Thursday, December 25, 2008
Wednesday, December 24, 2008
Monday, December 22, 2008
Saturday, December 20, 2008
I realize that since I’m new I have a bit (fine, a whole hell of a lot) of work to do to improve my organizational skills but being placed in the drunk tank almost every shift with virtually no equipment doesn’t help to improve organization – especially when I’m running around the department trying to find a freaking IV pole or a vital sign machine. Terrible.
I just got an email saying that she needs to keep a closer eye on me so she’s putting me in the psych/drunk tank area for the next several shifts. Hopefully I’ll have some fun stuff to post about but in the meantime, I’m going to relish my last several hours of freedom before being placed in my most hated area for the next 3 nights. Hopefully the massive snow storm and -20 windchills will keep people indoors and away from my area!
Sunday, December 14, 2008
Wake up thoroughly refreshed and run for 45 minutes. Take a shower, get dressed, have my hair arrange itself perfectly and merrily walk to the train station. When I get to work, I’d give the Starbucks guy a winning smile while ordering my latte and perhaps flirt a little (he’s cute!). When I get to the ER, I receive a perfect report that only includes what the patient came in with, the plan for the patient and what I have to do. I complete my assessments and interventions flawlessly while amiably chatting with fellow coworkers. I receive patients who are pleasant and don’t ask for narcs every 10 minutes. The docs write sane orders in legible handwriting and understand if there are delays from the lab. At the end of the day, I merrily go back to the train station after meeting up with friends for a treat before going home. When I get home, I’d shower, eat a delicious yet nutritious dinner and then crawl into bed and sleep a peaceful and restorative sleep.
Unfortunately my real day goes something like this:
I wake up 30 minutes late and first words out of my mouth are ‘OH CRAP I’M GONNA BE LATE AGAIN!’ I blindly find my way to the bathroom and stub my toe unleashing another deluge of profanities and then get dressed. I run like a madwoman to the train station and barely make it on only to face the glares of the commuters who made it on time. I catch a glimpse of myself and look something like this but am too drowsy to care. I glower at the coffee guy when he gives me a large instead of an x-large and wish a pox on his house. I stumble my way inside to be assaulted with a needlessly boring and drawn out report and then realize that there’s a boat-load of stuff that needs to be done. When the doc decides to be bitchy about a lab delay I utilize my proxy vernacular of passive aggression and steal his pens before passing out during my break. After wishing I chose chocolate-taster as a career I give a scathing smile to the narc addict while telling him/her that they can’t have another dose while the charge nurse brings me a patient with a chart that might as well say colostomy bag explosion. At the end of my shift I pass out on the train (probably drooling) and count-down to when my next set of days of begin. I get home, shower and furiously stuff my face before crashing and repeating the whole thing again the next day!
Clearly my ideal and real days are lacking some congruency but for the most part, my real days don’t have quite such an acerbic flavour as the one I’ve described above! What’s your version of an ideal day? What’s your real day like? Share please!
Monday, December 8, 2008
Tuesday, December 2, 2008
The other night I got a set of admission orders that included a dose of IV Cipro. I fax the orders down to the pharmacy and get a requisition ready to order it from central dispatch (drugs that are not stocked on the unit are sent to us by central dispatch during night shifts so a form has to be faxed to them – they deliver whatever is needed in 5-10 minutes). I get everything ready and start walking towards the fax machine when another nurse walks over with the bag, hangs it up and tells me that there’s a ‘secret stash’ of Cipro in the back rooms. Great. But how the hell was I supposed to know about secret stashes? I got irritated because I just wasted my time filling out the damn forms when I could have resited her IV and saving me a hell of a lot of time.
Yet another nurse that was preceptoring me has a thing against ‘fussy’ old people who ask for things when she’s busy planning her upcoming wedding. I’m mighty pissed at myself for giving into her way of working when I really should have had the balls to stand up for myself and the patient. This nurse had me convinced that since the patient was 99 years old and had a history of bone mets, she was not able to walk and she could not get hot water for tea (even though we were sitting on our asses doing nothing). She told me that if I tried to make her walk and she fell it would be my problem when our manager finds out about it. Fair enough. Except I never gave the patient a chance to explain herself and she ended up sobbing in her bed. I was aghast at myself for having made an elderly lady feel this way. I know that the ER is a busy and fast paced environment but I sure as hell would not want to be treated like a crazy piece of crap by a kid with 3 months of nursing experience when I’m elderly.
Since I can speak two other languages (besides English), some of the docs also ask me to translate for them. When this happens during a time when I’m really busy, I tell them to hold off for a little while unless it’s an emergency involving the ABCs (yes the nursing school basics), In that case, I quickly tell the patient what’s going on and when I can return. I know that I can’t be abandoning my own patients to run away and translate but that’s what we have float nurses for. When a situation like this came up, another nurse got pissed at me for taking too long translating! She told me that I should have told the doctor to hurry up with his assessment. Again in some cases that’s fair. But this was an exceptional case because the patient that I was translating for was a suicidal refugee who lost his wife and daughter in a bombing. That requires some diplomacy, tact and sensitivity – it most certainly is NOT the time to tell the doc to hurry up because I have to go triple chart on some mundane intervention. When I tried to explain this to her, she just mumbled something along the lines of ‘you weren’t hired as a translator’.
On top of this, I feel like a glorified babysitter when I have to deal with belligerent and violent drunks that constantly come in every Thursday, Friday and Saturday nights. I’m so sick of calling security to wrestle them down so I can put in yet ANOTHER line into them, hydrate them, give them a sandwich and kick them out in the morning just to have them come back the next week. During my last night shift, I was particularly infuriated with my entire patient load because you guessed it – they were all bloody drunks. I don’t feel like I’ve gone to school for 6 years just to babysit violent 300 lb men with drinking problems with ensuing incontinence and send them away with a smile and a breakfast at the end of my shift.
Not surprisingly, I feel the happiest at the end of my set of shifts because I know it’s the longest time before I have to come back into work. Likewise I feel the most depressed the night before my next set of shifts starts. The honeymoon is most definitely over. Work sucks something mighty fierce.
Saturday, November 29, 2008
Friday, November 14, 2008
Eventually he gets brought in and placed in the psych room. I also go back to observation but when I walk by the psych room he stops me and asks me for a pen. I saw him writing furiously so I figured why not and gave him my cruddy pen. About 20 minutes later, I walk by the room and I see his face covered in pen marks and he managed to wrap his head with medical tape! I asked the security guard about where he got the tape from and he told me that Princess Di was crawling around on the floor writing in “pregnancy pain” when he found a roll of tape under a chair and proceeded to tape his head! I wish I could have violated patient confidentiality and taken a picture because I’ve never seen anything quite so bizarre! The wrapping looked like a mummy’s bandages! Several minutes later Princess Di has to go to the bathroom. The security guard obliges and waits outside the door. When it was taking too long, the guard went into the bathroom and found him seran wrapping his chest and abdomen. I snuck away once again from observation just to be a part of the show! The on-call doc walks by, stops dead in his tracks and says, “Diana, I just saw you yesterday! What the hell is your problem now? You better not say you’re pregnant again!” Princess Di looks sheepishly at him and tell him that he wrapped himself for the x-ray so the baby will be protected. Oh good lord this man was insane (probably literally)! The doc just grabs the chart out of the nursing station, discharges him and tells him to get out! Princess Di threatens to report the shabby care he received to M15 and the Queen of England because she is his “mother”. Riiiight.
About an hour later, he walks into the waiting room and towards the triage desk again but this time the triage nurse tells him that the ER is closed – there’s too many people! He gets confused and bewildered and stumbles out of there. He didn’t come back for the rest of my shift but I’ve been told to keep an eye out for him because he’s almost frequent flyer number 1!
Thursday, November 13, 2008
Doc: Okay dear just relax and think of pleasant thoughts.
Pt: Man I’m thinking I look like Halle Barry! Life is gooooood!
Doc: What’s a halle berry?
Pt: DAYUM doc you one OLD DOOD!
Me and 2 other nurses: Giggle snort chuckle!
Doc: Just push in the stupid fentanyl!
Me: Sure thing – giggle snort chuckle!
Doc: Glares at everyone in the room
Monday, November 10, 2008
States symptoms started yesterday and generally experiences similar symptoms with onset of cold weather which resolve in several days.
Productive cough with yellow sputum.
No pain on inspiration.
Lungs clear bilaterally.
COLD!!!! WTF people??? You wake up and think "hmm... sunday morning, now is a good time to go to the neighbourhood ER?? GET A LIFE!!!
Thursday, November 6, 2008
So I try to pull myself up by my bootstraps and head over to the fast track area (seems to be where I’m usually placed). I have 8 patients and a very worried day shift nurse waiting for me. Report sounds something like this;
‘Curtain 1 is a 33 year old guy came in with coffee ground vomiting. He’s got 2 boluses of fluid and needs a pantoloc infusion started along with another PIV. He’s due for another CBC in two hours and he’s waiting for a GI consult. Keep a close eye on him. Curtain 2 is HIV/HIT positive and came in for query pneumonia. Her sats are now in the low 80s. She’s gonna need help and lots of it. Oh she’s also isolation for ESBL precautions. Watch out – she’s kind of a bitch and may try to hit you or rip of your mask. Curtain 3 is a homeless lady, EtOH abuse, left elbow cellulitis and waiting for an ortho consult to rule out septic arthritis. Her morphine tolerance can rival that of a large baby elephant so keep on signing out as much as you need but keep an eye out for respiratory depression but you knew that hahaha! Curtain 4 is another homeless EtOH abuser and is VERY tremulous. He needs hourly IV diazepam. He’s to be discharged when he stops shaking. Curtain 5 is a lol who’s waiting for a bed in medicine. The resident wrote a shit load of orders for her. My advice would be to start her cipro, ancef and avelox and let the floor worry about everything else. Keep an eye out on her I&Os cuz the resident is really anal about it. Jerk. Curtain 6 is a perforated appendicitis but GI can’t take her right now because they’ve got 3 urgent cases lined up ahead of her. She’s got admission orders so start her antibiotics quickly. Oh and she’ll probably be spiking a fever soon. Do hourly vitals on her cuz she just doesn’t look right. Good luck hon – make sure you ask for help. Good night’.
When that report was finished I wanted to hide in the bathroom and cry. Turns out that between patient transfers to the floor, I went to the bathroom and experienced what could be my first ever panic attack. I was definitely tachy, diaphoretic and vomited. Had I been older, I would have thought I was having an MI. Not a good patient load to start of with when I'm still a newbie. I don’t know how I managed to survive that night – all I remember is that my priority was sticking on high flow oxygen to bitchy HIV lady, getting pantoloc to coffee grounds guy, antibiotics for old lady and perforated api woman while begging admitting to find beds for the ones who were waiting. When I finally got a bed for my perforated api lady, I realized that I forgot to give her Tylenol for her fever. Since Tylenol was not in her admission orders, the medical directive becomes void on the floor. The floor nurse made sure she bitched at me. Funny thing is that I had Tylenol in my pocket and was willing to sign on the chart for it but she wouldn’t let me. Her problem.
Not that I want a night like that again, but looking back on it I got a month’s worth of learning in 12 hours. Sure I needed a stiff drink after that but since it was morning time when I was finished I just crawled up in my bed and tried to forget that any of the night actually happened. My boss is telling me that she wants to test run another independent shift in a few days so I suppose I better I get my butt into gear and get ready. I don’t wanna!
Monday, November 3, 2008
“Your mom sucks cock”
“Your mom sucked my cock you faggot” (to security guard)
“I’ll light your dick/vagina on fire bitch” (that one is actually pretty good no?)
“Jesus is dead bitches – I killed his ass” (no comment)
“I feel like shit assface” (after throwing up three times)
I’m always surrounded by classy gentlemen. This guy was screaming like a maniac on the top of his lungs AFTER 10 ml of Haldol. It took six big burly security guards to restrain him and even then he almost turned over the stretcher. Being forced to listen to that jackass made me realize how glad I was to be working with nice, normal non-psychotic women with pregnancy concerns.
Sunday, November 2, 2008
Now to put the anger into perspective – prior to receiving trauma-man, I got a patient with query hip fracture and ++ nausea complete with her insanely bitchy daughter in tow. The daughter hovered around the nursing station like a vulture ready to descend down on her pray and hack them mercilessly with mind-numbingly idiotic demands. Such demands included, “my mother should be allowed to eat” (before an unnecessary abdominal CT? get a life), “take her to the bathroom right now” (I don’t get paid enough to be your personal bitch) and last but certainly not least, “these sheets are much too rough for her skin so go get her something softer” (Do I look like the manger of the fucking Hilton? Go fuck yourself and then head over to a department store if you’re that concerned).
During her concerted efforts of putting the retard back into retarded, we got a call from EMS saying they were bringing trauma-man to us with an ETA of 5 minutes. Naturally, we all rush into the trauma room and get it prepped. I was getting the IV pumps and the cold lactated ringers prepped when I spotted the vulture. I ignored her and along with the trauma team ran over to the EMS crew to get report and start documenting like my life depended on it. When I was back in the trauma room and drawing up atropine (which has a half life of about nothing), this fuck-tard of a woman BARGES in and demands that either myself or my preceptor take her mother to the bathroom RIGHT NOW! This was the moment that I lost it at this woman. I was blinded by a ball of white fury so I don’t remember much but apparently I screamed at her and told her to get out and stay out if she doesn’t want to be thrown out by security. She walked away in a huff and then threatened to sue me.
You know what I have to say to you lady? FUCK YOU! How far up your ass is your head stuck that you can’t understand that a guy suddenly lacking vital signs with 50 people hanging every single drug known to mankind is less important than your mother’s voiding needs, who by the way is perfectly capable of walking! You asked for Vaseline earlier? I’ll get you a boat load of Vaseline and try to pry your head out of that entitled ass of yours. And then give it a swift kick for the good of the country. Your parents have failed as human beings by not putting you in a reed basket in the middle of a Florida swamp filled with ‘gators upon your birth. If I have to be sued by you, I’d love to see your uppity ass trying to defend your mommy-dearest having to hold it in while the rest of the team tried to SAVE A LIFE.
Idiot people just grate my nerves more and more everyday.
Saturday, November 1, 2008
Nurse 1: Did you hear about those dance lessons?
Nurse 2: Yeah I did but my husband won’t go cuz he’s a crappy dancer.
Nurse 1: My husband sucks at dancing as well – the only dancing he’s good at is between the sheets and even then I have to fake the shakes.
Nurse 2: 0_o - You need a new husband.
Thursday, October 30, 2008
Tuesday, October 28, 2008
Nurse 2: What the hell? How?
Boy nurse: She tried to grope my ass when I turned to hang her antibiotics!
Nurse 2: She is demented though – maybe she was just flailing her arms and one hit you.
Boy nurse: Then why did she wink at me?
Wednesday, October 22, 2008
Yesterday morning at around 0630 (why an hour before shift end? Why?) I got assigned to a mean girl (with her mean girl posse in tow) complaining of carbon monoxide poisoning. So I dragged my mildly nauseous, severely bleary eyed self to the exam room and started my assessment. Each question I asked was met with the trademark mean girl death stare from her and her posse before she managed to spit out an answer. I started by asking her what made her think she had carbon monoxide poisoning to which she replied, “my friggin carbon monoxide detector like totally went off so like whatever”. Right. I just couldn’t resist so I asked her, “did it ever occur to you on your long drive over that maybe the detector isn’t working well?” I was met with the death stare and another “whatEVAH”. So I carried on my assessment and asked her if she was feeling lightheaded, dizzy, nauseous, short of breath, feeling better outside the building rather than within, other people in the building complaining of the same symptoms or any flu like symptoms. Did I mention that her vital signs were unremarkable and her O2 sat was 100% on RA? She denied any symptoms and then asked “what the fuck does the fucking flu have to do with carbon monoxide poisoning? Gawd, are you like a fake nurse or like a tech or something?” Normally I put on my professional face and try to be as diplomatic as possible but I just shot back with my own death stare and told her that the doctor will probably need an arterial blood sample. When she asked where she’d get the needle, I couldn’t resist and told her that normally it’s obtained from the wrist but if he can’t get the artery, he might need a sample from the groin. Her shocked look of horror made my night but unfortunately it wasn’t enough to stop her bitchy remarks. While the resident was getting the sample, I had a bag filled with ice and a requisition prepared so she didn’t have to stay a minute longer than necessary. The mean ditz then told the resident to “check over her shit cuz she asked me like the dumbest fucking questions”. Luckily for me the residents and staff docs I work with are extremely nice and understand that I’m new so he too shot her his own frighteningly effective death stare before saying, “my coworkers are among the best in the country so I don’t need to double check their work” before walking out. Turns out her carboxyhemoglobin level tested at 0.0000 which pissed her off even more but there was nothing more that we could (or wanted) to do. She dramatically told us that it would be our fault if she died before calling us retards and storming out. Another chart in the discharged pile.
Tuesday, October 21, 2008
What I wanted to say to him was, “You just got 6 mg morphine half an hour ago. You’re not getting any more from me for a while even though I’d love to see your respirations drop at this point. We’re severely short on pillows so thank your lucky stars that I rummaged all around the unit to get you one while the doc was getting pissed at me for not helping out more quickly for a conscious sedation as well as having to look after 10 other people. NO you can’t get a fresh new paper cup for each little sip of filtered and/or vitamin enhanced water you inconsiderate jerk! It’s bad for the environment and look around you – this isn’t a 5 star restaurant and I’m not your waitress here to kiss your monkey ass so you’re getting the giant pitcher with good ol’ ice water! If you keep picking at that damn IV I swear I’ll use a 16 gauge in the smallest vein you’ve got and then smack your dumb ass with the IV basket before giving you more meds!”
What I ended up saying was, “Sir, you can’t get more morphine for at least another 2 hours. Try deep breathing instead. Unfortunately we don’t have any more clean pillows on the unit. We’re an environmentally conscious hospital so we try not to create unnecessary waste. And the government does not give us enough money to buy vitamin enhanced water – we usually spend our money on equipment and medications. Please stop picking at your IV because if it comes out, we’re going to have to re-site it which as you know hurts.”
Not to be a total bitch about pain (because it hurts after all) but it’s really irritating to see people in moderate amount of pain being assholes making idiotic demands while someone in unimaginable pain thanks you profusely for everything you’re doing for them while suppressing a sob. Needless to say I wheeled him out after his discharge with a huge smile.
Saturday, October 18, 2008
ER nurses have to collect a lot of blood. Many times it’s from patients that are either acting like total douche bags or from HIV/Hep C positive patients. My unit also uses a lot of butterflies to collect blood. I have also used my fair share of butterflies because they are really easy to manoeuvre but I can never activate their safety feature with one hand. I’m of course reluctant to put my hand near a used needle to try to cover it up. I also find that sometimes I can’t draw blood fast enough even when I see flash in the chamber. On top of all that, half the time the lab sends back a report that tells me I need to draw up another set of INRs/PTs because the first sample did not yield adequate results. Patients really love me when I have to tell them that they’ll have to wait for at least another two hours and that I’ll have to poke them again. But then I discovered the passive shielding blood collection needle. I freaking LOVE this thing! I get the vein EVERYTIME, get my blood drawn super fast and don’t get back angry lab reports. The passive shielding needle is a bit harder to manoeuvre than the butterfly but once you get the hang of it, you can’t go back. Best of all, as soon as you withdraw the needle, the safety shield clicks in automatically which means I have no chance of getting a needle stick when someone flinches their arm away or decides to have a seizure in the middle of venipuncture. I’m still working on my dexterity with this, but I think I’ll be reserving the butterfly for really tiny veins and smaller people.
I realize that this post sounds like a total testimonial for the BD folks, I (unfortunately) was not paid to write this. Its just something I now love! And yes, I’m a big time nerd.
Friday, October 17, 2008
I had a lady come in complaining of pain in her butt. Literally. She said that it hurt to sit and it felt like there was a pimple there that was pushing out other tissue. Sure enough there was a giant abscess and was right in the middle of her butt. In case you're wondering what it looked like, here's a picture of an abscess on a leg. Imagine that on your bum. Ouch. I was surprised as hell when one of the docs (who knows I’m a complete newbie) asked me to assist during the I&D but nonetheless jumped at the chance to see something gory and bloody. I was not disappointed. When the doc made the first incision, I gasped at the amount of pus that started to gush out of the abscess. I think it had to be about 50 cc. I haven’t consulted literature regarding average pus volumes in abscesses but that seemed like a lot. Apparently this woman had a history of abscesses in that region. Trying to critically think about why that could be, I started talking to her and found out that she used harsh soaps and scrubbed extra hard to “get rid of the bacteria”. Poor woman – she just kept breaking down her skin and letting the bacteria get in. Moral of the story; be kind to your behind.
Thursday, October 16, 2008
Currently, I’m ‘buddy-shifting’, meaning that I’m following different nurses around trying to get the hang of things. Some of those nurses understand that I’m a new grad but I need to learn so they let me try to run things and help out when I need it. In fact, a couple of shifts ago, I was pretty much running the fast track area. I actually felt like a NURSE instead of a scrub clad monkey with opposable digits. On the other hand there are some nurses that just make me feel like crap. For example, yesterday I was working in the fast track area with a nurse who kept telling me that I’m insanely slow and that I can’t keep up with the patient load. She was right that I couldn’t keep up but I think it was partly because she kept slamming me with new patients every 10 minutes. When I worked the fast track area previously, I discharged at least 2 patients before bringing another one in so I could keep a stretcher free in case a lol (little old lady) with a query hip fracture is brought in by EMS. When I explained my reasoning to her, she just looked at me like I was a total moron and started giving me report on 4 new patients. There are some days when I get really pissed at myself because I keep forgetting the details about patients. I still feel like I’m having the hardest time remembering who is going for what test at what time. I feel like an idiot giving report while realizing I forgot about a test or a new set of orders.
Another shock to my (nursing) system was the sheer number of patients I can see in a given day. When I was consolidating on the floor, I memorized the patient list, admitting diagnoses and med times within a week. I got sick of handing out the same pills every day. In the ER, I can see up to 30 patients a day presenting with everything ranging from abscesses in the ass crack (its true) to bleeding eyes and insane joint deformities. Throw in the Friday and Saturday night Drunky McDrunkingtons (my pet name for the drunks requiring a B&B) and I’m well on my way to climbing the steep learning curve.
I really hope that I don’t screw up and get tarred and feathered out of the ER. Now that I’ve had a taste of the autonomy nurses can have, I really don’t want to go to another unit. Attaining competence, confidence and beyond is my biggest goal – I really hope I get there sooner rather than later.
Thursday, August 14, 2008
Even mundane chores like cleaning are reminding me of my nurse-self – so far I’ve found enough alcohol swabs to open my own store, medical tape, a few pieces of sterile gauze, endless amount of post-its with vital signs and room numbers, a few stolen pens (I’ve told my colleagues repeatedly – if you leave a pen near me, it will be mine), two 3 ml syringes, and a butterfly. I had no intention of taking these things home with me (except for maybe the pens) but since I’m too lazy to go back to my unit to return them, I’ll keep them as a souvenir of my time in consolidation.
On the other hand, it is getting much easier to indulge a few other loves of mine – namely reading magazines (give Bitch a chance) and baking. In fact, I’ve made an amazing carrot cake and banana bread so far. This leads to yet another point – ironically, I ate much healthier when I was working but now that I’m at home (and baking), I need to sample my creations (for umm… quality control purposes). My treadmill in the dungeon (the basement) will be paid a reluctant visit soon.
But while I’m glad that consolidation is over (working full time for free is not conducive to having a life that needs occasional bursts of consumerism), I’m scared of joining the ‘real’ world of nursing. For the past few months I’ve practiced under my teacher’s license which provided me with a palpable sense of security. Now that that security is gone, I’m shaking in my boots about having to be solely responsible for the consequences of my decisions. But the increased pay (from $0/hr to $more/hr) should help alleviate some of those anxieties!
Monday, August 4, 2008
Why didn't our pathophysiology teacher explain it like this? It would have saved me hours of reading and note making!
Saturday, August 2, 2008
When we wheeled her bed over to the station, she asked ‘why am I here?’ to which another nurse replied, ‘because you stripped and peed on another patient’. She let out a laugh while telling us that we must be confused because she would never do something like that. There you go folks. We’ve been declared confused by a confused old lady.
I got to work on time to get a detailed report so I was feeling extra confident when doctors randomly decided to walk into patients’ rooms to ask questions.
A man was transferred from the ER onto our floor and was screaming lovely things towards the transport folk and nurses like, ‘fuck off you cocksuckers’, ‘I’ll fucking kill you cocksuckers with my bare hands’, ‘don’t fucking touch me’ and ‘AHHHHHHHHHHH’.
I did what could be considered the most perfect job at starting an IV.
It was on the screaming delirious patient who pulled it out 5 minutes later.
A patient’s wife gave me the most delicious almond and cashew chocolates for washing his face, changing his damp sodden sheets and putting Vaseline in his nose so his NG tube wouldn’t irritate him so much.
Another patient who was wandering and confused ate almost all of them.
The aforementioned patient’s son-in-law was devastatingly handsome.
He was happily married and had two kids. Oh and something with national nursing regulations…
We only had two new admissions.
Both of their histories were inaccurate at best because 45 minutes later, neither one of them could remember their names.
A guy at work was playing the best hip-hop and R&B songs to keep us all going.
A patient’s mother complained that we were playing too much ‘sex music’ at the nursing station. I kid you not.
I got to leave half an hour early and had enough time to pee before commuting back home,
I missed the train home because I decided to get frozen yogurt.
Yet another example of incompetence in the work place happened just two nights ago. I had to leave my night shift early because I had to go to school for an early morning exam that didn’t count for any marks. That’s just another rant. When I woke up from my slightly extended nap, I gathered up the sheets to throw them back in the laundry when I saw another nurse wheeling supplies over to the unit to help out with the 5 o’clock train. I said good morning to her and she said the same to me. That’s when I looked into the room that BOTH of us were passing by and saw my new admission from the night lying on the floor in a puddle of blood and urine moaning in pain. My reaction was to drop the pile of sheets I was carrying and rush to this man’s help. This nurse’s response was to ignore it so completely that I thought I missed something. She just left on her merry way. Again, I’m not licensed, but finding an elderly man in a pool of blood is something to be concerned about. He was admitted for falls due to seizures so before I went to take my break, I told him to ring the call bell if he wanted to get out of bed so someone would be with him and he could avoid breaking his ass. Being a sweet old guy that he was, he decided to not cause us trouble for a mere bathroom trip so he didn’t use the bell and he was ambulating by himself. Of course he fell and ended up with a scalp lac nearly 5 inches in length and while waiting on the floor for help, he wet himself. I wish I could have stayed with him because he really was a sweet old guy but unfortunately, all I had time to do was to help him back to bed, apply pressure to his wound and call the ER doc for stitches. I shudder to think what would have happened if I wasn’t there to see him because the oblivious nurse probably would not have thought to call someone over for help.
So the lesson of this post: no matter what you do, do it properly. If you’re a nurse, please don’t leave your patients blue and bleeding. That’s atrocious practice and makes you look like an incompetent idiot. If you don’t know what to do, call for help! Please don’t let your ego get in the way of someone’s health.
Tuesday, July 29, 2008
In any case, I can’t not write a little bit about hospital life so I’ll end this rant with a little anecdote. The nurses on our floor were recently told by the manager that we are no longer allowed to call computer on wheels ‘cows’. A big boned (read morbidly obese) patient complained that the staff were making fun of her when we said, “go get the cow to bed 04B”.
People are morons.
Thursday, July 3, 2008
He has had an operation on his knee and a pressure ulcer on his foot, so walking is extremely difficult for him. Yet, he insists on walking. So what are we to do? We bring him on over to the nurses’ station in a geri-chair to keep a close eye on him. Usually he just talks to himself, but on this day, he was particularly agitated. He tore apart his pillow so he was surrounded by polyester fluff for a while and then he tried to undo his gown by any means possible, including chewing on it.
While my teacher and I were busy with other patients and transcribing doctors’ orders, David soiled himself and was trying to remove his clothes to try to clean himself up. Now, before I go any further into this story, I should mention that David is MRSA positive and he is suspected to be positive for C. diff. Naturally, we do not want him to try to clean himself up in front of everyone and then touch other surfaces with dirty hands. I should also mention that the smell around the nursing station was so pungent and palpable that it felt like a physical blow to our olfaction.
He needed to be taken back into his room as quickly as possible to prevent any further olfactory trauma. When I started to wheel him back into his room, David started to whip at the air with his gown and a flat sheet yelling, “YEE HAW” and “Giddy up horsey”. Being the professional I am, I started to laugh until my sides hurt and tears started to flow freely! Truly, it was quite funny. However, the laughter stopped when we got to his room because his mood immediately changed. He saw his neighbor’s family visiting and thought that there were intruders in his room. David started yelling incoherently and held on for dear life to the doorway frame so I couldn’t push him into his room. Slowly, but surely, patients and their families started to peek out their doors to witness the spectacle that was about to unfold.
David is a big man. He weighs at least 200 lbs and he is about 6’2. The brakes on his chair weren’t working too well. This meant that I had to hold onto the chair with all of my strength as David tried to get away. For once in my life, I was extremely happy that I am not built like a frail sprite! Nonetheless, I managed to calm him down enough that he stopped struggling – which is when I quickly wheeled him into his room. I know that’s very deceptive but at the time I thought that this was the best way to prevent him from trying to get away and to stop the other patients gawking at us. I drew the curtain around his bed and reassured him that he was in his own room and that the ‘intruders’ were in their part of the room. I learned something then – placing your hand on a patient’s chest while kneeling down to be at their eye level and saying “stop” gently usually works for a little while.
My teacher then came into the room and wheeled over a commode chair for him. Like I said, he is a big man and extremely unsteady on his feet. As a result, he was very difficult to transfer, but we managed to wheel him over to the toilet. He finished his business and but when he stood up to go wash his hands, he nearly fell over and that would have been BAD… calamitous bad. I panicked and called the emergency alarm and yelled out for anyone else to come and help me. I think the alarm and my cries for help frightened David so he took a swing at me – and got me in the stomach. That literally knocked the wind out of me. I now have an angry looking purple bruise right in the middle of my stomach. Luckily my teacher was got there to hold down his wrists and managed to get him into the chair. Not so luckily, he swung his fist again and socked her one in the jaw. Now we were both momentarily incapacitated and David tried to walk. This is where professional nursing practice falls apart. I knew that if he stood he would fall and split his head open. I got up and almost tackled him back down into his chair and tied a restraint around him, which of course infuriated him. David started to swing his fists again and despite my best intentions, he got me in the ribs this time. “David! Don’t you dare hit us! You’re hurting us”, I told him. “You guys are trying to kill me” was his emphatic response along with another attempt to punch me. ‘That’s enough of this bullshit’, I thought. I went out of the room and drew up 3 ml of Haldol while my teacher called a code white. I knew that it was a prn med for him, but I wasn’t sure of the dosage. Nonetheless, I stuck that needle in good. Coincidently, that was the first time I’ve ever given an IM injection. What a way to start! A third nurse and two security guards finally arrived to help us get him dressed and back into his chair. 3 ml of Haldol and he still didn’t calm down for 20 minutes! When we finally managed to wheel him back to the nursing station, he was sleeping every so gently. He actually looked quite sweet.
Despite getting a good story out of this incident, I don’t think we handled it well at all. Here was a man who has dementia and felt extremely threatened by strangers descending down on him so he tried to defend himself. We became equally defensive and our response was to chemically restrain him and then call more strangers down to help us out. When I rechecked his MAR, his Haldol dosage was only 1 ml – I gave him three times the ordered dose. Of course we had to fill out an incident report, but I did not feel particularly proud at the thought of having to explain this to his family. Hopefully, the next time I see David, he’ll be feeling a lot better and I won’t have to be a part of a code white. For now though I will be nursing my own bruises.
Wednesday, July 2, 2008
I get to the hospital and my first stop is the friendly Tim’s, where the server has my order prepared as soon as he sees me – large black with two creams and two splendas on the side. The urge to get a honey cruller at times is quite strong but I have to begrudgingly walk away. The thought of seeing myself as a patient scares me! I’d much rather be the one who starts the IVs, not receives them.
Make my way up five flights of stairs (again, refer to comments about not wanting to be a patient) and get report from the day shift. At this time, I’m usually praying to any deity that comes to mind to give me a set of patients that won’t ring the call bell.
1930 – 2200
After getting report, I make my around the rooms introducing myself and doing initial assessments. I’m finding that lately I’ve been doing more mental status assessments than before. One patient told me to “fetch some tiger shrimps waitress”. He was on strict orders to not eat anything for 12 hours to prepare him for tests. When I told him this, he looked at me with puppy dog eyes and asked me, “why can’t I get some goddamned tiger shrimps?” I have to restrain myself from asking non-patients questions like, “Are you in any pain?”, “Did you have a bowel movement today?” and “Can I take a look at your feet?”
Oh but wait, what’s this? “Maha”, my preceptor calls out. “New order for Mr. K. We’re giving a unit of blood stat. Get the paperwork ready and lets take a trip down to the blood bank”. So I rush through my assessments, run down to the blood bank, get a new unit of blood, run back up, take baseline vitals and start to hang the blood. That is until my preceptor gently, but firmly reminds me that I need the Y-type tubing a 500 ml bag of normal saline. D’Oh! Off I go to the clean room, get tubing and saline, start to do baseline vitals but remember that they’re already done and hang up the new unit. Since I have to check this patient’s vital signs q5mins, I run out of the room to prepare a heparin injection for the patient next door. Back to do vitals – looking good! Run out for another 5 minutes, give the heparin injection, sign the sheet and run back to do more vitals. Now I have 15 minutes until the next set of vitals. ‘Great!’ I think. ‘Just enough time to get two sets of meds done!’ Finally, his transfusion is finished and he looks a lot better. Goody goody gum drops, I can sit now!
Documenting time – lots and lots of documenting. When I first started, I thought, ‘this isn’t too bad – 10 minutes and I’m done’. What a chump I’ve been. When I first started, I only documented 2 people’s vital signs. Going through all of the assessments for 10 patients gets very tedious, very quickly. Truly, it becomes a struggle to not check email, facebook or another equally insidious site.
What’s this? Peace? Quiet? Calmness throughout the ward? Can’t be. I’m nervous. Better do the first set of rounds to make sure patients are still in bed and alive. This sounds morbid and it is. I hate standing over patients, watching them breathe a full cycle with a flashlight pointed at them. First set of rounds go great, and since (for once), I’ve finished my documenting, I can get started on other jobs. We all start checking various machines to make sure they are working, medication carts are restocked, narcotic counts are done and new narcotic records for the next day are made.
Its first break, which means that I can now sleep, while the second break staff takes over the patient load. I would have preferred second break (from 0330-0530) because when I wake up, there is only 2 more hours to go! But I’ll take what I can get.
I feel groggy and slightly nauseous from having slept so little and needing so much more sleep. Nevertheless, I grab some fruit and start another round. This time I find a man trying to climb his bedside curtain. “Sir, what in God’s name are you doing?” He looks rather like a feral animal on the hunt hanging from his curtain while I point the flashlight at him. “Get back into bed!” He obliges and I thank my lucky stars that he didn’t pursue the matter further. When I come back to check up on him, I find him sitting up in his bed, shaving himself. In the dark. With a piece of paper. I thought I was on a cardiology floor, not a psych floor. My eyes are on fire so I go back to the nursing station to sit and pray that no one uses the call bell.
The guy who got a blood transfusion is not breathing well. I can hear coarse crackles from the doorway to his bed. Not good. My first thought was that he was having a reaction to the blood but when I went to take a look at him and went to take his vital signs, he was not displaying any telling symptoms of a transfusion reaction. He did not have a fever, chills, pain, fainting or dizziness, or bloody urine (those were the ones I remembered). Also, wouldn’t these symptoms start showing almost immediately after the transfusion? He finished receiving blood a few hours earlier. Coarse crackles were the only new development. I called my teacher over who pointed to the IV pole. “Notice anything there?” she asked. My blank bleary eyed look said it all. “He received 2 units of blood along with 500ml of normal saline all within the span of a few hours. Potential fluid overload perhaps?” I responded to her with a blank bleary eyed look once again before garbling something along the lines of “lots of watery stuff in lungs means Lasix make man feel better”. I’m so smooth. When we went to check his MAR, it turned out that there was no order for Lasix! That meant that we had to get a doctor, any doctor, to give an order for 20 mg of IV Lasix. Calling doctors and begging for obvious orders is one way to wake up. My teacher was visibly annoyed and told me that usually 20 mg of Lasix is a standard order with a blood transfusion. At least we got the order and the patient’s breathing finally sounded normal. Job well done!
A burst of activity and I have to stay awake! We start checking patients to make sure they’re still in bed and if they need to be cleaned up. The nurses on my floor call this the five o clock train because we all line up, take adjacent rooms and start cleaning patients up (if they need to be cleaned). Since its almost end of shift, foleys need to be emptied, I&Os need to be documented, CHF patients need to be weighed, 0600 meds need to be given out and report for the oncoming shift needs to be prepared. I feel myself getting increasingly restless as the clock ticks closer to 0730 because the only thing on my mind is a shower and my soft lavender and vanilla scented bed (courtesy of Downy). But when its finally quitting time, I run out to the train station where I’m greeted by fabulously well dressed people while I look like a smelly homeless person who stumbled across a pair of scrubs. It doesn’t matter because my day (err night) is DONE!
Tuesday, June 24, 2008
Sadly, his tranquility did not last for the rest of the shift. Towards the end of the shift, my teacher allowed me to test his blood sugar levels. When I approached him and explained what I was going to do, he nodded in agreement and let me proceed. However, when I was about to lance his finger, he jumped up at me (he was still cuffed to the bed) and menacingly said, “Boo! Scared ya didn’t I sweetness?” Of course he did. I jumped back, dropped the lance, testing strips and created a mess that I did not want to clean up while his jeering laughter provided the soundtrack to the moment. I ended up leaving the mess because I did not want to be in that room any longer. I didn’t get a blood sugar reading
Having done a short stint in a mental health facility, I thought I would be better prepared work with ‘shady’ characters, but this man made me recoil. I did not feel sorry for him at all. He was convicted of and found guilty of serious crimes. He deserved to be in jail. And yet, I could not stop thinking about what being hospitalized meant to him. Did he see his room as a temporary respite from his cell? Or was this the same prison with different but weaker wardens? Is that why he felt comfortable trying to scare us? Did hyperglycemia and the ensuing diagnosis of type II diabetes really matter to him? Most of all, I wanted to know if he was sorry for the crimes he committed and if not, then how did he rationalize and justify his choices? I wanted to know the answers to these questions, but I did not want to be the one to extract that information from him. I wanted him to forget that I existed because knowing that I am known by someone who is comfortable with panning out brutal violence for slight provocations scares me. This is one abyss that I am happy to leave far behind
Friday, June 20, 2008
While I can’t say I love my placement (because commuting there is a complete pain in the gluteal area), I have been learning a lot (and not the clichéd kind of learning either). My first day after orientation began with meeting a sweet old lady who ripped two IVs out of her arms. Upon seeing her hands, gown and the floor soaked with blood, I let out a small scream (think Homer Simpson-esq), grabbed cotton wipes from the counter and applied pressure to those wounds like no-body’s business. Later on, my preceptor complimented my ‘quick-thinking’ and proceeded to clean up the mess. I learned two things that day; 1) if a sweet old lady pulls out her IV lines, the next step after applying pressure and panicking is to flush the line out with normal saline and lock it up to retain positive pressure and 2) getting blood stains of shoes should be done as quickly as possible.
Yet another patient who made me temporarily forget my ‘burb induced misery was an Indian gentleman who is extremely hard of hearing, named Mr. S. Mr. S is a very demanding patient because he did not follow the rules of the hospital, which according to CCC (that’s client centered care for you lucky enough not to have it shoved down your throats) philosophy is perfectly acceptable. In fact, as nurses, we’re supposed to honor the client’s wishes. But not 45 minutes before shift change. Along with being nearly deaf, he has septic arthritis, which means he can’t ambulate without at least two people helping him. Describing the sequence of events in a chronological order is the best way to relay the sense of urgency and despair that I felt while taking care of Mr. S.
1845: 45 minutes before shift change. He decides to start shouting at around. We (being me, my preceptor and another student nurse) decide to indulge his crazy plan because our charting and 1800 meds are done. Wrong choice. Mr. S. takes 10 minutes to decide on the water temperature alone – and then soils himself.
1900: ½ hour before shift change. Mr. S. refuses to let housecleaning come into the shower to clean up the mess. The Eastern European lady comes in, takes a quick look and aptly declared, “that’s very stinky poo”. Meanwhile, I vomited up my 0500 breakfast. The other student nurse then rubs my back and asks if I’m pregnant!!! No, not pregnant. Merely revolted. Following my ‘pregnant’ pause, Mr. S. spots his son outside the shower (because he was called by my teacher to try to calm him down) and he starts to shout, “YOU BETRAY ME! MY OWN FLESH AND BLOOD BETRAY ME!” I believe sheer exhaustion and revulsion combined with residual nausea made me burst out laughing in the most inappropriate manner. Luckily he was hard of hearing and so my shameless laughter failed to further enflame his anger.
1915: 15 minutes before shift change. Mr. S. is smiling like a smug child who got his mother to buy him a candy bar after she refused to do so. “SISTER” he shouts. “Come, give me a warm blanket, a cup of coffee and something sweet to eat”. Did I mention he’s a very poorly controlled diabetic? His morning CBG reading topped of at 17 mmol/L. Not good.
1925: 5 minutes before shift change. “SISTER?”, he shouts once again. “Where the hell is my bloody coffee? SISTER?”. At this time, I have to remind him that he’s not getting coffee or anything sweet because we don’t want him to die in the middle of the night. “Mr. S. you can’t have something sweet right now because your blood sugars are completely out of control. And it’s almost time for bed. He replies, “you’re absolutely bloody useless. This entire hospital is bloody useless. Go. And don’t come back with something sweet for me. Some mithai (an Indian sweet) would be good”.
1930: Shift change. “Good night Mr. S”, To which he cordially replies, “You’re all bloody useless bandars (monkeys)!! Never come back in my room!”
“You sleep well and dream sweet dreams sir”.
1935: 5 minutes after shift change. I started to virox the blood and crap (literally) out of my shoes. “Frikkin crazies” I hear the other student nurse mutter to himself. “Hey, pass me another virox would ya?”
1945: We gave a very late report to the night nurses much to all of our chagrin.
2000: I never thought I’d be so happy to see my dad and his clunky old Nissan. “Hop to it popsie! I gotta shower and scour myself stat!” As usual, the day ended with a member of my family giving me weird looks while deciding if putting me in a psych ward would be a good choice or not.
Reflecting (yes, my school's favourite word) back on the situation, I wonder, did I honor the patient’s wishes? Probably not. Was I patriarchal in my treatment towards him? More than likely, I was. Did I practice CCC? Absolutely not. I practiced MCC (Maha Centered Care), which involved pursuing nothing more than a hot shower and my bed because my feet, knees, hips and back were screaming for rest. Could I have handled the situation with something better than snide remarks, vomiting and laughter? Probably. Will I try to handle a similar situation with more tact in the future? Of course, but it gets very difficult when a patient doesn’t respect your time.
So what do I think about my placement? I still say that it certainly is not as exciting as an emerg department might be, but the ‘burbs still have the potential to leave one shaking their head at the end of the day. My first impression: You betray me!
Sunday, May 18, 2008
That felt great. For about 10 minutes. And then I panicked. “What the hell will I do now?” I wondered (aloud on a subway). “I can’t spend the rest of my life as a poorly paid lab rat... I like pretty things too much. And a Master’s in biology? I’d rather give up cake”(again, muttered out loud in a subway). While I was contemplating the direction of my life and enjoying the increasing amount of empty seats near me, I saw some people get in the subway wearing scrubs. This story would be tied up in a neat little package if I said that that was the moment I decided to enrol in nursing school. But that wasn’t the case. I was lulled into a deep sleep by my food coma (a non-medical term coined by my friend, referring to a sleepy feeling after eating a heavy meal).
Over the next few months, I started to panic about what I would do with a crummy ol’ BSc in biology and started to consider my options. Luckily, I was also volunteering on a medical-surgical floor in a hospital and for some strange reason, I thought, ‘Hell, I could be a nurse. I like blood and guts, I like people, lots of folk in my family are in health care, I’ve always wanted to be in health care, and going to work in pyjamas is just the icing on the cake… umm… cake)’.
Shortly after hanging up a $30,000 piece of paper (my degree) on the wall, I got a letter saying that I had been accepted into nursing school. Awesome! I prepared for my new career by renting out the first 6 seasons of ER (fine, George Clooney was the real reason… gimme a break) and started becoming a much bigger nuisance to the nurses on the unit in which I was volunteering.
Suffice it to say that nursing school was nothing like I imagined it. I thought we would start learning gruesome and bloody stuff right away. Alas, that was not the case. We theorized and conceptualized (until our eyes bled) before we were allowed to touch patients. During the course of the nursing program, I was placed in units such as maternal/child care, long term care, neurosurgery (not nearly as impressive as it sounds), paediatrics, mental health and the community. And now, it’s finally (FINALLY) time to do the consolidation (an intense period of in-hospital or community training before graduation).
Since the consolidation period is probably the most exciting time of nursing school, I figured this is the ideal time to start a blog featuring heart-warming, gut-wrenching and sometimes just plain old twisted anecdotes. I’ve also been told that I have a keen sense of twisted anger when I’m sleep deprived and that it should be shared with others. So for my adoring public (consisting of about 3 people), here it is; Maha’s blog! Enjoy!