Throttle and hum

My day was humming along. I got my people cleaned up and all ready for the day. Then it was time for the tasks.

We had to move one patient around because, per our isolation status, his room had to be cleaned and he had to get a new bed. What fun....move patient to new bed, move him to a different spot, get the room cleaned, then put him back. All this so he can get his GoLytely for a colonoscopy. He was not thrilled once he tasted it. "Yuck. No way I can drink two gallons of THAT!"

My other patient was relatively easy. Get him a new Foley and rotate him around. No fuss, no muss. He stayed up really late watching TV so he slept most of the morning.

Then the throttle...the call to go home to get that necessary utility fixed, since they keep messing with it outside. Fun. Husband can't leave work, so I get to leave. I'm so glad the commute is short. I made it there just in time to let the repairman in the house.

More to come...

Slide on over, folks!

You'd think Tuesdays wouldn't be so bad...nurse brings in lots of pens from the conference, people are happy and we are slated for no admissions. I could dream about it, but it wasn't easy at all today. I told our specialist that I am one of the most highly paid janitors/support staff as I filled every single cart on the main hall with isolation gowns. Why? We have support staff, who don't really feel it's their job to do it. No, sitting in front of the boob tube (reserved for patients) and playing pool (also reserved for patients) is really a more productive effort. If my male boss only had some balls. Removing the pool table ones to his office might help the situation.

I had three patients today, and our clinic nurse actually got one ready, since she needed him for a procedure early. I was very grateful. The other two were their usual eccentric selves, and yes, for them it's all about bowels. One goes too much, one goes too little. One gets out of bed without issue and the other leaves a trail on the sliding board as he's transferring. What does the nurse win, Pat? Another heave ho back to the bed for the patient, with the nurse leading the charge.

Just remember all you nursing students out there, if a patient is stuck in transfer halfway on the bed, you can get them all the way there by employing a maneuver I like to call "the dump". Basically, you get their legs and heave them onto the bed. They may be on their side and a little off kilter, but once you get them to the safety of the bed, put up whatever rails you can on any side they could slide out on, and maneuver them around from the other. I love low air loss mattresses, especially if they're made up right, because, by nature, the sheets are slick and you can slide most people wherever you need them to go in bed with little effort.

Said sliding mess patient eventually did get cleaned up, got lunch and got to the wheelchair for afternoon therapy. It was a workout though, for him and for me. I read this article tonight very carefully, so I can keep my back out of trouble!

After all that excitement, I got to move another patient because his roommate was isolated for a new bug. Yes, I'm an expensive mover, too.

More later...stay tuned.

The merry, merry month of May

Ah, yes, it is. And it's been merry so far this week. I was temporarily inundated with multiple patients, but nothing too difficult. Some of my people are even fighting to get me back! How nice it is to feel loved!

Anyway, feeling loved is a heck of a lot better than smelly C-diff. Ugh! I had one patient with it this week and it's always fun when the docs want a room, they start saying, "Well, his WBC numbers are down, let's take him off isolation." All I have to say is, "What happened to those ID rules (infectious disease, such as this sample one)?" No one asked for any more tests, so who knows!

Today there was a party and BBQ for the patients. People everywhere. I got my patient up earlier than usual and he tried to go back to bed before I left. He's not liking that rehab status at all! There will be more excitement next week, but I'll be at home until the weekend.

Ah...more to come. Stay tuned!

Heave, ho!

There was a lot of heaving today. I had Mr. Colo again, and for a while, they had him on a prep. The gallon of GoLytely I delivered at 1600 yesterday was still in his room. He only made it through half of it. Since Mr. Colo was still stooling a bit, that was the beginning of the day. One of the nurse assistants told me the boss should assign him to two people. Yes, he should when we have really heavy patients (literally and figuratively), but he doesn't, so you have to go roaming the halls looking for help, as I normally do. Some people will help you (and I always try to reciprocate) and others will run when they see you going down the hall, so they're "busy".

Thankfully, J. was in charge, and I recruited her and K. and one of the LPNs, so I didn't have to ask the same person too many times. J. does a lot when she's in charge. She goes out looking for things to help people with and it's nice. I helped with a couple of orders, but not many, because my two patients and the meds kept me running literally the whole day. I sat for 20 minutes while I charged my cell phone today and ate lunch and that was it.

Tuesdays can get crazy because the docs have meetings early, then they round with one of the specialists, and sometimes they don't get done rounding until just as lunch is arriving. It makes for some interesting predicaments such as one today with Mr. Colo. I'm in the middle of passing my pills to the whole hall to which I'm assigned. Mr. Colo was very distended with gas. The docs tell me..."oh, we dig stimmed him and relieved some of the gas, so you'll need to clean him up." What.In.Hades.Is.Going.On?! I'm in the middle of passing pills and I have to stop, drop and roll to do a clean up. Yes, this was not a drill. Since no one told me exactly what kind of results I'd find, I had to stop and get J. to go in with me so I could clean up Mr. Colo, then go back to my pills. One of these days, the docs will figure this out!

I also had DQ on my team again and I managed to get him up into the shower and he was all fine and happy until we told him he had to move next door since his double room was needed for two isolation patients. (I so love bed bingo!) Of course, he skipped out on afternoon therapy, since he had to make sure we didn't mess up any of his stuff. He just hung out in the halls and got in the way as we moved Mr. Colo to DQ's room and then DQ to Mr. Colo's room as the housekeepers finished cleaning the rooms. DQ wasn't happy with the way we arranged the room, so he rearranged it several times until he found a configuration he liked. He's not happy with it, but we had no choice. The inn is full of isolation patients!

When I wasn't busy with my own patients, I helped K. get a couple of hers up to go places. One guy went and bought a pair of reading glasses. He was the happiest I've ever seen him. He was sleeping all morning, and when he came back he was so alert and social. K. left him up on his stretcher for the evening crew to return to bed.

At 1400, K. got an order to send another patient to x-ray for a hip film. We got him loaded up for the transporter, then put him back to bed when he returned.

I left the med cart for the 12 hour nurse (and her orienting student) and got everything cleaned up. At 1600, I told J. and K., "Let's run before we have to move anyone else." and so the day ended.

Evenings creeps up again Thursday. I'll rest my heaving shoulders until then...more to come.

Only Grandpa today

Yes, that's what some of the folks call my patient and he was it today. Officially, I had two patients, but one was gone the entire day, so I really couldn't do anything for him. Grandpa was balky and happy, but never at the same time. I did his dressings, but he had to complain about them first.

Next, he complained about his bed, but he's been doing that on and off since the weekend, so I was told. He complained so much, I called the vendor's 800 number, the tech came out and he checked it out. Nothing wrong, the tech said, and Grandpa was happy...for about 2 whole minutes. Happily, since Grandpa is demented, he forgot about being mad and was busy watching TV the last hour I worked.

So I wandered around...and found stuff to do. My admission never showed up since they kept him at Washington instead of sending him here. I helped other nurses transfer people going to x-ray and therapy, I filled isolation carts with gowns, I filled glove dispensers with gloves and I passed out trays at lunch. I picked them up afterward and put them on the dirty cart. I took off orders. I witnessed a consent with one of our docs. It wasn't too bad. I hate sitting around doing nothing!

At 1530, we got a call that one of our patients had to be moved since he's now a double isolation patient, and one organism is C-diff. Joy. Nothing like bed bingo for four people (yes, that's how many we had to move to get them straight) so late in the day. Housekeeping had left the unit, so our charge was left to her own devices to get things squared away. We moved them in pairs and it worked out smoothly.

My second patient came in the building, just as I was leaving for the day. Evening shift was out of report, so I was relieved of my duty. Hooray! The weather's been great here, so I just hope it stays that way...without any tornadoes or floods thrown in. I could use a day to rest!

More to come...

Ahh...the weekend!

Just what I needed! It's been a thrilling week and I was glad to be spending my weekend at home, thank you very much. The full moon and the crazy people at work were enough for me! I'm feeling better, since those meds kicked in my doc finally sent me. Hooray!

I left late Friday because I volunteered to take a patient to Washington for a scan. The tech left early, so when we got there, we had to wait for the on-call to show up. "He'll be here in 15 minutes" actually took over an hour. Thankfully, this was not an emergent scan, although it was ordered stat. The scan took 5 minutes and I got a whole lot more OT. Said patient wasn't too crazy except for when the "people" came back on the ride back to Madison. Oh, hooray! More documentation for the boss for me.

My days were pretty decent, even though I ran and ran and ran. My day seemed like this for a while: Do AM care, dressings, etc., get patient in chair. Feed or set up for lunch, let patient sit in chair some more (or go to therapy) then put to bed before end of shift. Heaving three guys around (even not big ones) with a lift, still is taxing. I did not have to do meds at all on day shift, which was a welcome change.

One of our long-time people decided to become a DNR this week after much discussion with the medical staff. We'll see what happens next.

An observation: all of our rooms, except one, are isolation now. You name the isolation, we've got it: MRSA, MRSA/VRE, MRSA/AB, and MRSA/VRE/AB. MRSA's just so popular in our neck of the woods that we have multiple rooms with people on this isolation. One coherent patient was so funny. He was calling MRSA "Mercedes", as in, "I've heard a lot about that Mercedes bug on TV."

The temps have been ricocheting around (one day 10 degrees, the next 50) so it makes you really sweat with the isolation gown and gloves on. I was in the non-isolation room one day with just gloves on for five minutes and my hands looked as if I had had them in water for 10-15 minutes straight. Ahh, you just gotta love the heating and cooling system when the weather does gymnastics.

More goodies to come...I went to some great CE seminars last week, so I'll post a little bit about what I learned in some Nuggets.

Enjoy the rest of your weekend, wherever you are!

Pick and choose

That pretty much describes my day, or at least the attitude of most of my patients. Two out of three could get up and go in their wheelchairs and both of them opted out. One didn't get ready until just before lunch appeared on the unit.

The tasks of the day weren't terrible--Foley replacement, WoundVAC dressing and managing ileostomies and colostomies. The Slug did get on my nerves a couple of times, but I managed to hide my irritation, since that would just be something she'd enjoy.

Education showed up and we had an impromptu in-service on flushing and drawing blood from central lines. I learned that our facility actually marks the lumens proximal and distal on our central lines. We don't have too many in rehab, since we mostly have folks with PICC lines.

I helped a couple of other nurses on the unit get their people up and out of bed. I try to do this with at least one person a day because I never know when I'll need help doing the same thing. Since none of my people got up, I just rounded and turned people. One of the other nurses, A., set up two of my patients for lunch, so that worked well for me. I fed Mr. I'm going home next week. He's happy to know he's getting out before Christmas.

Two patients left today and none were admitted, so it was relatively peaceful. One patient got to be bed bingoed to another room since he tested positive for MRSA in the nares. It worked out okay since Mr. W. was being discharged and his room, right across the hall, was a MRSA isolation room. Mr. Hogg (not his real name) in the Clinitron didn't mind at all, since he'll have a new roomie who likes to stay up late at night just like he does. I like Mr. Hogg. He's funny and is another artist on our unit. He draws cartoons that are downright hysterical, particularly of staff and the occasional nursing student. One of the characters he drew recently had a cleft chin that reminded me of Hank from the Family Guy.

I finished my paperwork and got to check out some of our VIP patient's photos from his ceremony last week. They were really good and the organizers even had a book made to commemorate the occasion. I'm sure he'll never forget it!

After that, it was time to get my coat and go home. More tomorrow.

Remnants of Ike...no Tina

Yes, we're getting that rain here in our neck of the Midwest. The yard now has a big lake in it. Three of my five evening shifts are done and the last few days have been interesting enough.

Friday I went to a prescription drug abuse seminar put on by a local psych hospital. They even had free CEs for the RNs and all sorts of goodies. I registered via e-mail and got a confirmation but I forgot to bring the e-mail along. I show up early figuring my name is on the lists there and my name is no where to be found (for CE people and non-CE people). I was very agitated about this, but a lot of other people were, too, (and they actually paid for the CEs and need them this month for their various licenses) so I decided the best course of action was to find the local Starbucks, get a coffee and read my e-mail.

I had plans for lunch, so I found a Starbucks in the neighborhood, so I didn't have to drive around in rush hour traffic. I couldn't get on to the wifi hotspot on my Palm, so I read my Rehabilitation Nursing magazine from cover to cover (it's on polytrauma), which I had meant to do for a couple of weeks. It was a good read and I highly recommend it. I wanted my e-mail, though, so I headed up the street to a local eatery that had accessible wifi and I found a nice booth and newspaper and I read my e-mail and the paper until lunchtime. It was a diversion, but a pleasant one nevertheless.

After my fun surfing and reading, I met my friend C. for lunch. C. was happy I got bumped so she could escape the office a little earlier. We had a great time.

At work, I've been lucky enough again to be pushing the med cart. Supposedly, we get a less taxing assignment when we're giving pills, but it's not necessarily the case. I had the AB boys (that's what I'm calling them because of their bug--acinetobacter) up in the front and it was hellish. The room was so hot. Something is wrong with the HVAC system and these guys have fans, but to go in their room garbed up in an isolation gown makes me sweat like mad. It's a lot of work. They can be needy. Thankfully, C. the charge on Thursday kept them quiet for me while I adjusted to being back at work and on the pill delivery route, which, incidentally is all the way at the other end of the unit. (Our boss is really good at crazy geographical assignments like that!)

Outside of that, our new schedule came out and yes, I did actually get those vacation days I asked for recently. I got lucky and found a couple of blank spots on the calendar and asked my boss if I could take off three days in October and three days in November. I'll actually be away for six whole days, since those days are right before my normal weekend off. My husband Dahey is going to surprise me this year for our anniversary. He's making all the plans. All I have to do is show up. At least that was a good excuse for buying a new dress and some other new clothes recently. Bubba will be hanging out with my friend's boys while we're out, so he should have fun.

More later. Stay tuned.