Some you win...

I felt like I was winning today until I got to my patient as arranged today. When I saw him, he was a mess. Bedraggled and anxious. Terrified. Lonely. I worked with him the best I could, but it didn't seem to be enough.

I called one of our other staffers to help.  I did everything I could.

Finally, I wrote my note. I finished my work that needed to be done. Even though, I accomplished much, it didn't feel that way.

I tried. It was all I could do today. I will do the same the next time.

Something to look forward to...

As if random communicable diseases on a seasonal basis was not enough.

Why teenagers act crazy (from www.nytimes.com).

Hot Friday

The unit (and some of our patients) was steaming...literally and figuratively.

As usual, in our neck of the woods, it was hot today. No one told this to the HVAC people, who last year, were lucky enough to have the heat on in mid-May when we had a cold spell. Oh, the joy of rooms that are so hot, patients sticking around in them get sick and vomit. This happened to one of our characters today...just as I was finishing my lunch.

His nurse of course, was nowhere to be found when he first started retching. I got the lucky job of elevating his head, turning it and getting him a bucket. By that time, it was too late. He was a mess. His nurse did show up and I did stick around to help her clean him up and get the doc to look at him, since he's a nice guy and he just doesn't normally do that. He had some other complaints that seemed a bit strange, so we gave him the full treatment...EKG and all. No surprise that after we got his IV access started he tells everyone, "I sure feel better now that I threw up!"

I had the same two patients and Mr. Colo. (They're still working on a colostomy for him...he needs it). I was working with some new nurses, too, so that made things interesting. Trying to demonstrate new stuff and have patients cooperate can be a challenge. Fridays are busy days and one of my normally reasonable characters got crabby fast. He wanted to be "waited on first". Thankfully, the charge nurse helped me out, but I was guilty only of not being able to be in two places at once.

This character is an anxious respiratory mess and you know that ABC stuff (airway, breathing, circulation)...well, he knows the routine and he just hams it up. Just for grins, I put him on an O2 sat monitor, as I start his trach trial (he needs to be plugged for several hours for his trip home). What do you know, he sats in the 90s all the time. All his entreaties for suction, etc., were driving me nuts. I just made him cough up the little bit of sputum he has (always white), because he needs to know how to do it. I still had to suction him twice this afternoon and he made a big mess going back to bed. Happily, I had a helper, so we got done reasonably quickly, but it was still a mess.

My other patients were reasonably less demanding, even the more demanding one. We kept his water cup filled and he was happy. It didn't hurt that I found an ice cream for him at lunch, either!

Needless to say, this wet and tired nurse was so happy to get out of Dodge and get a shower at home. The temperature at home was a delight. The night is young and so is the weekend, which I'll enjoy two days in a row off.

It doesn't get any better! More to come...

I get to rest...

On the evening shift. Yes, it's true. Days can be rough and today was no exception.

I got the characters I had on evenings last time. Joy. No one else wants one or both, so I get stuck in their room. When no one is anxious, all is good. When there's anxiety for them, there's lots of work for me.

Tomorrow will probably be different, though. One leaves early for his weekly appointment off-site. The other's got issues, and if that resident doesn't fix them tonight, he'll be going out with the last guy who was really perturbed that he was on bedrest all weekend. Alas, we'll see what happens.

More to come...

Rest after Thanksgiving...or TGIF

After a day and a half where I got to play the roles of wife, mother, cook and galley slave, I was happy, happy, happy to go back to work where the only dishes I saw belonged to patients and I did not have to wash them. Hooray!

I got one of the same patients (a/k/a Mr. Easy--he gave himself that name) and one I haven't taken care of in a while, Mr. I'm Going Home in a Week (if my family actually comes for training). He's a sweet old man and as usual, he's getting anxious about leaving the hotel. Who wants to leave after a year plus of 24/7 staffing to scratch your nose when you'll have to go with your family who won't like it when you ring for them 20 times in two hours? No one really does.

Overall, Mr. IGHIW was in a reasonably good mood with only a couple of bouts of anxiety. I got him in his chair and out of his room for about two hours, so that worked for him. He was tired when he got back.

Mr. Easy ate too much yesterday so he vegged all day in bed, even when his wife came. He ate a little lunch and just slept all day. No fuss, no muss.

I got to do some paperwork and talk to our big boss about getting my certifications next year. I'm still working out the details, but I know for sure I will get at least one, depending on what the official regulations are. Both are attractive, since we get a bonus and pay grade advancements for getting them, but if there are technicalities, I want to know about those ahead of time.

Now, the weekend is here, so now I get to pay the bills and go on about my other fun weekend duties.

More later. Enjoy your weekend, wherever you are!

Back to work

Oh, I had to wake up this morning to the alarm clock, which I have not done in days!

I got up early so I could make my breakfast and lunch and get ready to take Bubba to school. Dahey leaves before we do, so he was out and off to work in the dark.

I got Bubba to his latchkey program and away to work I went. I checked my e-mails and boy, there were a lot! The most exciting one was the invite to a special out-of-town conference in November. I have to get all my paperwork done tomorrow so I can go. The admin upstairs, L., has been assigned to help me. (You know it's going to be interesting when she tells you that you have to fill out a 12 page form...in order to book your flight.)

I had two patients I haven't had in a long time and I was the med nurse on one hall. It kept me busy. Today, the docs make group rounds to inspect wounds, so this is also interesting. I try to hang out in the room, undo the dressing, then get everyone cleaned up. They got into my room early, but I was really busy with these two guys...and their roommate had me helping him, too. Mr. R. is very needy, which is not unusual for a COPDer. He's always worried about something--his mask, his bowel program, his turns. He looked a bit ashen today, which is very scary in light of the fact that even with his fragile health, he's a full code. I pray we don't have to do CPR on him while I'm working!

I met some new LPNs visiting us with the recruiter. We're looking for them, so we'll see if they come to work for us!

More tomorrow...getting tired and I need to go to bed!

Vacation...all I ever wanted!

Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!

Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.

I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.

One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.

I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.

We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.

I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.

As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?

Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!

Stay tuned...back to work next week!