Yes, it's not any old weekend...it's Super Bowl weekend! Go Cardinals!
Anyway, it was back to the evening shift for me and it's been run, run, run ever since. I got lassoed into a med cart again, and since the census is close to our max, it's busy. Lots of fun stuff going on, including,
1. The charge got to write up an incident report the other night for an omitted IV. The IV nurse (yes, we have those sometimes) forgot--by several hours for this big-deal drug. He/she was embarrassed by the whole thing and I think he/she's learned a valuable lesson...don't surf and play with IVs. Said nurse might not have missed the time if he/she hadn't been on the 'net...just an observation as I was running back and forth down the hall.
2. The good cop/bad cop incident is okay, so far. Lovely manager assigned me to patient on Thursday. Charge talked to him and he's been civil to me so far. I know he's still irritated (he tells people this on the phone) but I think he realizes it's for his own good, since he got a new little PU on him since the incident. He's really a pressure relief/turning advocate now!
3. The Slug was with us again the last couple of nights. It's really a pain that no one does anything about her. If I hear how "valuable" she is one more time, I'm going to throw up! How valuable is an employee who's making six figures yet is too poor to go to FedEx or some place else to do her long distance faxes, and other assorted no-nos, like parking her kids in the nurses' station (that's right, next to the computers) until it's time to go home? Oh, I really would love to see the JC inspectors do a site visit with her working evenings!
Nevertheless, I get to work with one of the best charge nurses we have all weekend. It helps when you feel like someone's got your back if you need it!
More goodies later...stay tuned.
Saturday, January 31, 2009
Thursday, January 29, 2009
Nuggets for January 29: Occupation-specific issues
There are a lot of occupation-specific conditions that have been cropping up in the news and elsewhere. Here are some of interesting ones I've encountered recently.
The US Bureau of Labor Statistics has an interesting general article about occupational injuries for nurses. They also have a great IIF (Illnesses, Injuries and Fatalities) section.
The NY Times recently ran an article about degenerative brain disease among former NFL players. For more on chronic traumatic encephalopathy, check it out at eMedicine.com.
You'd never think that they'd have this kind of information, but Apple, yes, the computer, iPod and iPhone people have a great section on ergonomics and reducing eye strain.
And in the "No, I didn't make this up" category, it's been outed as a hoax disorder--the infamous cello scrotum. Alas, gentlemen, the symphony can go on!
The US Bureau of Labor Statistics has an interesting general article about occupational injuries for nurses. They also have a great IIF (Illnesses, Injuries and Fatalities) section.
The NY Times recently ran an article about degenerative brain disease among former NFL players. For more on chronic traumatic encephalopathy, check it out at eMedicine.com.
You'd never think that they'd have this kind of information, but Apple, yes, the computer, iPod and iPhone people have a great section on ergonomics and reducing eye strain.
And in the "No, I didn't make this up" category, it's been outed as a hoax disorder--the infamous cello scrotum. Alas, gentlemen, the symphony can go on!
Wednesday, January 28, 2009
Good cop, bad cop
That was my day yesterday. Instead of playing good cop like I usually do, I had to play bad cop. One of our folks violated one of the rules he agreed to and I had to go to the big man (our director) to have him play the heavy. (It was helpful that he was strolling around on the floor...I didn't feel so bad about it...and he wrote up the note, too.) Nothing is more annoying than a patient who gets mad at you in the middle of the shift.
Since the weather was crappy here again, the usual evening shift folks called in yet again, so the call was out for volunteers. I stayed with our charge over an extra few hours to get the main work of evenings done. I had to deliver pills twice on this round and since we're full, it was busy. Everyone wanted pain pills, besides their regularly scheduled one. One particular pain pill character had a fit because his doc decided to schedule his pain meds instead of letting him call us for the PRNs. Someone was not happy with 75mg of morphine (SR) daily (divvied up BID at optimum times) and his q 4 hour Vicodin 7.5s, along with his assorted adjuvants. What did this win him? More drug education from me. The docs changed his med routine a) so he can show up with less pain and actually do the rehab he's supposed to do and b) give him enough at night so he sleeps well. After about five minutes on that sales pitch, he finally believed me, and then it was on to his demented neighbor.
One of the 12 hour folks picked up my assignment, and since she'll usually do it, I told her about what I had left to do, which was minimal. Many of our 7P to 7A people will not do dressings if they think the evening people (4-8) could have done it, but this nurse is good about it. Thankfully, I only had to leave one dressing, and that was because the patient would not turn until I left (at 2000).
I figured the rest of the folks leaving at 2000 were gone because I couldn't find them. I went outside to more big, fluffy flakes of snow, so I cleaned my car. I saw one of the nurses, but not the other, so she must have been trapped in one of the rooms (she had one of our more persnickety characters tonight). I pulled my car up to hers and the two of us got hers cleaned off, and I was on my way.
Bubba is off school today...so we'll be playing and working in the snow. More later!
Since the weather was crappy here again, the usual evening shift folks called in yet again, so the call was out for volunteers. I stayed with our charge over an extra few hours to get the main work of evenings done. I had to deliver pills twice on this round and since we're full, it was busy. Everyone wanted pain pills, besides their regularly scheduled one. One particular pain pill character had a fit because his doc decided to schedule his pain meds instead of letting him call us for the PRNs. Someone was not happy with 75mg of morphine (SR) daily (divvied up BID at optimum times) and his q 4 hour Vicodin 7.5s, along with his assorted adjuvants. What did this win him? More drug education from me. The docs changed his med routine a) so he can show up with less pain and actually do the rehab he's supposed to do and b) give him enough at night so he sleeps well. After about five minutes on that sales pitch, he finally believed me, and then it was on to his demented neighbor.
One of the 12 hour folks picked up my assignment, and since she'll usually do it, I told her about what I had left to do, which was minimal. Many of our 7P to 7A people will not do dressings if they think the evening people (4-8) could have done it, but this nurse is good about it. Thankfully, I only had to leave one dressing, and that was because the patient would not turn until I left (at 2000).
I figured the rest of the folks leaving at 2000 were gone because I couldn't find them. I went outside to more big, fluffy flakes of snow, so I cleaned my car. I saw one of the nurses, but not the other, so she must have been trapped in one of the rooms (she had one of our more persnickety characters tonight). I pulled my car up to hers and the two of us got hers cleaned off, and I was on my way.
Bubba is off school today...so we'll be playing and working in the snow. More later!
Tuesday, January 27, 2009
Nuggets for January 27
Oh, the weather outside is frightful, but it's great inside! Here are a few tidbits of information on the stuff that's happening in my world from the internet and the blogosphere. Enjoy your day whatever the weather!
I ran into this interesting article about PTSD and smoking cessation on Yahoo!News in the Health section.
We don't run into this too often, but Brown-Sequard syndrome is a spinal cord injury that appears every so often on our unit.
It's interesting to read radiology reports on patients, but sometimes, I just have to look all over to figure out what's going on. Here are a few interesting items I've come across lately.
Since I couldn't figure out the acronym, I just went searching and I found out what exactly
IPMN tumors are from this article.
Finally, I found this great Google book on CT scans while I was looking up the definition of punctate cysts at www.m-w.com which now has a medical definitions section you can choose when looking up a word used in medical terminology.
I ran into this interesting article about PTSD and smoking cessation on Yahoo!News in the Health section.
We don't run into this too often, but Brown-Sequard syndrome is a spinal cord injury that appears every so often on our unit.
It's interesting to read radiology reports on patients, but sometimes, I just have to look all over to figure out what's going on. Here are a few interesting items I've come across lately.
Since I couldn't figure out the acronym, I just went searching and I found out what exactly
IPMN tumors are from this article.
Finally, I found this great Google book on CT scans while I was looking up the definition of punctate cysts at www.m-w.com which now has a medical definitions section you can choose when looking up a word used in medical terminology.
From the mailbag...
Truthfully, I don't get much mail from this blog, and it doesn't bother me a bit. I read comments and that keeps me pretty busy.
Since we're officially in a recession, here's the latest job opening someone sent to me. Yes, I'm as shocked as you are, but if any of you know someone who wants or needs a new position and may fit the requirements, check this one out below.
If you want more information, go to the link below and tell them Wayne sent you.
Position: Director of Rehab
Location: Methodist Hospital, Houston, TX
Requirements: prefer masters prepared RN with rehab experience (didn't indicate any other specifics)
Website: www.methodisthealth.com
Contact: Wayne Wauters, senior recruiter
Since we're officially in a recession, here's the latest job opening someone sent to me. Yes, I'm as shocked as you are, but if any of you know someone who wants or needs a new position and may fit the requirements, check this one out below.
If you want more information, go to the link below and tell them Wayne sent you.
Position: Director of Rehab
Location: Methodist Hospital, Houston, TX
Requirements: prefer masters prepared RN with rehab experience (didn't indicate any other specifics)
Website: www.methodisthealth.com
Contact: Wayne Wauters, senior recruiter
Monday, January 26, 2009
Get up and go Monday
I managed to get up and go, even if I felt a little slow. So did a couple of our patients.
Our first admission was on site when I arrived around 0715. This is highly unusual, but this patient came from home and was not picked up, so this added another element of excitement to my day when I went into report and I found out that I'd be the admitting nurse.
Happily, I got my assessment and some paperwork out of the way before I started getting my other two patients ready. One of the volunteers set up one of my patients and he got ready and I didn't have to do too much.
I got him ready and up in his chair, and away I went to the next patient. The next guy was a little perturbed that he had to wait for the docs, but that's what happens sometimes when they're rounding and talking. Better late than never to therapy!
The rest of the day went reasonably well, and I even got to eat my lunch by 1330. I got my patient to therapy for all of the afternoon session. He went back to bed and watched a movie on his laptop, which thoroughly entranced his roommate, who had never seen a DVD before.
It was all good, even if I escaped a couple of minutes late. More fun tomorrow...we'll see how crazy the weather is! Stay tuned!
Our first admission was on site when I arrived around 0715. This is highly unusual, but this patient came from home and was not picked up, so this added another element of excitement to my day when I went into report and I found out that I'd be the admitting nurse.
Happily, I got my assessment and some paperwork out of the way before I started getting my other two patients ready. One of the volunteers set up one of my patients and he got ready and I didn't have to do too much.
I got him ready and up in his chair, and away I went to the next patient. The next guy was a little perturbed that he had to wait for the docs, but that's what happens sometimes when they're rounding and talking. Better late than never to therapy!
The rest of the day went reasonably well, and I even got to eat my lunch by 1330. I got my patient to therapy for all of the afternoon session. He went back to bed and watched a movie on his laptop, which thoroughly entranced his roommate, who had never seen a DVD before.
It was all good, even if I escaped a couple of minutes late. More fun tomorrow...we'll see how crazy the weather is! Stay tuned!
Sunday, January 25, 2009
Sobering
That was how my week ended. My patients were doing well, fluffed and buffed, but elsewhere on the unit, there was a cloud.
No, not the "happy cloud" the instructors told people to go to in the class some of our cohorts took, but a pall of the doom you know is coming.
One patient came in and within a couple of hours got his first order of vitamin K and some more elaborate diagnostic tests. Someone was drinking a little more than they let on...
Another got the bad news that he's got a terminal illness. No timeline yet, so he just hid under the covers most of the day.
Finally, I managed to bugger up the med cart. Technology is great, but the instructions on resetting it were not. Trial and error can be your friend, but when you're busy, you just don't want to go there.
Thankfully, I resolved the problem and got things to work. Hooray! More to come next week. Enjoy the rest of your weekend...wherever you are!
No, not the "happy cloud" the instructors told people to go to in the class some of our cohorts took, but a pall of the doom you know is coming.
One patient came in and within a couple of hours got his first order of vitamin K and some more elaborate diagnostic tests. Someone was drinking a little more than they let on...
Another got the bad news that he's got a terminal illness. No timeline yet, so he just hid under the covers most of the day.
Finally, I managed to bugger up the med cart. Technology is great, but the instructions on resetting it were not. Trial and error can be your friend, but when you're busy, you just don't want to go there.
Thankfully, I resolved the problem and got things to work. Hooray! More to come next week. Enjoy the rest of your weekend...wherever you are!
Friday, January 23, 2009
Nuggets for January 23
It's a happy, happy Friday, all! I love the weekend, especially when I'm not working.
Since the week is done, here are a few interesting things I've encountered lately.
What do you do when you get a needlestick? Here's the VA's resource for occupational exposure and HIV. While digging around on this very subject, I found a great resource on HIV called The Body Pro.
It's a little more complicated than a needlestick, but we had to deal with a patient who recently had a transbronchial biospy of the lung this week. Thurlbeck's Pathology of the Lung has some interesting facts about this type of procedure used to diagnose all sorts of lung conditions, from cancer to infection.
Finally, with all the MRSA and shenanigans going around we had a patient with a very scary looking butt cheek and one of these. If it's not MRSA, I'll be surprised. I've only seen one previous to this, on my pediatric clinical in nursing school and it involved MRSA and I & D and it was nasty!
On that memorable note, have a great weekend! We'll be eating cake (for Bubba's birthday party with all the kids).
Since the week is done, here are a few interesting things I've encountered lately.
What do you do when you get a needlestick? Here's the VA's resource for occupational exposure and HIV. While digging around on this very subject, I found a great resource on HIV called The Body Pro.
It's a little more complicated than a needlestick, but we had to deal with a patient who recently had a transbronchial biospy of the lung this week. Thurlbeck's Pathology of the Lung has some interesting facts about this type of procedure used to diagnose all sorts of lung conditions, from cancer to infection.
Finally, with all the MRSA and shenanigans going around we had a patient with a very scary looking butt cheek and one of these. If it's not MRSA, I'll be surprised. I've only seen one previous to this, on my pediatric clinical in nursing school and it involved MRSA and I & D and it was nasty!
On that memorable note, have a great weekend! We'll be eating cake (for Bubba's birthday party with all the kids).
Wednesday, January 21, 2009
It never happens...usually.
That was my day today. Even though, I'm coming down with another cold (I'll be happy to get rid of them once and for all!), my day went along smoothly.
Surprisingly, since it usually never happens, I had some of the same patients I had on my evening gig. I told them I was just as surprised as they were. I got both of them rolling quickly and it was great. I had to check the computer for orders, and that went well, too. One patient got up in his chair, rolled around and checked things out. It was a beautiful, sunny day, and the temperature even started creeping up to pleasant January levels.
My boss told me I got my permanent appointment. He was a bit taken aback which kind of makes me wonder about him. I think that four hour meeting he was in today fried his brain a bit.
Happily, the census is down for the moment. Hopefully, it will stay that way for a while. I know we'll enjoy the reasonable quiet.
More to come...stay tuned.
Surprisingly, since it usually never happens, I had some of the same patients I had on my evening gig. I told them I was just as surprised as they were. I got both of them rolling quickly and it was great. I had to check the computer for orders, and that went well, too. One patient got up in his chair, rolled around and checked things out. It was a beautiful, sunny day, and the temperature even started creeping up to pleasant January levels.
My boss told me I got my permanent appointment. He was a bit taken aback which kind of makes me wonder about him. I think that four hour meeting he was in today fried his brain a bit.
Happily, the census is down for the moment. Hopefully, it will stay that way for a while. I know we'll enjoy the reasonable quiet.
More to come...stay tuned.
Tuesday, January 20, 2009
Nuggets for January 20
Happy Inauguration Day to all!
Here are a few things I've encountered at work lately and some interesting resources.
Proteus Mirabilis was on the list of UTI causes for one of our folks and just so happens to be one of the major causes of SIRS, systemic inflammatory response syndrome, which has a mortality rate of 20-50%.
This article discusses prealbumin levels and we monitor this frequently, particularly, since we have a lot of patients with stage 3 and 4 pressure sores.
We monitor albumin levels, too, and this article from Dr. Michael Eades talks about this lab value.
This article entitled "Nursing industry desperate to find new hires" on http://www.msnbc.com/ was my favorite. I have yet to see a lot of these sorts of tricks in my neck of the woods. Last year, maybe. I just don't think everyone's doing this right now, even though this article makes it look that way.
And now for something completely different...
I saw this on CNN.com for your favorite old-school vinyl audiophile.
One of my patients, who likes to draw, was working on an EDM schematic, instead of his usual watercolors. I didn't understand the schematic, but this guy is using these notes for the basis of a book he's writing with another author. Who says you can't do productive things on bedrest?
This isn't work-related, either, but from a public health standpoint, it's interesting. (from today's www.nytimes.com)
E-cards on the rise for notifying re: STDs
Here are a few things I've encountered at work lately and some interesting resources.
Proteus Mirabilis was on the list of UTI causes for one of our folks and just so happens to be one of the major causes of SIRS, systemic inflammatory response syndrome, which has a mortality rate of 20-50%.
This article discusses prealbumin levels and we monitor this frequently, particularly, since we have a lot of patients with stage 3 and 4 pressure sores.
We monitor albumin levels, too, and this article from Dr. Michael Eades talks about this lab value.
This article entitled "Nursing industry desperate to find new hires" on http://www.msnbc.com/ was my favorite. I have yet to see a lot of these sorts of tricks in my neck of the woods. Last year, maybe. I just don't think everyone's doing this right now, even though this article makes it look that way.
And now for something completely different...
I saw this on CNN.com for your favorite old-school vinyl audiophile.
One of my patients, who likes to draw, was working on an EDM schematic, instead of his usual watercolors. I didn't understand the schematic, but this guy is using these notes for the basis of a book he's writing with another author. Who says you can't do productive things on bedrest?
This isn't work-related, either, but from a public health standpoint, it's interesting. (from today's www.nytimes.com)
E-cards on the rise for notifying re: STDs
Monday, January 19, 2009
One to go...
Ahh, I really like Mondays when I know that I'll be finished with my five-in-a-row schedule. Sure, I only get one day off and then I'm back until the end of the week, but one day off after five on is better than nothing!
I still feel like I'm hanging on to that random Christmas virus I got. A little nose running, a little hacking cough, a lot of perturbed nurse, who's been trying to rest and beat it. Well, we shall see how it goes!
The last few days I've had pretty much the same assignment--two patients and the med wagon again. Even with LPNs on most of this weekend, I haven't lost that. I don't mind really, since I have an easy area to deal with, and I know pretty much what they want after dealing with them all this time.
Bubba has his birthday this week, so I'll be busy getting ready for the party this weekend. We had a little craziness here with the weather, so that messed me up a bit, but now I'm getting all my stuff going. I'll be really busy tomorrow! I'm glad it's my day off!
More later...
I still feel like I'm hanging on to that random Christmas virus I got. A little nose running, a little hacking cough, a lot of perturbed nurse, who's been trying to rest and beat it. Well, we shall see how it goes!
The last few days I've had pretty much the same assignment--two patients and the med wagon again. Even with LPNs on most of this weekend, I haven't lost that. I don't mind really, since I have an easy area to deal with, and I know pretty much what they want after dealing with them all this time.
Bubba has his birthday this week, so I'll be busy getting ready for the party this weekend. We had a little craziness here with the weather, so that messed me up a bit, but now I'm getting all my stuff going. I'll be really busy tomorrow! I'm glad it's my day off!
More later...
Thursday, January 15, 2009
Nuggets for January 15
Well, it's back to work today, and I still have a bunch of stuff to do before I go. Here are a few things I've found while traversing the internet and various blogs.
My Own Woman has a great post for new nurses. Read it and live it. (I'm not brand new, but I'm still new at nursing and it really made me think.)
Tex from Weird Nursing Tales always has a great sing-a-long on his site. The latest, describes what I get to deal with on evening shift.
As a student nurse, I really enjoyed my trips to OR land at PrivateU's hospital. I almost considered going that route after getting my degree. If you're interested in the jobs of the OR nurse, check out UnsinkableMB's post on life as an OR nurse.
Jeepgirl has one of the reasons why I'm happy there's no full moon this weekend. Some of our people will just be crazy, anyway. All I can hope for is that a few more of them make it out by Friday, so the census comes down a bit before the weekend!
My Own Woman has a great post for new nurses. Read it and live it. (I'm not brand new, but I'm still new at nursing and it really made me think.)
Tex from Weird Nursing Tales always has a great sing-a-long on his site. The latest, describes what I get to deal with on evening shift.
As a student nurse, I really enjoyed my trips to OR land at PrivateU's hospital. I almost considered going that route after getting my degree. If you're interested in the jobs of the OR nurse, check out UnsinkableMB's post on life as an OR nurse.
Jeepgirl has one of the reasons why I'm happy there's no full moon this weekend. Some of our people will just be crazy, anyway. All I can hope for is that a few more of them make it out by Friday, so the census comes down a bit before the weekend!
Tuesday, January 13, 2009
Wax on, wax off
I'm not doing any waxing here or at work, but, I am off tomorrow. Yes!
Today was a busy day, even though we weren't saddled with the admissions of yesterday. Mr. AKA blew his IV at 0500 and I could not stick him because he'd already been stuck 7 times before I got to him. How many people did it take (and sticks) after that to get a working IV? Only 5 more tries with two veteran nurses. It was terrible. Why they didn't give him a PICC is beyond me. He was off fluids today, so I had to encourage PO fluids and he's still tired. I got him cleaned up finally, which was the first bath and shave he's had in a week. (The Washington folks were "short-handed" he said, so he didn't get a bath). I just can't stand to have people be dirty!
We had to feed him his breakfast, he nibbled at lunch and I had to really push him to drink. He drank more in the afternoon than he did all day. I checked him out again before I left and he was doing better. I still worry about him, though. He's been through a lot.
My other guy went off to his appointment, so all I had to do was get him cleaned up and ready for the pickup. That was a breeze. His neighbor, Yosemite Sam, got cleaned up in the shower today, since he agreed to let his nurse do that. He wouldn't agree to a total scrubdown, though, so she just had to shoot water into the crusty beard and rub.
I got all the rest of my work done with five minutes to spare. It was nice to stroll out on time.
More later...
Today was a busy day, even though we weren't saddled with the admissions of yesterday. Mr. AKA blew his IV at 0500 and I could not stick him because he'd already been stuck 7 times before I got to him. How many people did it take (and sticks) after that to get a working IV? Only 5 more tries with two veteran nurses. It was terrible. Why they didn't give him a PICC is beyond me. He was off fluids today, so I had to encourage PO fluids and he's still tired. I got him cleaned up finally, which was the first bath and shave he's had in a week. (The Washington folks were "short-handed" he said, so he didn't get a bath). I just can't stand to have people be dirty!
We had to feed him his breakfast, he nibbled at lunch and I had to really push him to drink. He drank more in the afternoon than he did all day. I checked him out again before I left and he was doing better. I still worry about him, though. He's been through a lot.
My other guy went off to his appointment, so all I had to do was get him cleaned up and ready for the pickup. That was a breeze. His neighbor, Yosemite Sam, got cleaned up in the shower today, since he agreed to let his nurse do that. He wouldn't agree to a total scrubdown, though, so she just had to shoot water into the crusty beard and rub.
I got all the rest of my work done with five minutes to spare. It was nice to stroll out on time.
More later...
Walking...in the ICU?
I can only imagine how many nurses and support staff it will take to get some of these folks out of bed.
We deal with lots of tubes and wires in a rehab setting, but I can only imagine that number squared in an ICU.
We deal with lots of tubes and wires in a rehab setting, but I can only imagine that number squared in an ICU.
Monday, January 12, 2009
Foley, anyone, Foley?
That was my day today. I had three patients and I got to change two Foleys. Both of them needed it...they were gross! Each patient got a nice, clean, silicone catheter (a 16 and an 18). One I put in at a nice, leisurely pace, and the other I had to do in five minutes or less. Thankfully, I had most of the stuff already in the room.
One patient came in from out of town (Mr. Foley #2) early (no one noticed the error until he showed up) and my other patient came back from our mothership, Washington. Mr. AKA was happy as a clam to see us, even though he felt nauseated. His next door neighbor at Washington was a demented character who had a sitter but chose to yell all night and keep him awake.
Before he left Washington, the docs decided Mr. AKA needed an echocardiogram, so that slowed his return. Mr. AKA has hypokinesis and diastolic dysfunction. Being late was not a bad thing in hindsight, though, since the bed guy had not yet returned his low-air loss mattress as was promised earlier this morning.
Our PT doc assessed him and she was fried. She decided to admit too many patients (3 out of 4) and she was really snapping people's heads off left and right. She refused to let me look at the wounds with her, so I had to do my skin assessment and redress the wounds later. I was a bit irritated by that, but I survived. Mr. AKA felt a little better before I left, so I was happy and finished by 1615.
I got everything done and charted but I just don't feel like I did my best work. Hopefully, tomorrow is bit smoother. At least, we won't have four admissions like we did today!
Stay tuned...
One patient came in from out of town (Mr. Foley #2) early (no one noticed the error until he showed up) and my other patient came back from our mothership, Washington. Mr. AKA was happy as a clam to see us, even though he felt nauseated. His next door neighbor at Washington was a demented character who had a sitter but chose to yell all night and keep him awake.
Before he left Washington, the docs decided Mr. AKA needed an echocardiogram, so that slowed his return. Mr. AKA has hypokinesis and diastolic dysfunction. Being late was not a bad thing in hindsight, though, since the bed guy had not yet returned his low-air loss mattress as was promised earlier this morning.
Our PT doc assessed him and she was fried. She decided to admit too many patients (3 out of 4) and she was really snapping people's heads off left and right. She refused to let me look at the wounds with her, so I had to do my skin assessment and redress the wounds later. I was a bit irritated by that, but I survived. Mr. AKA felt a little better before I left, so I was happy and finished by 1615.
I got everything done and charted but I just don't feel like I did my best work. Hopefully, tomorrow is bit smoother. At least, we won't have four admissions like we did today!
Stay tuned...
Saturday, January 10, 2009
RehabRN book club
Hopefully, this year, I can be a little more regular on this segment.
Besides reading all those nursing-related books, (see CRRN posts) I'm going to highlight some of the stuff I read in my nursing off-time.
One of the first good books I've read lately is The Edge of Medicine by William Hanson. Okay, it's sort of a shop book (medicine), but a good one which points out how breakthroughs in medical technology will change how we live. If you're using telemedicine or eICU where you work, you'll understand what I'm talking about, because the future is already in progress.
Just today, I finished reading Fixing Hell by retired Army Col. Larry James. This was a very moving book.We haven't gotten a lot of OEF/OIF vets yet in our area, but this book has helped me to clarify and understand some of the PTSD issues as a nurse. It also helps to see how the psychologists have to deal with the same issues themselves.
More later...stay tuned.
Besides reading all those nursing-related books, (see CRRN posts) I'm going to highlight some of the stuff I read in my nursing off-time.
One of the first good books I've read lately is The Edge of Medicine by William Hanson. Okay, it's sort of a shop book (medicine), but a good one which points out how breakthroughs in medical technology will change how we live. If you're using telemedicine or eICU where you work, you'll understand what I'm talking about, because the future is already in progress.
Just today, I finished reading Fixing Hell by retired Army Col. Larry James. This was a very moving book.We haven't gotten a lot of OEF/OIF vets yet in our area, but this book has helped me to clarify and understand some of the PTSD issues as a nurse. It also helps to see how the psychologists have to deal with the same issues themselves.
More later...stay tuned.
Friday, January 9, 2009
OT for the weekend...nope!
Hooray, it's Friday and I got out on time. The boss wanted me to stay over another four hours, but Dahey already had plans, since this is my off weekend. I'm sitting here with a nice glass of wine and all of my administrative tasks at home are pretty much done. That holiday paycheck was nice!
My patients were good. Both got up and went to therapy and got evaluations for various stuff, like Aspen seating. One patient got a new loaner chair, so we had to work with him on driving it (the other had a neck-controlled drive system which was great, except when you had to lift in and out of it!).
The medication administration IT team was on the floor again, because those new med carts we got are actually the first ones for our hospital system period, not just for Madison. We gave the sales rep a lot of ideas for stuff we wanted, particularly for locking up controlled substances.
The big problem: rehab units tend to have a lot of people walking and/or rolling around in them, so having a cart that only uses a simple code to get into it is not a good thing. The company's answer was, "Don't leave the cart unattended." and while it may not be unattended, a nurse may need to turn his/her back. Lots of things can happen when you turn your back. Happily, the bigwigs are working on getting us a controls drawer that requires us each to have a special user ID to unlock it. Personally, I won't be storing my controls on the cart until they do. I may just do like one of my coworkers said today and put them in my pocket in a Ziploc, so they're in my possession!
Happy weekend all! Stay tuned...more next week!
My patients were good. Both got up and went to therapy and got evaluations for various stuff, like Aspen seating. One patient got a new loaner chair, so we had to work with him on driving it (the other had a neck-controlled drive system which was great, except when you had to lift in and out of it!).
The medication administration IT team was on the floor again, because those new med carts we got are actually the first ones for our hospital system period, not just for Madison. We gave the sales rep a lot of ideas for stuff we wanted, particularly for locking up controlled substances.
The big problem: rehab units tend to have a lot of people walking and/or rolling around in them, so having a cart that only uses a simple code to get into it is not a good thing. The company's answer was, "Don't leave the cart unattended." and while it may not be unattended, a nurse may need to turn his/her back. Lots of things can happen when you turn your back. Happily, the bigwigs are working on getting us a controls drawer that requires us each to have a special user ID to unlock it. Personally, I won't be storing my controls on the cart until they do. I may just do like one of my coworkers said today and put them in my pocket in a Ziploc, so they're in my possession!
Happy weekend all! Stay tuned...more next week!
Thursday, January 8, 2009
Another day...until the weekend
I got some good news this week. I may actually get my permanent appointment soon. The paperwork is in...hooray! This document tells a little bit about classification and nurses in the VA. You can cure insomnia if you read all of Title 38, just like you can with economics readings as I mentioned to one of my coworkers today.
One of my patients was up and out right away to an appointment. One was out at 1030, so all I had to do was get him ready and he was gone the rest of the shift. The other one stayed in bed until after lunch and then he got up in his chair and rolled around. He was with us when I started this spring, so it was nice to see him come back and everything went well.
More goodies tomorrow!
One of my patients was up and out right away to an appointment. One was out at 1030, so all I had to do was get him ready and he was gone the rest of the shift. The other one stayed in bed until after lunch and then he got up in his chair and rolled around. He was with us when I started this spring, so it was nice to see him come back and everything went well.
More goodies tomorrow!
Wednesday, January 7, 2009
Heard on the unit
In this first of the year installment, I didn't have to do much to hear some pretty interesting comments. Happily, there is no smellavision (yet) on the internet or some of these would be harder to bear.
"The first time I smelled Jack Daniel's (whiskey) I thought it was my grandmother's perfume." Picasso
Picasso's not his real name, but this guy is one of our regular artists in residence. No, he didn't get any big honors like our other guy who got to be a VIP late last year, but he's always got something new going on, like his secret pastel drawing in the sketch book.
He keeps making drawings for some of the nurses, so I guess I'm going to have to commission something from him to get one myself. This one about Picasso's Granny just happened to pop up as we were talking about French-Canadians. I guess Granny liked the taste of Jack to some old silly perfume!
"I like it up here at the penthouse level (waving his hand in front of his nose)." Mr. VIP
Somebody was emitting noxious odors in VIP's room, so to get away from it, he had someone raise up his bed about 4 feet off the floor, which is pretty far away from that nursing standard of a "locked and low bed."
"It's all in the technique, folks, all in the technique." Mr. AMA
Yes, Mr. AMA returned to us again to get healed up and promises not to leave AMA this time. (just like the last few times...) AMA's nurse and I tried to get him positioned right to go to x-ray and he bellyached until one of the nursing assistants reoriented his pillow, hence the quote. (The NA got it just right!)
"W., it's been nice knowing you. I'm leaving here for good. Dr. T. won't let me smoke. Screw him!" Ms. Cig
Ms. Cig did not agree to not smoking on our unit, so she asked for and got transportation back to her home. (Note: our boss does not let patients with pressure sores smoke.) She was so happy to get her carton of cigarettes back on her way out the door, that she disappeared and had a smoke before the ambulance came to pick her up. It didn't help that they were over an hour late!
It's back to the old grind tomorrow. Stay tuned!
"The first time I smelled Jack Daniel's (whiskey) I thought it was my grandmother's perfume." Picasso
Picasso's not his real name, but this guy is one of our regular artists in residence. No, he didn't get any big honors like our other guy who got to be a VIP late last year, but he's always got something new going on, like his secret pastel drawing in the sketch book.
He keeps making drawings for some of the nurses, so I guess I'm going to have to commission something from him to get one myself. This one about Picasso's Granny just happened to pop up as we were talking about French-Canadians. I guess Granny liked the taste of Jack to some old silly perfume!
"I like it up here at the penthouse level (waving his hand in front of his nose)." Mr. VIP
Somebody was emitting noxious odors in VIP's room, so to get away from it, he had someone raise up his bed about 4 feet off the floor, which is pretty far away from that nursing standard of a "locked and low bed."
"It's all in the technique, folks, all in the technique." Mr. AMA
Yes, Mr. AMA returned to us again to get healed up and promises not to leave AMA this time. (just like the last few times...) AMA's nurse and I tried to get him positioned right to go to x-ray and he bellyached until one of the nursing assistants reoriented his pillow, hence the quote. (The NA got it just right!)
"W., it's been nice knowing you. I'm leaving here for good. Dr. T. won't let me smoke. Screw him!" Ms. Cig
Ms. Cig did not agree to not smoking on our unit, so she asked for and got transportation back to her home. (Note: our boss does not let patients with pressure sores smoke.) She was so happy to get her carton of cigarettes back on her way out the door, that she disappeared and had a smoke before the ambulance came to pick her up. It didn't help that they were over an hour late!
It's back to the old grind tomorrow. Stay tuned!
Tuesday, January 6, 2009
Read, read, read
That was my day today...after I took a nap to recover from my last evening shift of the week. I'm so glad Dahey works at an industrial site because I really needed those earplugs to silence the crazy barking Beagle next door (it always barks during the day just as I'm trying to sleep!)
The great countdown to the CRRN exam is on! I have until April 15 to apply and I have to take the test sometime in June according to the ARN web site. Hopefully, I can get a day off when(and if) I need it!
The great countdown to the CRRN exam is on! I have until April 15 to apply and I have to take the test sometime in June according to the ARN web site. Hopefully, I can get a day off when(and if) I need it!
Here are a couple of the books I was reading today, some of which came from this list.
1. Rehabilitation Nursing by Shirley Hoeman. It's the classic, it's big, and it's got a lot of information in it. The fourth edition was revised in 2008, which also makes this book the newest one I have.
2. Gerontologic Nursing by Meiner and Lueckenotte. It's not the one on the ARN list, but I figured it looked pretty good.
3. Nursing TimeSavers: Neurological Disorders. It's 20th century, but has some really good sections with diagrams in a small package on neuroanatomy and signs and symptoms of various diseases.
4. Rehabilitation Nursing Procedures Manual, Second Edition. This book comes from the folks at the nation's premier rehab hospital, the Rehabilitation Institute of Chicago (RIC). It's 20th century, too, but just leafing through it today, I picked up a few new tricks about taking care of patients with TLSOs, halos and helping with donning and doffing clothes.
I also ran through a few units in the Rehab Nursing Series for the CRRN. It has a workbook which you must print from PDF (it's about 200 pages). I've been working with just the book and it was really helpful to sit down with both today.
Now it's time to get ready for work tomorrow. More to come.
Sunday, January 4, 2009
Happy hump day to me!
Well, it's not really Wednesday, but I'm on the downward slide of my evening rotation, so this is always a good thing.
My patients have been pretty good and I'm secretly hoping we're fully staffed tonight so I can ditch the med wagon, even if it means I get another patient. I have one good one and one wacky one, so hopefully, if I end up with a third, it'll be a good one to tip the scales and keep my sanity.
I got acquainted with a new drug yesterday--the belladonna/opium suppository. One of my patient's gets this for his pain (he's a quad who's been getting up a ton for therapy since his debilitating illness). He's quite a character. At least, he's liking his CPAP now, but he still needs his "muscle relaxer" once he's ready to put it on every night at 2300. I found out that his "relaxer" is not Baclofen or something else, but rather, good old Ativan.
I still feel cruddy, but with rest and fluids and good old Mucinex, I'm tackling work pretty well. All this resting makes me feel like I'm slacking at home, but I'm hoping it'll pay off later and I'll be done with this virus soon enough.
I'm still working on my CRRN stuff. Since this is the first week of the year, I'm going to have to start a countdown.
More later on that...gotta get ready for work!
My patients have been pretty good and I'm secretly hoping we're fully staffed tonight so I can ditch the med wagon, even if it means I get another patient. I have one good one and one wacky one, so hopefully, if I end up with a third, it'll be a good one to tip the scales and keep my sanity.
I got acquainted with a new drug yesterday--the belladonna/opium suppository. One of my patient's gets this for his pain (he's a quad who's been getting up a ton for therapy since his debilitating illness). He's quite a character. At least, he's liking his CPAP now, but he still needs his "muscle relaxer" once he's ready to put it on every night at 2300. I found out that his "relaxer" is not Baclofen or something else, but rather, good old Ativan.
I still feel cruddy, but with rest and fluids and good old Mucinex, I'm tackling work pretty well. All this resting makes me feel like I'm slacking at home, but I'm hoping it'll pay off later and I'll be done with this virus soon enough.
I'm still working on my CRRN stuff. Since this is the first week of the year, I'm going to have to start a countdown.
More later on that...gotta get ready for work!
Friday, January 2, 2009
The evenings of 2009
Last night wasn't terrible, but when you have a whole lot of demented people on your unit, it can get interesting! I had one of the hootin' and hollerin' characters (I say this since mine looks like a skinny, white-haired version of Yosemite Sam) who threatened to hit me if I did his bowel routine. Happy New Year to you, too, Buddy!
Sammy did let me do his dressings and turn him and by the end of the night, he was nice, sweet and replying "yes, ma'am" to everything I asked.
The rest of the cast of characters:
1. The man who wanted President-elect Obama to be his power of attorney, and then, he wanted screenshots of his TV as "proof" of neglect. It's starting to look like the Baclofen is messing him up, since his order just got changed. Thanks, docs, we need a little more excitement on evenings and nights.
2. His roommate wasn't seeing anything last night, but he wasn't believing much, either, especially when I politely asked him to check his med cup before he tossed it. He had pills in it that I did not want to go get again from the Pyxis when he could just take them as they are.
3. The nice, sweet man down the hall with the massive dressing changes is now refusing them. Not sure if he's PO'd at the staff, or if they told him he may have to leave. Sometimes, people like to take it out on the nurses when the docs aren't available. We're just handy targets.
Thankfully, the staffing was great. We had a lot of people on evenings who I don't normally get to work with and that was nice. Everyone was helping each other out a lot, which makes the load lighter.
I'm not sure how tonight will turn out, but the first evening of the year went pretty well. One down and four to go!
Sammy did let me do his dressings and turn him and by the end of the night, he was nice, sweet and replying "yes, ma'am" to everything I asked.
The rest of the cast of characters:
1. The man who wanted President-elect Obama to be his power of attorney, and then, he wanted screenshots of his TV as "proof" of neglect. It's starting to look like the Baclofen is messing him up, since his order just got changed. Thanks, docs, we need a little more excitement on evenings and nights.
2. His roommate wasn't seeing anything last night, but he wasn't believing much, either, especially when I politely asked him to check his med cup before he tossed it. He had pills in it that I did not want to go get again from the Pyxis when he could just take them as they are.
3. The nice, sweet man down the hall with the massive dressing changes is now refusing them. Not sure if he's PO'd at the staff, or if they told him he may have to leave. Sometimes, people like to take it out on the nurses when the docs aren't available. We're just handy targets.
Thankfully, the staffing was great. We had a lot of people on evenings who I don't normally get to work with and that was nice. Everyone was helping each other out a lot, which makes the load lighter.
I'm not sure how tonight will turn out, but the first evening of the year went pretty well. One down and four to go!
Thursday, January 1, 2009
Happy New Year!
Oh, it's still cold, and I'm still hacking from this cold/random virus, but it's great to get to sleep in before I go back to the evening shift tonight.
We had lots of fun here at the homestead last night. I actually made that red lentil soup in the crockpot, and even though I put a tad too much chicken stock in it, it worked. I packed up the remainers and Dahey will have a hot, steamy bowl of soup next week (a few times, actually) in his lunch. Since I've been on a soup run of sorts lately, he's had soup in his lunch just about every day. Right now, this is the fourth variety in our freezer.
Bubba went straight to bed at his usual time and Dahey and I retreated to the TV room with the remaining sparkly wine and watched this movie, since it's still technically the holiday season. We laughed and laughed. I got on the couch to watch the 10PM news, saw maybe two minutes and fell asleep. I woke up at 0035 to a talk show with Tiger Woods on it, and so I turned off the TV and went to bed.
Speaking of Dahey, no movin', movin' yet. Such is his work and contracting. Thankfully, he's still working, so we'll just be happy with that. Too many people are unemployed right now and work + paycheck = paid bills and no foreclosures, so I must say, that is the best gift of all.
I had some free time yesterday, so I ran through last year's resolutions. So far, this year's look about the same.
Work:
1. I will work hard to be a team player. (I notice that since there's a nursing shortage, people can act like NFL free agents sometimes, which can be hard to deal with. I don't want to be one of those people!)
2. I will learn something new every day. (It helps that I'm reviewing for certification!)
3. I will make sure I do one thing better than the day before.
4. I will grumble less and smile more. (Gotta keep those wrinkles away somehow!)
Home:
1. I will organize my paperwork. (This will be on my list forever!)
2. I will be nicer to my husband and son. (Sometimes Mommy can be a tad...bi%$chy...oops, glad "speller" doesn't read this blog!)
3. I will watch what I eat and drink more water. (Water = good, eating...well, not so good lately! Too much candy and cookies for the nursing staff!)
4. I will read more. (This is one from last year. I just need to put more in the RehabRN book club.)
Hope your start of the year is happy wherever you are. More to come!
We had lots of fun here at the homestead last night. I actually made that red lentil soup in the crockpot, and even though I put a tad too much chicken stock in it, it worked. I packed up the remainers and Dahey will have a hot, steamy bowl of soup next week (a few times, actually) in his lunch. Since I've been on a soup run of sorts lately, he's had soup in his lunch just about every day. Right now, this is the fourth variety in our freezer.
Bubba went straight to bed at his usual time and Dahey and I retreated to the TV room with the remaining sparkly wine and watched this movie, since it's still technically the holiday season. We laughed and laughed. I got on the couch to watch the 10PM news, saw maybe two minutes and fell asleep. I woke up at 0035 to a talk show with Tiger Woods on it, and so I turned off the TV and went to bed.
Speaking of Dahey, no movin', movin' yet. Such is his work and contracting. Thankfully, he's still working, so we'll just be happy with that. Too many people are unemployed right now and work + paycheck = paid bills and no foreclosures, so I must say, that is the best gift of all.
I had some free time yesterday, so I ran through last year's resolutions. So far, this year's look about the same.
Work:
1. I will work hard to be a team player. (I notice that since there's a nursing shortage, people can act like NFL free agents sometimes, which can be hard to deal with. I don't want to be one of those people!)
2. I will learn something new every day. (It helps that I'm reviewing for certification!)
3. I will make sure I do one thing better than the day before.
4. I will grumble less and smile more. (Gotta keep those wrinkles away somehow!)
Home:
1. I will organize my paperwork. (This will be on my list forever!)
2. I will be nicer to my husband and son. (Sometimes Mommy can be a tad...bi%$chy...oops, glad "speller" doesn't read this blog!
3. I will watch what I eat and drink more water. (Water = good, eating...well, not so good lately! Too much candy and cookies for the nursing staff!)
4. I will read more. (This is one from last year. I just need to put more in the RehabRN book club.)
Hope your start of the year is happy wherever you are. More to come!
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