiled when she saw the name.................................................LIFESAVER!!!!

One of those people who had an impact

2009-07-05T08:01:00.001-04:00

A few nights ago I was doing rounds and in talking with a nurse about her assignment saw a name on a chart. I laughed and said "that was the name of the principle of my middle school, what a coincidence!" She stated "she is a retired principle so maybe that's her". Being 3 am I didn't think it was a great idea to check and figured I'd go back first thing in the morning. As usual though I forgot in the excitement of getting off work and my bed calling me!!

I was then off for 3 nights so figured I missed my opportunity to check and see if it was the same person. But hoping I hadn't I head up to that floor last night to check. Sure enough, she is no longer in the census. Still hoping I check and sure enough she had been moved to another floor. I head down there and poke my head in.

I politely say her name "hello Mrs. Johnson" (because you would never think of calling her by her first name) "Were you by chance the principle of Tyler Middle School? "Why yes I was. What is your name?" She asks. I tell her my maiden name. "Oh yes, I remember you." She says. In my head I'm thinking yeah right she remembers me since I was a kid who never got in trouble, but then after talking for a few she asks about how my brother is doing....guess she does remember me since I hadn't mentioned him at that point!!!

Then I tell her what an impact she has had on my life. Many of the life's lessons that I learned at Tyler I still remember to this day. Walk on the right side of the hall, don't walk by a piece of trash without picking it up, be respectful & courteous, don't chew gum in school. These were the major rules there. I still walk on the right side and you know when I'm at the mall etc it makes it so much easier and when people don't it is so hard to get around and I'm worried my small children will get trampled especially around the holidays. I still pick up trash around the hospital. It makes for such a cleaner place to work and therefor more enjoyable. Plus it's just good for the environment. Being respectful and courteous..........do I really need to explain that one??? :-)

As to the gum chewing....I never understood that one. And actually that was the only detention I ever got in all my days of school. Darn it I was going to chew gum!!! So, I asked her about it. And she explained that it was her little war that helped us learn about bigger wars. Basically that in life there will always be a war to fight and that we needed to learn that there will always be someone higher up than you telling you what to do so you might as well get used to it early in life. You can either fight it or learn to give up on the smaller stuff and get along. Not a bad lesson in my opinion!

I told her what an impact she still has on me all these years later and she was blown away. She was so happy to hear it. We talked about my job and all the teaching etc I do now. She told me that even though I had never directly taken care of her she could tell by my actions in our conversation what a good nurse and a good person I am. It was nice to hear. Maybe I'll stop in an see her again tonite!

Featured Healthblogger on Wellsphere

2009-06-19T06:56:00.001-04:00

I'm honored to be chosen to be a featured healthblogger on wellsphere. I was contacted by them and asked to be a featured blogger on their site. After checking out their site and liking what they had there for health information I decided to give it a go. Check out their site: http://www.wellsphere.com/home.s

Check out my profile: http://www.wellsphere.com/tracey-profile/135510

And I get this really cool badge to put on my blog which will go up soon. Come back and check it out.

Quite the honor if you ask me!!

Designed with nurses in mind

2009-05-26T04:04:00.001-04:00

When the Children's Hospital of Pittsburg was redesigned recently by Astorino Inc. it was done after much consideration of the aging nursing popluation. Read below the story about this design project and how it helped with the physical burdens that we face as nurses while laboring to care for our patients. The photo is of one of their new care team stations and was taken by Alexander Denmarsh.

CHILDREN’S HOSPITAL OF PITTSBURGH OF UPMC: DESIGNED TO HEAL

Architecture firm Astorino employs unique research technique to translate needs and experiences of patients, families and staff into a world-class healthcare facility

PITTSBURGH, PA, May 11, 2009 – Children’s Hospital of Pittsburgh of UPMC has unveiled a new, thoughtful design that distinguishes itself as a model for pediatric healthcare for the 21st century. Astorino, the full-service architectural and engineering firm that designed the hospital, created this revolutionary facility by employing a unique process that gained insights into the hearts and minds of patients, families and staff. The result is a healing space that meets the deepest needs of all who will inhabit this 10-acre campus for generations to come.

Astorino leveraged deep design research from its affiliate company fathom to address the innermost needs of patients, families and staff. To best determine what those needs were, fathom used a market research tool originated by Olson Zaltman Associates, a Harvard University-based company. The Zaltman Metaphor Elicitation Technique (ZMET) is a unique one-on-one interview process that invites participants to find images that represent their deepest thoughts and feelings about a given topic. Through this research study, key metaphors for the ideal experience at Children’s emerged; Transformation became the overarching theme and Control, Connection and Energy were identified as supporting metaphors.

“Children and their families go through incredibly trying times at hospitals,” said Louis D. Astorino FAIA, CEO and Chairman of Astorino. “Unfortunately, most environments today do little to aid in the healing process because they are not designed with people’s deepest needs in mind. The design of Children’s Hospital of Pittsburgh of UPMC is intended to alleviate stress and enhance the transformative healing process that patients and their families experience when in a hospital.”

Transforming the Hospital Experience
Fundamentally, the new design is about transformation – moving from an unbalanced state to a balanced state. The theme of transformation runs throughout the hospital in an effort to guide patients and their families through the arduous process of treatment and healing. It starts before patients even see a doctor during the walk through the Transformation Corridor, a hallway that connects the parking garage to the hospital’s main lobby. Visitors begin to experience the feeling of transformation from the change in seasons represented in the floor patterns to the impressive wall mural of a cocoon turning into a butterfly.
Maximizing Energy Accelerates Healing Process
An atmosphere of positive energy is infused both inside and outside the building, giving patients, family members and staff opportunities to “recharge their batteries”. For example, the spacious waiting room – filled with movable, patterned furniture in bright colors – provides ample room for patients to run freely and offers positive distractions, such as art work, a fish tank, toys and games. The outdoor spaces, chapel, library and various medicine-free sanctuaries are calming areas where families and patients can clear their minds. Playrooms, fitness areas and sibling centers offer energy sources for higher-intensity activities and provide welcome distractions. The Family Town Square, a central gathering location, includes a two-story movie screen that can be used for showing educational and entertainment programs. The cafeteria exudes a whimsical, carnival feel complete with light fixtures that resemble cotton candy. Astorino also addressed the number one way energy is replenished – a good night’s sleep – by eliminating noise distractions, such as the overhead paging system.
Increasing Control Empowers Hospital Users
Hospitals today present fearful unknowns and are not designed to empower people to take control over their life and environment. Children’s new design provides increased control over variables that can normally cause stress among patients, families and physicians. For example, patient rooms were turned into kid-friendly spaces that are intimate and private, and allow children to take control over things like lighting and display of personal items. Floor plans were also organized to maximize usable space, increase productivity and reduce medical errors (i.e. care team stations were decentralized so staff is never far away from their patients; they were also designed with private and confidential areas for nurses and doctors to conference).

Creating Connections Fosters Sense of Community
Children’s design connects patients with the outside world, themselves and others and alleviates the sense of isolation often felt inside hospitals. For example, the building’s rich and colorful interior and exterior – with lively red, blue, yellow and orange colors – provides an emotional connection for children. Private rooms with separate areas for parents to sleep keep families close and connected, but also comfortable. The 4,000 square-foot Rooftop Healing Garden offers everyone a comfortable space to socially interact and rejuvenate. Windows placed at the end of each hallway also enable patients to see and connect with the outside world.

Louis D. Astorino continued, “Healthcare is rapidly changing – from the way people receive care to advances in medicine – and architects need to be more nimble than ever to be able to respond to these changes. At Astorino, we believe design can play an active role in the healing process and we hope that our work at Children’s will not just prove this, but inspire others to create designs that meet the deepest needs of users and pave the way for better care.”

About Astorino
Astorino is at the forefront of where people and design intersect. A full-service architectural and engineering firm, Astorino deploys a discovery, design, and build strategy, combining unprecedented human-centered research, design and construction services into one seamless process. Each service inspires the other, creating a final product that meets the deepest needs of people who live, heal, work and play in these environments. For more information, please visit www.astorino.com

Do I need to know?

2009-05-18T07:15:00.001-04:00

Last night I was assigned to the CCU for the first 4 hours of my shift as they were short a nurse and getting a post-PCI patient (heart attack that just got angioplasty) along with another ER admission. So I took the PCI patient and did her admission. Figured that would help and then I would turn her over to the 11pm nurse.

She came with corrections officers. Usually they only come with 1 but for some reason she had 2. She wasn't unusually dangerous, it just had something to do with transportation etc. Anyway, after I got the admission paperwork that I had to do with her done and was out at the nurse's desk doing the rest one of my coworkers asked why they were in there with her. I said cuz she is a prisoner. She gets all excited and asks if she is shackled to the bed etc and lots of other questions. Then she asked the one that really got me thinking......

What is she in prison for? I told her I had no idea. She asked if I had asked the CO. Nope. Is it in her chart? Nope. Did you ask her? Nope. Don't you want to know? NOPE. Then she asked why. I took a minute and thought about it.......

Isn't our judgment already a bit clouded just in knowing that she is a prisoner? Do I really want to cloud it any more by knowing what got her there? Instead why don't I just know that she is a person that needs my care. Sure, she's done something that a jury of her peers and our society deemed wrong but right now she is a sick person who needs my care. This is all I want to know. I also know that she is appreciative of my care and is respectful and cooperative. Why ruin that?

I'm not saying that I have never wondered the same thing my coworker did. I have. I even asked once. We had another prisoner who came in quite frequently for CHF. After the 4th or 5th time I took care of her I finally got up the nerve to ask her. She told me that she committed arson. She was very ashamed about it too. She even cried as she told me. I knew in that moment that I never wanted to know again what someone was in prison for. Who knows, maybe I needed her to know that I don't need to know. Maybe without her I would still be like my coworker. I'm blessed instead to ask myself: Do I need to know? and know the answer is NO everytime.

I've been listed as a top 50 blog!!

2009-05-17T19:03:00.001-04:00

How exciting for me!! I've been listed as a top 50 nursing blog!!! I'm honored. Thanks for being a reader and thanks to onlinenursingdegreeguide.org for listing me. The entire top 50 list can be found here: http://onlinenursingdegreeguide.org/2009/top-50-nursing-blogs/ Please check it out and have fun reading the other blogs. They are broken down into catagories to make it easier to find what type of nursing blog you are looking for even.

Thanks again both to my readers and to the list!

Nursing novellas as continuing education

2009-05-13T19:13:00.001-04:00

I got an email the other day asking if I would be willing to put a press release on my blog. Being skeptical of anything but my own stories I was a bit leary at first. But I opened the press release to read it and it actually sounded like a pretty good idea. So many states require CEUs and so many out there are certified which also requires CEUs. I know that's the only reason I haven't yet gotten certified in critical care. I have a 5 year old and 3 year old twins. There is no way I'd be able to keep up with the CEUs. But this sounds like a great way to get some of them. Here is the press release so judge for yourself:

Pritchett & Hull Associates, Inc.

3440 Oakcliff Road NE, Suite 110

Atlanta, GA 30340

Email: kenb@p-h.com

Web: http://www.p-h.com

NURSING NOVELLAS

Amy Vega takes a Novel Approach to Nursing Education
FOR IMMEDIATE RELEASE
For more information call:

Ken Baumann

(770)451-0602

ATLANTA, GEORGIA, APRIL 27, 2009 – When you think of continuing education for nursing, you may imagine medical textbooks, complicated graphs and loads of acronyms. Well, Amy Glenn Vega hopes to transform continuing education by taking nursing lessons and crafting them into steamy page-turners nurses can read while cozying up next to the fireplace in their favorite comfy chairs.

Amy is a Health Care Educator at the Southern Regional Area Health Education Center in Fayetteville, NC, who has put lots of different theories into practice to reach students over fifteen years. What’s the best way to help teach a nurse who’s in-demand, underappreciated and overworked? Amy Vega has taken the novel approach. “I’d see lots of nurses sipping coffee and taking a brief escape behind the pages of a novel. Then it dawned on me - what if learning something new was as easy as reading a story?”

Nursing Novellas is a new series that helps nurses learn more about dealing with major interpersonal issues in health care using the fictional cast at Dogwood Regional Hospital in North Carolina. Inside a whirlwind of work, family and love-lives in crisis, the nurses of Med-Surg South find ways to come together and overcome their personal and professional challenges. Real nurses learn through reading and sharing these fictional experiences, and then through discussing them with other nurses.

Amy’s first novella, Lions and Tigers and Nurses, deals with the lateral violence that is so rampant in healthcare. According to the American Nurses Association, 60% of workplace assaults take place in healthcare related services. “If lateral violence continues to erode the workforce at this rate, our quality of health care will be dramatically compromised,” said Amy Vega. “In my book, I tried to illustrate some of the major learning takeaways about lateral violence in a way that is entertaining and memorable.”

Lions and Tigers and Nurses and the second novella, Broken Heart, which is about coping with change and loss, will be available in June from Pritchett & Hull Associates, Inc., Amazon and all major booksellers. Continuing Nursing Education credit is offered and provided by the Southern Regional AHEC. Amy Glenn Vega is an active blogger and her website, nursingnovellas.com, is a place that nurses, nursing students and anyone working in or interested in healthcare can discuss and learn about the major issues and challenges facing healthcare and healthcare professionals.

Amy Glenn Vega is not a nurse, nor does she play one on TV. However, she has worked closely with nurses over the past fifteen years in her career as a health care educator and a former Emergency Medical Technician-Intermediate. She obtained her Masters in Business Administration and Masters in Health Administration at Pfeiffer University, and her Bachelor of Science in Health Education at the University of North Carolina in Chapel Hill. She has served in multiple roles in health care education, to include community health, patient education, and staff development. She is currently employed as a Director of Interdisciplinary Continuing Education at Southern Regional Area Health Education Center in Fayetteville, NC. A gifted storyteller, Amy has combined the power of story with teaching in the educational fiction series, "Nursing Novellas." Amy is also a North Carolina Registered Health Educator and was recently appointed as a Fellow to the Academy of Health Care Education Professionals.

Southern Regional AHEC is approved as a provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Pritchett & Hull Associates, Inc. publishes healthcare materials for nurses & nursing students that encourage exploring and confronting the challenges of current and future healthcare through personal and staff development in fun, creative and challenging ways. The result is better teaching, better prepared healthcare professionals and better quality of care for our future healthcare challenges. P&H brings People & Health together.

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To learn more about Nursing Novellas, please visit Amy Vega’s website at www.nursingnovellas.com. To learn more about how P&H can help bring People & Health together in fun and innovative ways, please call Ken Baumann, Marketing Director at 770.451.0602 or email Ken at kenb@p-h.com or visit www.p-h.com

And I thought we had it bad

2009-05-07T07:55:00.001-04:00

As a nurse I've seen a lot of gross and awful things. I thought that my job was pretty near the top of the list of seeing bad things. However, this night I think someone else got the worst of it.

I went down to the ER and heard some serious screaming. Asking what was going on I heard quite the story. Apparently in the behavioral hall there was a patient that was an older woman in her 70's that was psychotic. According to hear daughters this was new for her. She had always been a bit eccentric but never like this before. Now, for the last week, she was paranoid and hallucinating. They had a whole list of things written down that she had been saying and supposedly seeing.

The worst of it however, was what she did to the police that were called to pick her up. When they came and knocked on her door she freaked out and greeted them by throwing a severed kitten head at them. Yes, a kitten head. Can you just imagine being that police officer? And having that happen to you?

I actually felt bad for 3 souls that night: 1) the kitten, 2) the police officer and 3) the woman.

I never did get the chance to find out what made her acutely psychotic either. I would have liked to have known. They were questioning a UTI.....but seriously.......a UTI that makes you decapitate your own kitten? She did have other issues too. She apparently had many, many cats and didn't take the greatest care of herself, them or the house. All around a sad, sad story.

A disturbing trend.....local or national?

2009-03-24T02:50:00.001-04:00

I want everyone in the US who reads this to respond if possible. In my hospital we are trying to find out if this is a trend in our hospital or something national. So, please respond!!!

Our hospitalists are giving out huge amounts of pain meds these days. I remember when I started nursing (10 years ago) we gave out demerol (wow!) and morphine only. To give diludid was a rarity and it was reserved for someone with chronic pain or someone in intense pain that demerol or morphine didn't work for. These days demerol isn't used and morphine is even going by the wayside except for cardiac patients.

For our chronic pain patients and really everyone we are giving out diludid like it is candy. For those that come in with acute pain they will get anywhere from 0.5-2 mg IV q 4-6 hours depending on their age & size, etc. But for those that are our chronic pain patients we are giving anywhere from 2-8 mg IV q 2-4 hours!!!! Yes that's right we sometimes are giving 8mg of IV diludid q3h!! That's enough to kill an elephant! But the patient that was getting it last week was complaining that it wasn't enough! What???

This is becoming disturbing to us nurses and we were talking about it the other day. We are surprised about several things: 1) the doctors are ordering doses this high, 2) the pharmacists are allowing us to administer doses this high and 3) patients are tolerating doses this high without complications.

So my question for those out there reading this is........

Is this happening out there or just here?

S....t.....u.....c......k

2009-03-04T10:53:00.003-05:00

The other morning I head to the ER and they ask me if I had heard about the PCI that is coming in. Knowing that it is my job to open the cath lab when a PCI arrives, I ask what they are talking about. Apparently, they got an EMS patch that they were responding to a chest pain call and when they got there and did the initial EKG it was for a man that was actively having an anterior MI. It looked like a pretty big one by the EKG they had faxed over....with tombstones and recriprocal changes.

We had just gotten slightly over a foot of snow within the last day that had just ended in the last several hours. When the EMS got the guy into the ambulance and started for the hospital it got stuck in the snow!!

From what I hear it was approximately 30 min that they were stuck in the snow before finally digging themselves out. We aren't sure why they didn't just dispatch another ambulance since the poor guy was actively infarcting his heart the entire time. They were finally pulling into the ER bay as I was leaving for the day so unfortunately I'm not sure how he made out. Maybe a future update.........................

12 seconds

2009-02-09T02:55:00.001-05:00

Sometimes you should be careful what you wish for.....

For instance, one night our ER was going down 2 nurses at 3am so I was assigned to go there for 3am -7am to cover. Usually when they are going down 1 nurse I just go as helping hands since I have to cover any METs or Codes that may occur during that period too. But this night they were particularly short so I was asked to take an assignment and the charge nurse would cover me if any emergencies happened elsewhere.

I was given 3 beds in the observation area but only 2 were filled. They were both going to be admitted but there were no beds in the hospital so both were holds. Both elderly and both settled in and asleep. A set of signs on each, a pair of assessments and a talk with one who had family and I was in the clear.

I then asked the charge nurse several times to give me another patient to fill my other bed but she said no as she already had 3 of her own and didn't want to cover 3 more if I had to leave. So, I helped others and waited and waited and waited. And, of course, being me complained a bit as to how useless I was being.

Then about 5:50am the triage nurse doesn't consult with the charge nurse and puts a patient in my 3rd bed. I go in to see what he is and find a young man in his early 30's. She tells me he had just had a syncopal episode at work with a LOC for approx 10-15 seconds. Kinda impressive but I'm not really expecting much. They rarely repeat themselves for us nurses!!

The tech gets an EKG, I get him on the monitor and we start chatting etc. I'm actually starting to think like an ER nurse (scary for a critical care nurse at heart!!) and go get a rainbow of lab tubes to get his blood while I put his IV in. I start an 18 in his AC. As I'm getting the last tube of blood I hear the monitor start to beep and look up. He had this whole time been a nice NSR in the 80's with no ectopy or anything funny. Now he's in the 40's!! Yikes!

I ask him how he's feeling and he initially says fine. Then changes his mind and says he's a bit nauseated. I look out and there is NO ONE to be found at the nursing desk!! Oh shit!!!!! I then look back at the monitor and his heart rate is now 30's and he's telling me that he is really feeling quite nauseated and not good at all. I look again and see another nurse and barely get her attention but luckily she comes to my aid. She gets some atropine and goes to flush my IV site and in my haste to tape the site in I had taped it too far down and we cannot get the flush syringe on the catheter. Oh shit BIG TIME now as he is now in full blown asystole and his limbs are stiffening and he is totally out.

I finally get the tape off, get the site flushed and she gets the atropine in. Not sure if his heart restarted on it's own or with the atropine but it did restart. Thank God!! He then wakes and asks what happened. The doc explains that he showed us what happened when he had the last syncopal episode and thanked him for helping in the diagnosis!! I told him that if he really wanted to get my attention he didn't need to make his heart stop, that there were easier ways to do it!!

All in all he was in asystole for a total of 12.4 seconds by the monitor strip! Needless to say he didn't tolerate it well at all. Much more and he would have gotten some good ol' fashioned CPR. He was close as it was. Went to the CCU and got a temp pacer in his jugular and then a PPM the next day. I don't think they ever found a cause.

But I definitely learned a lesson.........................when in the ER be careful what you ask for!!!!!

Super Pube

2009-02-08T07:18:00.001-05:00

I get this call from a nurse on one of the floors the other night and she says "Can you come and check this super pube for me?" I make my way up there and am wondering what I'm going to find.....................a HUGE pubic hair or a superpubic catheter!!!

"Just a nurse"

2009-01-15T10:04:00.003-05:00

I came across this blog post on the Happy Hospitalist's blog and wanted to share it with my other nurse readers. It's a great story. Thanks again Happy!

http://thehappyhospitalist.blogspot.com/2009/01/just-nurse.html

Raisins on sticks

2009-01-15T07:21:00.002-05:00

Wow, it's been awhile since I've been here. I've been sick on/off for about 8 months now. Had some 4 month long mystery illness that spontaneously resolved in the late summer to early fall and then recently had Lyme disease and mono at the same time. Now just found out that I've had iron deficiency anemia for at least 6 months if not more. Needless to say I haven't been feeling my best and since I can't give up being a mom or nurse the blog is the thing that went!! But I'm back and am going to try and get back into the swing of blogging my nursing stories at least a few times a week.

This is actually a story that one of the cardiologists I used to work closely with told me. The background that made it so much more funny is that he is in his early 50's and quite reserved. He does talk and joke with the nurses but never in a way that the younger male docs would if you get my drift.

He was in late one evening and we had a confused older lady who was continuously taking her gown off. We were joking about how this lady just liked to be naked no matter what we tried to do. So he pipes up with "I've got a story for you gals about older naked ladies". Coming from him we weren't really sure what to expect.

He tells us about all the times he walks into an exam room to see a patient and it is an older lady in her 70's or 80's and she will be sitting there on the exam table naked from the waist up. He says "I'm a cardiologist.......not a GYN who would need to do a breast exam." We figure with him that's the punch line but oh no it gets better!

He goes on to say "yep it just takes me by surprise each time.....there they are sitting there chest bare and it's like two raisins hanging on the ends of the sticks."

Can't we all just get along

2008-10-13T11:34:00.002-04:00

Since starting my job as a resource nurse and being all over my hospital I've seen lots of things from basically all prospectives. I was never one that fell into that whole dept against dept thing anyway but now it annoys me even more. Aren't we all here for the patients instead of to be against each other?

The other night I spent 7 of my 10 hour shift working in the ER due to them being so short staffed and so busy. The only dinner they got was the tray of day old sandwiches, chips and coffee I got them from the cafeteria as no one had a chance to go to the bathroom never mind get food. As I'm in the cafeteria I hear a tele nurse say something to the effect of "the ER needs to quit whining."

I so wanted to say something to defend them as I knew firsthand how busy they were. Ambulance after ambulance pulling up, multiple stabbings, chest pains, an acute MI, etc, etc. But then I got to thinking of the nights that the tele floor gets 6 admissions from the ER in an 8 hour shift and they bring them up one after another without enough time to get the first one settled in and the next one is arriving. I've been up on the tele floor helping them when this happens and overheard the ER later saying something about the tele floor nurses whining too.

And it's certainly not just the tele floor...ICU was giving the ER a hard time the last night I worked too. It's all around. Basically on every floor. No one understands what the other floors go through. The floors don't understand that the ER cannot refuse ambulances and have to find room for them when they arrive. And the ER doesn't understand that the floors have 6-9 patients apiece that includes confused, busy, rude, heavy, etc patients and their family members.

So, again I ask..........aren't we all here for the patient? And can we all not just get along?

Why I couldn't be an ER nurse

2008-10-08T08:39:00.000-04:00

I've been spending a lot of time down in the ED since starting my new job. I like it in small chunks but couldn't do it full time. Not that there aren't bad things that happen in nursing all over but the things I've seen in the ED seem to just top them for me. Although I guess L&D would have worse but luckily I don't have to go there!!

A week or so ago I was down there about 2 am when a MVA came in. It involved a woman in her early 30's and her 3 yo son. The boy wasn't hurt too bad at all....just a few minor scratches. The mom was fully boarded and collared. And FREAKING out. At first I thought that she was freaking because she and her little one had been in the accident as I would be. I mean they would have to tie me down to keep me away from making sure my kid was ok you know!!

Well, turns out she was freaking because she was drunk. Her BAL was .20! Our legal limit here is .08. And that was just the beginning. Her DAILY meds included ativan, vicodin and percocet. Yup, on top of the alcohol. Wait it gets worse........

The carseat was improperly installed and had come loose in the accident so it was by the Grace of God that kid wasn't hurt more. Think I'm done............

Her license had recently been suspended too!!

OMGosh! I'm not sure if I could have taken care of her. I know in nursing we aren't supposed to be judgmental and usually I'm pretty good about that. But I was really struggling with it in this case. The ED is definitely not for me!!

P.S. Wondering how bad mom was hurt? She fractured her lower back where the lumbar and thoracic vertebra meet. And the kiddo went home with Dad who wasn't married to mom anymore.

I've been listed!

2008-10-08T08:34:00.000-04:00

I got an email the other day that my blog has been listed on a top 100 list!!

Lots of others that I read are on it too. You can check it out at rncentral.

Thanks for reading me!!

My first month

2008-09-23T16:07:00.000-04:00

I've just about finished my first month in my new job as a MET/resource nurse. I really love my new job!! It's great for someone who is social and loves action.

The first two weeks were fairly mellow but now that staff knows we are here (I work three 12 hour night shifts and my partner works four 10 hour night shifts) we are being called upon much more often.

My first week started with a bang in that I transferred two patients to my old floor (CCU) on my first night! But then the second night I had not one page!! Then the third night I helped in the ED with a code on a 40 yo that we pulled through who died a few days later in the ICU. In my down time (which there was a lot of this week) I mentored the new GNs and introduced myself and my position to the staff.

My second week started out with 4 Code Mr. Greens (extremely agitated patient) in the same 12 hour shift!! Not my cup of tea! But then had a trauma code, several METs and a BAT (stroke).

The last two weeks things have really picked up and I have had quite a few more METs and just clinical calls in general. The hospitalists are getting to know my partner and I better and are giving us more leeway in judgment calls which is nice. The staff is excited to have us around and the ADNs are glad to have another set of hands in the hospital to help them too.

All in all the position is working out great! I'm quite happy with it so far. :0)

What is your blog film rated?

2008-09-21T14:38:00.000-04:00

I found this on another blog and figured I'd try it. I wasn't sure what mine would come back as since sometimes I tend to rant!! But it bases it purely on the words used.

Here is my rating:

Created by OnePlusYou - Online Dating

It's only issue was with my usage of the word pain.........interesting!

An interesting shirt

2008-09-20T02:44:00.000-04:00

Tonight I had to go to our locked inpatient psych unit to relieve them for break since there is only 2 RNs there at night. I've done it before and it has always gone well with all the patients sleeping the whole time I'm there.

Tonight 3 patients were still awake when I got there at 12:30 am. They were conversing quietly at a table in the common area. I just sat at the nurse's desk while 1 RN when to break. All was fine. Then 1 patient gets up and I happen to notice his shirt. It was a black tee shirt and on the back it said "Caution does not play well with others"!!! And the not was underlined!!

I about fell out of my chair and had a really hard time not laughing!!! To see a psych patient with that shirt on just seemed hysterical to me! Maybe I'm the only one though.....I'm not sure!

Quiz.........a or b?

2008-09-11T16:47:00.000-04:00

I know I haven't been blogging here for a little while and I plan on doing an update of my new job quite soon but had an incident the other night that I have to quiz everyone on:

Which is the correct situation for an anesthesiologist to teach a hospitalist to intubate?

a) a controlled OR setting

b) a setting where the patient is in flash pulmonary edema with a pH of 6.8 and CO2 of 100

Please leave your answer in the comments section. I imagine you can guess which one happened to me the other night. Grrrr.

One night left

2008-08-14T08:58:00.001-04:00

I just finished my second to last shift in CCU. Then I have a week of vacation before starting my new job. For those that aren't sure what my new job is see this post.

It is bitter sweet really. I'm sad to leave CCU and all my coworkers. But at the same time I'm excited to try something new and have a new challenge. I'm nervously excited!!!

This past week has been all about tying up loose ends for the new job. Getting a new locker in a new area, getting a new boss, finding out what will be involved in the self-orientation, etc.

The first two weeks will be a self-orientation period for myself and the other gal that will be working the 4 nights I'm not. We are pioneering this position at our hospital so that is quite exciting that we can shape this into what we want it to be along with the expectations that management has for it. I'm sure at times it will be frustrating but I'm looking forward to the challenges it will bring.

Does it really matter at that point???

2008-08-05T01:42:00.000-04:00

We get this patient in DT's (alcohol withdrawal) and my coworker that is assigned to her asks her, as part of the admission assessment, how much she drinks. The patient tells her that she drinks 1L (yes 1 liter!!) of vodka daily.

Now I was taught in nursing school that with cigarrettes and alcohol the patient rarely admits to the actual amount and that the general rule of thumb for both is to double it and then you are closer to the acutal amount.

Does this mean that this woman actually drinks 2L of vodka daily? And if it is 1L or 2L does the difference really matter at that point? She's pickling her liver either way and currently in DT's so, I ask again........when it's THAT much does the actual amount really matter?

It didn't to us then but it just got me thinking..............

A new blog for me

2008-07-31T06:03:00.000-04:00

I wanted to post the link for my newest blog here. I started one that is more about my personal life rather than my nursing life. No personal identifying details though so if anyone likes my writing style and it interested in reading it then feel free. You can find it at http://seeingdoublesob.wordpress.com. It's still a work in progress and only has one post but more will come!!

A little push and some perspective

2008-07-27T02:30:00.000-04:00

I had an older gentleman two nights in a row recently. He was recovering from a big abdominal surgery and had gotten transferred to my unit after complaints of chest pain. We ruled him out for a heart attack but he had some other problems such as acute renal failure and an early pneumonia so he would be staying with us for a little while.

My first night with him he was surrounded by family members. He had had a rough night the night before including the transfer, a bout of confusion, and not much sleep. When I asked him if he wanted to get cleaned up for the night he refused saying he just wanted to sleep. Fine with me. My preceptor had taught me long ago that in a critical care unit you don't die from a little stink!! Missing one bath isn't too big a deal when the patient is pretty clean anyway and just wants to rest/sleep. We did turn and reposition during the night though.

I come in the second night and he has no visitors. They have all gone home already. He is still feeling pretty icky and again requests to sleep. But he needs some good respiratory toileting and a good lifting of his spirits. So I inform him that sleep isn't an option right now and that he needs to get cleaned up and repositioned. I promise him a back rub and that it will all make him feel lots better. He whispers something that I cannot understand. I ask him to repeat it and when I finally understand it he has said "not worth the trouble". I tell him that YES he is worth the trouble and that, in fact, it is no trouble at all. He just nods.

I take the first washcloth of warm soapy water and rub his shoulder with it and his tense body immediately relaxes and he whispers "that feels good". I tell him that I'm glad. He's been having tons of anxiety the past few days and hyperventilates with any stimulation. We've been between a rock and a hard place on giving him any anti-anxiety meds though as we don't want to further compromise his respiratory status.

I get done with his trunk, arms & legs and get a new cloth for his privates. I tell him that I am going to do them and he immediately tenses again and freaks out while I do that area. As soon as I'm done I reassure him that I'm done with that area and that it was necessary to do it since he has a catheter in. He whispers "I hate you" though I can tell it isn't with much vigor! After a turn, back rub, sheet change and rectal temp I'm done.

A fellow nurse comes in to help pull him up in the bed and get him repositioned on his side. I ask if he is comfortable and notice that he is again relaxed and see that he nods "yes" to being comfortable. Then I ask if he is ready for me to be done torturing him. He whispers "I am so glad you did that for me", claps his hands and has a sparkle in his eyes. I actually almost cried!! Mostly because the night before he was so confused that all night long he was intermittently sitting up and yelling out "help me" and it wasn't easy to calm him down. He was just a confused old man. And the next night he was a sweet old man. Kind of puts it into prospective. Either way, he is an old man who is a human being. I think sometimes it is easy to forget that as we take care of these sick people each shift.

The second night he took a short nap after his bath and then awoke quite confused again similar to the way he was the night before. But tonite I have my perspective back and also my patience. Sometimes I lose that perspective and I'm sad when that happens. Not that it's a great excuse but that first night we had only 1 lucid patient on the entire floor. Makes us all crazy sometimes you know!

Where do they find these docs???

2008-07-24T04:00:00.000-04:00

I go out on a MET call the other night (known to some of you also as rapid response teams ) and it is for this older gentleman who is unresponsive. We go through our usual protocols and the nursing super is asked by the floor nurses if we want the hospitalist and she agrees to it since we have done our thing and cannot really do more at this point.

In he walks. Having had prior experience with him I know that I am really no better off except that I have someone who can write orders. We disagree on what is wrong with the patient. The floor nurses found him acutely unresponsive and hypotensive. This doc thinks that it's the klonopin they restarted today despite the fact that he usually takes it at home. I think it's an acute stroke. But either way he's a DNR/DNI and the family doesn't want much major done.

We do do some bloodwork and a CT of his head. He has some irregular neuro respirations and his tongue is falling back into his throat due to his mental status. So my doc asks for anesthesia to be paged to find out how to manage the airway. The nursing super's and my jaws hit the floor!! We remind him that he is a DNR/DNI and that if he gets anesthesia involved they will want to intubate. They really don't like being invited to parties they cannot be involved in anyway. I suggest a nasal trumpet (or nasal airway) for this purpose. This will nicely get his tongue out of the way and help him maintain his airway to the best of his OWN abilities. He agrees. And then asks "can YOU put that in?" Uhhh YUP *eyeroll*!!

The floor nurses then cart the patient off to CT scan and I'm finishing my paperwork and getting ready to go back to the CCU when this doc comes up to me and is asking me tons of questions about the nasal trumpet. Basic questions too! Such as "how do you know when to use those?" "How do you put them in?" "Are they better than an oral airway?" "Do they aspirate less with them?" On and on and on. I'm getting more nervous by the minute as he is a hospitalist who is supposed to be prepared for any situation that happens in a hospital. I could understand if an OB or a dermatologist or even a regular internist who mostly sees patients in the office but occasionally sees them in the hospital doesn't know this stuff. But a hospitalist???

So, I have just two questions for you:

1. Where do they get these docs????

2. Am I asking too much?????

The other side of the bed part 2

2008-07-18T20:58:00.000-04:00

For those that were going to follow my other blog on my daughter's surgery sorry you ended up finding nothing. I attempted to post onto it while I was gone but the children's hospital that we were in had a filter on their wifi blocking "social networking" sites. So, I attempted to post onto it using google docs but it would only post onto this blog for me. Despite me changing it to post onto that one it would still only post onto this one. Grrr!!

Anyway, all went well with her. And it was actually easy to be a parent instead of the nurse!! Much easier than I thought it would be. Possibly that was because everything went so well though!! I had imagined it would be a rough few days since they were doing surgery on her throat but instead it was a breeze. The worst part was the 24 hours she was in the PICU and confined to the bed and bored!!! Boy did she want up and boy was my back sore from holding her so much!!!

I imagine if things had not gone so well it would have been much harder to stay out of the nurses' way. About the only thing I did that a "normal" parent wouldn't do was hit the silence button on the IV pump when she was asleep so that it wouldn't wake her!! I didn't think that was too much overstepping bounds though. My Mom did ask me once if I was being "nice to the nurses" and "staying out of their way"? Of course, I asked her whatever did she mean??? and she quickly reminded me of when one of my twins was in the NICU and was having a major apnea/bradycardia/desat spell and she was trying to yank me out of the room as I was screaming hysterically. But, come on, was I really going to leave then??? I think she imagined that as me getting in the way but I was far from it. I never got in the nurse's way....I just wasn't leaving my son.

Ok, back to happy times.....my daughter came through this with flying colors and is home doing great now. I'm back to being a nurse rather than patient parent which is how I like it. :) (though I'm still on medical leave until she gets cleared early next week so I'm liking that too)

The other side of the bed

2008-07-13T03:06:00.000-04:00

Unless I find some time and think of some old stories there will be nothing new here for a little while. I'm going to the other side of the bed (or should I say my daughter is) and I will be off for the next 1 1/2 weeks.

My daughter has a laryngel cleft and is going to have it repaired tomorrow (Monday, July 14). I think it is hard to be a nurse and be on the other side of the bed for any reason. Whether it is youself or any family member.

I recently experienced this with my husband as he had an AFib ablation done just prior to Christmas and then his follow up in April. And I have experienced it a ton with my daughter as she has had issues since birth and this will be her 5th hospitalization in her almost 3 years.

I have yet to decide if being a nurse makes it harder because you want to "do it all" or if it is because you just know too much. Or in the case of my daughter I know too much but too little at the same time as I have no real pedi experience. Either way, I'll be away from this blog until I come back to work. But if you want updates on her progress you can still visit me at her blog titled Jenny's Journey.

Good tidings until I'm here again.

Families

2008-07-06T07:53:00.000-04:00

It never ceases to amaze me the myraid of family types we get. It is never easy to have a loved one sick or in the hosptial. I do know this first hand as I have a chronically sick child that has been hospitalized 4 times in her almost 3 years of life.

Here is a sampling of the families we had the last shift I worked:

We had a lady who spoke little English and so her family stayed with her for much of her hospitalization. They sacrificied their own home life to help provide for her. They were quite nice to us and helped us in any way they could.

We had a man who was estranged from his family and though he had been in the hospital for over a month we have been unable to get ahold of any family to let them know what he has been through.

We had another family who saw how busy we were with the relvolving door of transfers out to get admits in and felt bad for us so brought us a "snack" which was really a pizza enough to feed us all.

Then we had a family of a man dying. And it was an unexpected death that was going to occur so they were just entering the stages of grief. His first day there everyone was nice and everything was thank you etc. Then it all changed and we could do nothing right in their eyes. It made for a miserable shift. I can understand a family member being upset with me if I've done something wrong to their loved one or made a mistake. But when I have taken care of them like I would my own family member and you are yelling at me just because you need someone to take your grief out on I just don't deal well with that. I know it's not personal but I'm not a punching bad ya know.

Our morning view

2008-07-01T03:39:00.000-04:00

There are various reasons I work the night shift most of which I won't get into now but I did want to share this reason. I brought my camera to work a few nights in a row as we marvel at the sunrise each morning. For years I have said that I want to get a picture of it so finally I did. Of course, pictures just don't do it justice but here is our view each morning. I took it a couple of different mornings as it looks so different each day. We overlook a river from my side of the hospital and it is just so pretty each morning. These are taken through the window of a patient room.

The river looks pretty neat with all the lights shining off it each night too. A coworker and I went to the top level of the parking garage and took this:

Like I said, the pictures just don't do it justice but seeing the sun rise each morning that I'm here is a pretty cool thing!!

Change of shift

2008-06-27T04:16:00.000-04:00

I'm in my first change of shift!!! I wanted to thank Braden for inviting me to participate and for using my story.

When I first started blogging I had no idea that it was such a social network. In the few months that I have been blogging I have had a great time reading other's blogs and getting a sense of what it is like out there for other nurses. I have also enjoyed writing down some of my cherished memories and also getting some stress off my chest!! It has been good for me. I'm looking forward to continuing on and I want to thank everyone that has read my blog and especially to those that have commented to me.

Check out the latest edition of change of shift here. And be sure to click on my story!!

I also wanted to welcome Kaitlyn (AKA Katie) from this post on my blog to the blogging world. She did a beautiful first post on how she feels about the start of her career and I'm so glad she took my advice and started a blog of her own. I only wish I had started one at the beginning of my career so that I would have all the memories that she will end up with written down.

So, WELCOME Kaitlyn!!

My tax dollars hard at work

2008-06-20T02:51:00.000-04:00

Tonight I took care of this patient who has been in my hospital since April 9th. He originally came in with a medication reaction and was intubated. He was trached and then de-trached. His kidneys failed at some point so he is on dialysis now. He was in ICU for quite awhile and then transferred out to a regular medical floor. Complains of chest pain for a few days and then has some questionable EKG changes so buys himself a bed in the CCU. Has a negative MIBI stress so I transfer him back to the medical floor.

Are you wondering where my tax dollars come into play?

He is an illegal alien from a S. American country. So, he doesn't work and has no insurance. No outpatient dialysis center will take him due to no insurance so he has to remain hospitalized. Apparently we cannot discharge a patient who has no outpatient dialysis set up. So instead he drains tax money by being hospitalized for 2 1/2 months only so he can have dialysis 3x a week.

I have no issues with someone not having insurance. I recently took care of another young man in his 30's who underwent 2 angioplasties in about a week's time (long story involving med noncompliance) who had no insurance. He also racked up a big bill but at least he works. He talked with a social worker and is applying for state insurance etc and will work out a payment plan with the hospital. He'll be paying for a long time but at least he'll pay.

We will see nothing, not one penny from this guy. I also have no problem with the fact that he got some medical care. Sure, we are the melting pot etc but he's getting care at tax payer expense (and his bill must be in the millions at this point) when other American citizens are scared to come to the doctor at all due to the cost of their copays. It's a sad situation that our healthcare system is in.

Oh and the other thing I wonder about.............why did we only stress test him and not just do a cardiac cath. I mean come on....aren't stress tests more inaccurate than caths? We already have the million dollar work up so why not just do it right??????

And for those of you that are shaking your heads at me right now thinking I'm horrible to be saying all this I have something for you to think about. If you or I moved to his S. American country and lived there illegally and didn't work or worked under the table and got this sick............would that country take care of us like we have taken care of this man? I seriously doubt it.

WWJD?

2008-06-18T11:35:00.001-04:00

Do you ever get those patients or families that just won't leave you or your unit alone after they go? We had one recently. I'm all for patients & families telling us that we did a good job and saying thanks.......heck it makes me feel good when MY name specifically is on the card.

We had this patient recently that I'll call Harry. He originally came in with cellulitis of his leg. But being obese, diabetic and waiting a few too many days to come in didn't fare well for him. Within 2-3 days of admission he was in full blown septic shock.....intubated and on 3 pressors. It was touch and go for at least a week with him.

He had a lovely wife we initially thought, though somewhat strange. Then we found out why. She is a born again Christian. Now, don't anyone take offense here. I'm a practicing Episcopal and go to church as often as my working schedule allows. My kids just finished another year of Sunday School. We say our prayers, repent, fast at Lent, and recite the Nicene Creed. We are a God loving family. I have even been known to share scripture on friend's caringbridge sites that are for their chronically sick children.

Now that we've gotten that straight let's get back to Harry's wife. She would stay at his bedside all day which was wonderful for him. But then she would go home and immediately call and ask us to pray WITH her for him. Instead we would put the phone up to his ear and she seriously would pray for hours (2-3) over the phone to him from home. We went about our nursing duties while she did this.

Long story short.......after many antibiotics and a trach Harry pulled through and got to go home. I AM sure that the prayer had some role in it. However, now she calls on a weekly basis to talk to her favorite nurses. She weekly sends her favorite nurses and docs prayer books etc. She just cannot shove Jesus far enough into your face. I always thought religion was kind of like politics and that you were supposed to keep it to yourself or at least find out if the other person wants to talk about your views.

Her most recent mailing was for this Christian camp/retreat that she would like her favorite 3 to go to with her and Harry. She's even willing to pay their way if they will come and keep an eye on him while they are there!! Yikes woman, let it go!!

My daughter will be having major surgery in a little under a month. I'm just starting to wonder what I should do for the nurses to thank them. Hmmmmmm..........maybe some cookies, chocolates, or just a nice thank you note with the names of the ones who took care of her. What do you guys think?

Being the good Episcopal that I am though, I will be saying a prayer for her before the surgery starts.

Bringing back memories

2008-06-18T05:52:00.000-04:00

Every year my hospital hires what they call clinical partners. They are nursing students that will be entering their senior year in their nursing program in the fall. They are hired for the summer to shadow a nurse on each unit usually for either the day or evening shift. It's a good program though we have recently gotten some interesting CP's on our unit.

This year we have Katie (name changed for privacy). She's doing great and is a real go getter. She is always asking questions and seems to want to learn. She knows about the job I'm going to be going to soon so she picks my brain often. She's good for the ego too!!!

The last shift I worked with her brought back quite a few memories for me. We had a DNR patient who had been in the hospital for a month pass away with all his family at his side. This was her first real and family grieving death and her first time seeing a dead body.

This brought me back to my first death and dead body. My first death was also a DNR thankfully. I was still on the med/surg/onco floor then and it was an older gentleman that had cancer and had been with us for a bit over a month. I had my 8 patient assignment and had started with the sickest and was making my way forward. One of my coworkers came up to me and asked if the patient in room 10 was expected to die. I hadn't been told he was so I was kinda freaked out by it all. I had been involved in a code before but this was MY patient. The code was right before change of shift and she didn't make it but I was going home so I wasn't involved in her post-mortum care at all. I distinctly remember walking into my patient's room and seeing his dead body and feeling kinda strange. Like I didn't belong there. And then with post-mortum care like I was violating him even though his spirit had already left. Over time I have gotten used to handling death and dead bodies but I remember that first one like it was yesterday.

I asked Katie as she was helping us do the PM care if it was her first dead body and she got all quiet and said it was. Welcome to the club sweetie. You have had your induction and it goes on from here.

Before PM care was even finished on this man they call an angioplasty code overhead. Being fresh and new Katie gets all excited and says she went on one the other day but it didn't turn out to be someone needing angioplasty so she didn't really get to see anything good. So, I take her to the ED in hopes this is the real thing. It was and she got to experience it from ED to cath lab to CCU. What a neat experience for her.

Again, this brings back memories, mostly from nursing school of getting to do the "whole" process in patient care. Seeing beginning to end and being satisfied that the patient got the care they needed. Kind of a cool experince and one that we more seasoned nurses don't get to experience anymore.

The lovely call light system we have

2008-06-17T02:06:00.000-04:00

Our call light system is horrible. They have been telling us for years that we will be getting a new one. Even had several vendors in for us to help pick a new one. But here we are still stuck with this stinking executone.

Almost every shift I work it goes off for service. And when I say it goes off I mean it beeps incessantly. Did I say incessantly? INCESSANTLY. We beep engineering and they say they are working on it and an hour later guess what......................IT'S STILL BEEPING. AHHHHHHHH.

I have little tolerance for noises (surprising that I would work in a critical care unit with monitors huh!!) and tonite we were very busy and sure enough beep, Beep, BEep, BEEp, BEEP goes the executone.

I THINK I MAY GO HOMICIDAL SOON..................or at the very least to the insane asylum.

Code what????

2008-06-16T09:55:00.000-04:00

I was perusing some other nursing blogs late last night as I couldn't sleep (ahh the joys of working nights and trying to have a normal family life on your nights off) and ran into this post by Braden over at 20 out of 10 regarding all the types of code calls they have there. Laughing hysterically I thought to myself "hey, self, we have the same thing!!" Though my hospital has gotten away from calling them all code this and code that. We now just have initials called overhead too.

Here are a sampling of the ones we have:

Code 8 (the regular code blue in most places but like Braden said named after a number so as not to scare the patients)

Code Mr. Green (severely agitated patient or visitor)

Code PCI (primary angioplasty)

Code Adam (lost or kidnapped pedi patient)

Code Orange (I think this is a bomb threat)

Code 123 Red (fire)

I think that's it for the actual "codes". Now to move on to the initials:

MET called overheard along with the floor and room # means medical emergency team or rapid response team in some places

BAT called again along with the floor means the acute stroke team

Ok I think that's it on the alpha-numeric soup!!

Updated:

I checked the back of my badge after I got to work and not surprisingly I got a few of these wrong!! The bomb threat is actually a Code Grey. And I skipped one: Code 911 (nope not the one where a patient is actually coding!!) which is an external disaster during which the phone tree should be activated to get as much staff as possible in the building. This would be something like a major accident or chemical spill involving mass casualties etc.

Paperwork

2008-06-12T04:06:00.000-04:00

I would love my job if it weren't for paperwork. Need I say more nurses???

Due to the litigious nature of our society we are always creating new paperwork. In fact, there is so much paperwork that says that you took care of the patient thoroughly that you hardly have time to actually take care of the patient. And one form is never enough either. We must have multiple forms to say the same thing over and over again. The hospital admin says that they are doing their best to eliminate double charting but then the next email from them is the introduction to....................you guessed it..............another new form.

So here it is 4am and as usual I'm just now getting to my paperwork. (Though I guess really I'm here blogging to avoid doing it for a few more minutes!!) All the while chanting silently to myself "I love my job, I love my job, I love my job......................." and feeling like this (just insert scrubs instead of the tie):

One complication after another

2008-06-06T04:30:00.000-04:00

Remember the guy from two posts ago that was the "happy" guy from a sad one and a happy one? Well, things didn't go so well for him after that. He remained NSR but that's about all that went well for him.

The next morning he got up to go to the BR for a BM (I've come to hate BM's ya know!!) and passed out with bradycardia to asystole. After a minute of CPR he came back to and said he had quite the good feeling like an endorphin release. Luckily I was at home sleeping to miss all of it!!

Needless to say, this earned him a pacemaker once we had corrected his INR. So, I come in after 2 days off expecting to not see him there. Not only is he still here now with a pacer, but in the cath lab during the pacer insertion they nicked his lung and his post-pacer CXR showed a moderate to large pneumothorax..........uggh. What next?!?

I'll tell ya what. Being allergic to PCN they Rx'd vancomycin as his pacer antibiotic. Not long after his dose I go into his room to check on him (and he and his SO are so nice that I had been in and out practically all evening anyway) and he's red from the clavicles up..............WTF is going on now I ask myself. Could this actually be Red Man Syndrome? I have read about it but had never actually seen it. But then again, I tell myself, he's had practically every other complication.......RAFl, pauses, then intractable RAFl again, does ok with the TEE and cardioversion but then has asystole so what more could go right for this poor guy!!!!

So was it Red Man Syndrome? We aren't fully sure as no doc laid their beady eyes on him (one of the joys of a community hospital) but it certainly fit the symptoms of a mild case of it.

Oh and want to hear something funny..........I'm going to teach sex education with him to his 7th & 8th grade science class!!!! Yup, you read that right!! He teaches science to middle schoolers and his school nurse doesn't feel comfortable helping with the girls (WHAT???) so right now he teaches it co-ed but we've gotten along so well that he asked me if I'd be comfortable teaching it with him. Hey, why not. I'm always up for an adventure. How bad could it be???

Some nursing humor

2008-06-05T01:19:00.000-04:00

I thought it was time for some humor so here goes...........

Letterman's Top 10 for reasons to become a nurse:

1) Pays better then fast food, though the hours aren't as good.
2) Fashionable shoes and sexy white uniforms.
3) Needles: "Tis better to give than receive"
4) Reassure your patients that all bleeding stops...eventually.
5) Expose yourself to rare, exciting and new diseases.
6) Interesting aromas.
7) Courteous and infallible doctors who always leave clear orders in perfectly legible handwriting.
8) Do enough charting to navigate around the world.
9) Celebrate all the holidays with your friends- at work.
10) Take comfort that most of your patients survive no matter what you do to them.

Pharmacy joke

A nice, calm and respectable lady went into the pharmacy, walked up to the pharmacist, looked straight into his eyes, and said, "I would like to buy some cyanide."

The pharmacist asked, "Why in the world do you need cyanide?"

The lady replied, "I need it to poison my husband."

The pharmacist's eyes got big and he exclaimed, "Lord have mercy! I can't give you cyanide to kill your husband. That's against the law! I'll lose my license! They'll throw both of us in jail! All kinds of bad things will happen.

Absolutely not! You CANNOT have any cyanide!"

The lady reached into her purse and pulled out a picture of her
husband in bed with the pharmacist's wife.

The pharmacist looked at the picture and replied, "Well now, that's
different. You didn't tell me you had a prescription."

YOU KNOW YOU'RE A NURSE IF...

1) the front of your scrubs reads

"Nurses... here to save your ass, not kiss it!"

2) you occasionally park in the space with the
"physicians only" sign... and knock it over.

3) you believe some patients are alive only because

it's illegal to kill them.

4) you recognize that you can't cure stupid.

5) you own at least three pens with the names of
prescription medications on them.

6) you believe there's a special place in hell for the
inventor of the call light.

7) you believe that saying "it can't get any worse"
causes it to get worse just to show you it can.

8) you wash your hands BEFORE you go to the bathroom.

9) you believe that any job where you can drive to work
in your pajamas is a cool one.

10) you consider a tongue depressor an eating utensil.

11) eating microwave popcorn out of a clean bedpan

is perfectly natural.

12) you've been exposed to so many x-rays that you
consider it a form of birth control.

13) you've ever heard a patient with a nose ring, a brow
ring, and twelve earrings say "I'm afraid of shots."

14) you've ever placed a bet
on someone's blood alcohol level.

15) you've told a confused patient that your name is

that of a coworker and to call if they need help.

16) your bladder can expand to the size of

a winnebago's water tank.

17) you have seen more penises than

any prostitute could dream of.

18) you believe that not all patients are annoying...
some are unconscious.

19) your family and friends refuse to watch

medical sitcoms with you because you spend

the whole time correcting everyone and

pointing out upside down x-rays.

20) you don't get excited about blood,

unless it's your own.

21) you've sworn to have "do not resuscitate"

tattooed on your chest. Soon.

22) discussing dismemberment over a gourmet meal
is perfectly normal to you.

23) your idea of fine dining is anywhere

you can sit down to eat.

24) your idea of a good time is a

cardiac arrest at shift change.

25) you believe in the aerial spraying of prozac.

26) you believe that "shallow gene pool"

should be a recognized diagnosis.

27) you believe that the government should

require permits to reproduce.

28) you believe that unspeakable evils will befall anyone
who utters the phrase "Wow, it's really quiet, isn't it?

29) you have ever wanted to write a book entitled
"Suicide: getting it right the first time."

30) you have ever had a patient look you straight in the
eye and say "I have no idea how that got stuck in there."

31) you've had to leave a patient's room

before you begin to laugh uncontrollably.

A sad one and a happy one

2008-06-02T13:28:00.000-04:00

Remains orally intubated. Unresponsive to noxious stimuli. No pupillary response. No gag or cough reflux. Does not breathe over ventilator assisted respirations. No spontaneous movements.

This is how my charted started last night. The man I was writing about was 59 years old. How sad is that. A little over a week ago he went in for routine surgery and then had a small stroke (of the blood clot variety). He came to my hospital's rehab unit post-stroke and was there for a few hours before suffering a massive bleeding episode in his brain from the blood thinners they had put him on after his last stroke in hopes of preventing another one. This all happened just as his family was coming in to visit him. Needless to say unexpected and quite shocking for them.

We immediately called the organ donation center in hopes that the family would be willing to go that route due to the futility of his condition. Unfortunately they were not willing. In fact, they were so in shock they didn't speak more than a word or two to us for about the first 24 hours that he was with us. Finally today they are beginning to open up and see the reality and gravity of the situation. Code status has finally been addressed and he will not be tortured thru unnecessary attempts at bringing him back to life since he is practically brain dead already.

Such a shame at 59. :(

Now, to end on a happy note.........my other patient was such a nice guy. 55 and in a rapid heart rhythm called atrial flutter. His heart rate was 140-150's all weekend despite numerous attempts to control it. Everytime we tried we ended up with either long pauses in his heart rate or dropping blood pressure. Neither one a good thing!!

Today I was supposed to go home at my usual time of 7:15 am and after having him for 3 nights in a row wouldn't have known how he made out unless I called for an update (which I rarely do). But thanks to 2 call outs I stayed until 11:15 (whoo hooo to 4 hours of time and a half!!!!) so I got to be there for half his day.

Today his day included a TEE (an internal heart ultrasound) and then a DC cardioversion (heart shock back into the right rhythm and rate). His dayshift nurse (who also had had him all weekend) and I were nervously excited when he was wheeled back onto the floor to see what his rate & rhythm were...................YES NSR in the 80's. I think we both jumped for joy!!! What a nice outcome for this man. Hopefully he'll stay NSR now and this will be it for awhile for him. Home on a new med or two and that will be that. With A flutter though I doubt it will be the last time we'll see him unfortunately. Here's hoping though!!!!

Atrial flutter rhythm picture

The one who "got" to me

2008-06-02T01:59:00.000-04:00

They say that in your career you'll have at least one patient who "gets" to you. One who you become quite close to and that you never forget. That happened to me early in my career. He was this young Chinese man in his early 30's. He had chronic lymphacytic leukemia (CLL).

In the beginning looking at him you'd never even know he was sick. He came into the hospital almost monthly back when I worked on the med/surg/oncology floor. Somehow I seemed to always be assigned to him so we built quite the rapport. His wife worked an odd shift and got off around 1am and would come to see him each night after she got off so I got to know her pretty well too. What a sweet story they had....

He came to the US from China in his 20's. She was still in China when they "met" and they courted over the phone and were soon engaged. The plan was for her to move to the US and for them to be married. The day he found out about his CLL he called her and tried to break things off. She outright refused even when he told her he would probably die from this.

The doctors here told him that he had a good chance of going into remission if he would undergo a bone marrow transplant. None of the few family members he had in the US matched and the ones in China couldn't be tested. He was unwilling to take an unrelated donor specimen. The chemo unfortunately wasn't enough.

Over the months as I took care of him multiple times I watched him slowly decline. He always asked if I was working and wanted to sit and chat if I had time. I remember one night he told me that he was going to have an ultrasound in the morning as his abdomen had gotten quite hard and swollen. Trying to still have a sense of humor despite his pain and suffering he told me that "they are going to take a look at the baby in there!" As usual he had me in stitches.

One night as his disease process progressed and I didn't have him another nurse called me to his room to help her and it sounded serious. There he was in the bed having a grand mal seizure. I had such a hard time helping as it was almost like I was seeing a family member at that point. For a minute I didn't know what to do. Then the nurse in me kicked in and I was able to help my colleague with stabilizing him. Unfortunately his wife was there to witness the whole thing.

I dreaded going into work as his death became more imminent. I wasn't sure I could handle being there when he died. They talked and talked about not becoming too close to patients in nursing school for just this reason and here I was in my first year as a nurse and it was already happening. I wasn't sure I was cut out for this. I had a long talk with some of my coworkers about it all and they reassured me that you will always have at least one patient in your career that this happens with. As long as it isn't all of them then it's OK. I guess I just got mine out of the way early. This man died on the day shift and as selfish as it is I was happy that it happened then. I was completely devastated and I really don't think I could have handled being there for it. Since then I have become close with other patients but never like this.

"This is what you are meant to be doing and we will never forget you"

2008-06-01T04:42:00.000-04:00

One night I picked up a patient from a fellow nurse and figured it would be a typical shift. We'll call this patient JJ. She was in her mid 40's and otherwise fairly healthy other than being a smoker. She came in after vomiting at home and having some respiratory distress. My coworker had gotten her all settled in and told me that she was doing fairly well and that she had pneumonia. We figured she would probably end up on a ventilator at some point in the next few days due to the way she was looking (she had a pretty bad pneumonia) but not imminentely. Ok, I say, no big deal right.........we see patients with pneumonia all the time. That's where I was wrong!!!!

I go in and say hello to JJ, do my assessment and she seems fairly stable. Out of breath with minimal exertion but I expect this really. I check her oxygen, iv fluids, etc. All looks well. Go out to the nurses station to check my labs and see what time she needs meds. I'm in the middle of this when I look over and she's attempting to get out of her bed!!! Ahhhh!! I run to her room to ask her what is the matter?? She states that she needs to get up. She is now clearly in severe respiratory distress and quite confused. This is NOT GOOD!!

I stat page the resp therapist (RT) and pulmonologist. RT comes right away but it takes 3 more calls to get the doc on the phone...Grrrr! He wants to try bipap (a tight mask that goes on the face that is sometimes successfully tried before the ventilator). He also tells me that he does not want to intubate this lady as he feels she won't have a good outcome but doesn't explain why. As she's not doing well I don't take the time to try and get him to explain I just take the orders and get back into the room.

At this point 3 people are holding her down to keep her in the bed. This is sometimes typical as people in this severe of respiratory distress for some reason want to get up and walk around!! We try the bipap which she promptly rips off so we have no choice but to intubate her and put her on the ventilator. Anesthesia is called and she is heavily sedated and intubated. Finally calm.........whew!!! Able to breathe with a secure airway. Crisis averted.........or so I thought as now she is coding and has no pulse...........OMG. This is NOT what I had expected. We start CPR and someone goes to call the doc again. Everyone shows up and we work on her for about 30 mins and get her heart going again.

I call the pulmonologist to tell him what happened and he says "well I'm not too surprised and next time when I tell you I don't want to intubate someone maybe you'll listen" WTF I think? What am I supposed to do? The woman cannot breathe. Just as I'm getting over that one though he tells me that he'll call me back in 30 min and not to call him as he's going out to dinner with his wife and another couple.......ummmm ok then. Jerk. As if I don't have enough going on I have to put up with his nonsense too!!! I hang up the phone, walk back into the room and she codes again. Luckily we get her back once again.

By then we have contacted her husband to let him know what is going on and he has come in. We get her all cleaned up and have him come in. The doctor and I update him and he visits with her. How sad to see his sadness. But luckily at this point she is still alive. He then tells me they have 2 teenage sons and I am even gladder that we saved her. Now, I'm just hoping that we did a good enough job and that she will pull through it. Only time will tell as I'm off for a few nights.

I come back a few nights later and there are her husband and sons at her side. He comes and says hi to me and tells me that he needs to thank me. I ask what for and he tells me that the day shift nurse from that day told him what actually happened that night and that if I wasn't there she wouldn't have made it. You are welcome I say but that it wasn't so much "me" and that any nurse that night would have saved her and he replies with "that's not what I was told". We leave it at that and he gives me a smile and goes back to her side. I have other patients that night.

She remains on the ventilator for almost 2 weeks to get over her pneumonia and sometimes I have her and sometimes I don't. I get to know her husband off and on. He always says hello though if I'm on. She finally is extubated successfully and remembers nothing. My heart sinks and I wonder what I did wrong that night several weeks ago. Did she go without oxygen too long and does she have brain damage now? Or is this just the lingering effects of the medications we use for sedation and amnesia when patients are on vents? Of course, I'm desperately hoping for the latter.

Fast forward another week and guess what...............JJ is back to her normal self!!!! She has no memory from the weeks that she was intubated but that's just dandy as that's what we want but she remembers everything else from her life. I'm so happy to hear this when I come in. I happened to be working the night she gets transferred out of CCU to the respiratory floor. As they are wheeling her out she says to me "my husband says I'm supposed to thank you......so thank you so much for all you did for me." Your welcome I say!! Then her sons take their turns and thank me for all I did for their mom.......again I tell them it was my pleasure. Then over comes her husband who envelopes me in this huge hug. And then comes a moment I will never forget as long as I live....these were his words: "thank you so much for saving my wife. If you have ever wondered if you should have become a nurse then look over there at my sons. If it weren't for you they would be without their mother right now. This is what you are meant to be doing and we will never forget you."

Oh my gosh did it take everything I had not to cry at that point. Not that I haven't cried on the job before...I have. But that was just such a powerful moment for me. And, again, one I will never forget.

I got a new job

2008-05-30T08:26:00.000-04:00

I have worked in CCU for 7 1/2 years now. I have finally decided it is time for a change. From time to time over those 7 1/2 years gotten restless and looked at the job postings and even considered and applied to go to labor & delivery but didn't get the job. But this time it was for real.

Part of what made me know I was ready for something new was my comfort level in CCU. When I first started there I used to drive into work wondering who I was working with. Hoping that certain people would be on with me knowing that if they weren't there it could be bad......real bad. This was because I couldn't handle just anything that came through those doors. I could handle the basics. My patient would tell me he was having chest pain......ok, check to make sure his o2 is in, do an ekg, give him some morphine, turn his nitroglycerine up, etc....I had my check list to run through. Situation handled. Someone's BP was in the 70's.......either turn the drip causing it down/off or give a bolus of IVF or start a pressor, etc. Situation handled. Someone went into flash pulmonary edema........oh crap this was a REAL crisis!! Or someone went into severe resp distress, or was in cardiogenic shock, etc. Those were things I was unprepared to handle.

But give me 7 1/2 years under my belt and for the last several I could care less who I was working with except for the friendships that were there for the shift. I could also care less what came through the doors, in fact the sicker the better in my opinion. I always volunteer to take care of the sickest patients in the unit. The best shifts are ones that involve some sort of crisis situation. Don't get me wrong, I do feel bad for the person involved and I do my absolute best to give them the best but I live for the intensity of it. I've moved from being a scared green CCU nurse to being in charge about 50% of the time that I work. People actually look up to ME!! Never thought when I came to CCU that would happen!! It's a good feeling though.

About 18 months ago our hospital started a MET. It stands for medical emergency team. It is a team made up of an ICU or CCU nurse and a respiratory therapist that respond to the inpatient floors when a nurse from there calls for an acute change in their patient's condition. It's purpose is to prevent inpatient deaths. I really like being a part of this team and teaching novice nurses to critically think etc.

But all along we have complained to management that the problem with the team is that it takes us away from our own critically ill patients. When a MET call goes out I have to leave my 1-3 critical patients anywhere from 20-60 mins to evaluate this other patient and give my recommendations on how to handle the situation. Sometimes these patients are able to have some treatment and stay there and sometimes they are moved to the ICU or CCU. The entire time the team has been in existence we have asked for a nurse to be dedicated to this position.

Finally...............they listened!!! And created a position called a resource nurse. It is only on the off shift so I will stay the same hours 7pm-7am and still 3 days a week. But since there isn't a MET called every night there will be other responsibilities too. I will also respond to all code 8's in the hospital (our call for an inpatient death) and all BAT's which is our brain attack team or acute stroke to evaluate whether a patient having an acute stroke can receive the clot buster drug to lessen the severity of the stroke. Then in my downtime I will be rounding on the inpatient units and helping to "put out fires" and trying basically to prevent bad outcomes for patients. Nurses can call me if they are unsure of a situation or procedure etc.

I'm sure there will be some grunt work involved and some aspects I won't like but all in all I'm excited and looking forward to it!! It's a great change. I love bedside nursing but at the same time there is a lot of bedside nursing that I'm sick of and won't miss. Doing this I'll still be doing bedside nursing but not to the degree that I do it now. I'll be starting in mid-July.

Why I became a nurse

2008-05-23T02:22:00.000-04:00

I didn't always want to be a nurse. In fact, when I was younger I had wanted to be a veterinarian. From the time I was a kid until I worked for my first vet I knew that's what I'd be. But then it just wasn't for me. (That's another story though!!) While I was in college trying to figure out what I wanted to be I got a job at a hospital as a phlebotomist (drawing blood). I worked early each morning and then went to school. It was a nice little routine and I liked the job. It was a technical job that you were either good at or not. I, thankfully, happened to be good at it.

A few months after I started I met Kenneth. He was in his late 60's and had already burried 2 of his sons. He had a lovely wife but was in ill health with a bad heart and bad lungs. He was deeply depressed about his sons' deaths and his health status. This was just one of many hospitalizations for him. I went in one morning to draw his blood and we started chatting. I could tell that he was a sad fellow but did my best to cheer him up. I then told him I'd see him the next morning. He resonded with "You were so nice to talk so much with me. If I make it out of here I'd like to give you a hug before I go home." So I told him that it wouldn't be an IF but a WHEN.

That night he took a turn for the worse and was transferred to the ICU. I didn't find out until I got to work that morning at 5am and went to get my bloodwork slips for my floors. I took the 500 hall and looked for his name but it wasn't there. My fellow phleb told me that Kenneth was in his pile in the ICU. We quickly switched around the assignments so that I could draw the ICU.

When I got to Kenneth's room in the ICU I was shocked at what I found. Kenneth, that I was just chatting with yesterday, was today sedated and on a ventilator. He had stopped breathing during the night and had had to be resiscutated. For some reason this affected me deeply and I started to cry right there in his room. He was light enough with his sedation to know that it was me who was drawing his morning labs and he too started crying when I told him that he would be getting that hug when he got off that machine and got better.

He spent a week in the ICU on the vent before being successfully extubated. In another several days he was transferred back to the 500 hall. Several days after that he was discharged home. And yes, before going home I got my hug!!

His wife thanked me profusely as apparently I was all he talked about once the breathing tube came out. He spoke of how he owed his life to me because he had given up and was ready to go and meet God until I came into his ICU room that morning and re-promised him that hug that we had talked about the day before. I became close to Kenneth and his wife after that and visited with them often. Kenneth used to call me his angel and always said that I had saved him. I always denied it and said he went overboard with it all but I knew that if I could make a difference for someone without any nursing knowledge then I could surely make a difference for lots more people with nursing knowledge. It did take me a few years and several more changes in my college major to figure this out but eventually I did get here.

As for where Kenneth is now.........honestly I'm not sure. I'm embarrased to say that too. This all happened when I lived in the south and I live in Connecticut now. I kept in touch with them for several years after I moved here but like all relationships, over time this one fizzled too. I imagine he has passed on by now with his medical history but with Kenneth you just never know. I do still think of him often though.

All about me

2008-05-22T03:39:00.000-04:00

I'm Tracey a 31 year old cardiac intensive care RN at a community hospital. I have been a nurse for 9 years now and have spent 7 1/2 of them in the CCU. Before that I worked in a medical/surgical/oncology unit. I liked the med/surg/onco but critical care was my passion. I didn't want to go there right out of nursing school as I wanted to get my feet wet before trying critical care. I'm glad I did it that way. It's not the right choice for everyone but it was for me. I have always worked the night shift. For the first about 3 years I only worked 11p-7a but then switched to 12 hour shifts 7p-7a so that I would only have to do 3 shifts a week. It works great for my family.

I'm an adreneline junky so critical care is my forte. I love the excitement of busy nights and patients that are quite sick. In fact, I would love to work somewhere that the patients are much sicker than they are here. I usually volunteer for the sickest patients in my unit. My co-workers are usually willing to comply too!!

Recently I applied for a new job called a critical care resource nurse. I have my interview Friday am. I was told that basically the position is mine and the interview is just a formality. This position involves doing all the emergencies in the building as well as rounding on the inpatient non-critical units putting out fires and keeping the patients stable or transferring them to the critical care units if they are unstable. Again..........just my forte!!!

I created this blog to write about the stresses involved in being a nurse, especially a critical care one. Though I am an adreneline junky it is a stressful job at times. Especially dealing with difficult patients, difficult families, confused patients, combative patients and worst of all patient deaths. I have sat with numerous patients while they died whose family wasn't there. Each one takes a small piece of my heart no matter if I'd known and cared for them for 5 minutes or 5 weeks. Death is a fact of life but not an easy one to deal with.

If you are interested in reading such stories then come along for my journey. You'll hear amazing stories along with sad ones, happy ones, and everything in between.