Yes, I'm being silly after my most recent evening shift because I can. I feel fortunate that I left with my mind reasonably intact to drive home.
It's not even a full moon, but the crazies are out. We must be running a special, and while we're not a polytrauma unit, we keep getting TBI patients, who just came off one-to-one status. We don't have enough regular staff, nor PRN agency staffing, like the mothership, but they can send us people and suddenly, they don't need that one-on-one anymore. Hmm, must be a lot of miracles going on these days at Madison. The only miracle I see is the patient leaving one place for another (our little unit).
The crazies aren't actually the TBI people. Happily, they've been quiet. The crazies are our regular, crochety characters who really need to go home. They're bored, so they create problems to get attention diverted to them from other patients.
One regular decided his bed was too hard. (Remind you of someone...maybe Goldilocks?) We called the bed vendor. They check out fancy low air loss mattress on the bed. Bed works based on all their requirements. Patient waits until bed vendor is gone. Patient goes crazy, rings lights, spews expletives and acts all sorts of silly, just below the level where we can call security and get him some nice Haldol (a spray can of that would have been a delight). Charge nurse had to get one of our regular beds and plop Crochety on it, so he'd finally be quiet, for a moment. He continued to be a regal pain all night, for one reason or another. Sometimes, I think this patient did this because he was genuinely bored and it is truly a control issue.
My patients were reasonably good, but I always wonder why the boss gives me the assignment I get. It never ceases to amaze me that I get an assignment to give out pills to half the unit and try to feed two people at once.
Besides Mr. Crochety, we had a guy get unstable on us, so he took an ambulance trip. He was diverted from the hospital we intended to send him to, so the charge had fun getting with the ambulance crew to find out where indeed he was, since she had no idea to whom to give report. Turns out this patient verbalized chest pain and they pulled off and got him to the closest hospital en route instead of trying to get him to Madison.
I ended the night by finally doing all of my charting. I usually chart as I go, but there was no way to do that on that shift. Finishing with my faculties intact was enough relief for me.
Stay tuned...who knows what wild and crazy stuff the weekend will bring!
Friday, August 28, 2009
Thursday, August 27, 2009
When life hands you lemons....
This lady has made lemonade (see this photo). There have been a lot of stories in the news lately about service animals and schools (for more, see this CDC page), but this was the best one I've seen yet. Occasionally, we see a patient or two with a service dog on our unit.
Hope she has a big office with a nice park or something outside where she can walk with her friend at lunch.
Hope she has a big office with a nice park or something outside where she can walk with her friend at lunch.
Wednesday, August 26, 2009
Nuggets for August 26
So many goodies, so little time. Here are a few interesting things I've run across in my travels on the internet. Hope you enjoy!
The Bellingham Herald has an interesting piece called Why Medicaid should get out of the long term care business.
The Wall Street Journal online had an interesting article recently called Hospitals Own Up to Medical Errors.
The NY Times has had a few good stories recently you should read if you haven't already:
For Parents on NICU, the Trauma May Last
PTSD is not uncommon among the parents of preemies.
Saving the world's women
This article, from the NY Times magazine, details the plight of women in the developing world.
Guilt and Atonement on the Path to Adulthood
An interesting view on children, self-control and guilt
The Bellingham Herald has an interesting piece called Why Medicaid should get out of the long term care business.
The Wall Street Journal online had an interesting article recently called Hospitals Own Up to Medical Errors.
The NY Times has had a few good stories recently you should read if you haven't already:
For Parents on NICU, the Trauma May Last
PTSD is not uncommon among the parents of preemies.
Saving the world's women
This article, from the NY Times magazine, details the plight of women in the developing world.
Guilt and Atonement on the Path to Adulthood
An interesting view on children, self-control and guilt
Tuesday, August 25, 2009
He was, and still is a hero...
To many people on our rehab unit, Christopher Reeve is gone, but not forgotten. He brought spinal cord injury and related research a spotlight with star power. Who could ever believe Superman could become a SCI patient?
His son, Matthew, is running marathons in his honor on Team Reeve. Check out this story in the NY Times for more information.
His son, Matthew, is running marathons in his honor on Team Reeve. Check out this story in the NY Times for more information.
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...
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...
Monday, August 24, 2009
Sure, it looks easy
But running around and doing everything you need to do on Monday can get really, really crazy.
I thought I had a reasonable assignment, but I ended up getting involved in miscellany again. One minute it was transferring a patient who didn't want to go anywhere for a test, the next it was changing trach ties. Finally, I get my people finished in time for lunch...literally just in time, as lunch was delivered.
Next, I straightened a room, ate my lunch and enjoyed peace and quiet, when I found out my admission had arrived. I spent the rest of the afternoon getting things done--assessment and paperwork. When I thought I was done, I had to teach to a few people how to draw blood from a PICC. Oh, we so need a refresher on blood draws for some people, including order of the draw. I also realized I need to get educated on bloodstream infections, particularly regarding blood cultures and PICC catheter cultures.
Finally, I finished my day. I was able to sit down to do my paperwork. While I had a moment, I got in on a conversation about alcoholism (an observation by another coworker) and she mentioned this resource. It also made me think later that we might just need to involve more of our patients in alcohol treatment programs than we currently do.
The day didn't quite work the way I thought it would, but it was not terrible. We'll see how the rest of the week goes...stay tuned.
I thought I had a reasonable assignment, but I ended up getting involved in miscellany again. One minute it was transferring a patient who didn't want to go anywhere for a test, the next it was changing trach ties. Finally, I get my people finished in time for lunch...literally just in time, as lunch was delivered.
Next, I straightened a room, ate my lunch and enjoyed peace and quiet, when I found out my admission had arrived. I spent the rest of the afternoon getting things done--assessment and paperwork. When I thought I was done, I had to teach to a few people how to draw blood from a PICC. Oh, we so need a refresher on blood draws for some people, including order of the draw. I also realized I need to get educated on bloodstream infections, particularly regarding blood cultures and PICC catheter cultures.
Finally, I finished my day. I was able to sit down to do my paperwork. While I had a moment, I got in on a conversation about alcoholism (an observation by another coworker) and she mentioned this resource. It also made me think later that we might just need to involve more of our patients in alcohol treatment programs than we currently do.
The day didn't quite work the way I thought it would, but it was not terrible. We'll see how the rest of the week goes...stay tuned.
Thursday, August 20, 2009
Wednesday, August 19, 2009
Remember that patience thing?
Thank goodness I had a lot of patient patients today. Oh. My. Freaking. Heavens. If it wasn't one thing, it was another.
I never do EKGs and I had to do two today. I am so, so, so happy one of our new (to us) nurses was working, because, with her help, F. and I tag-teamed to get them done right after another when the docs would go from "Hi how you doing?" rounding, to barking this order and that STAT! F., I wouldn't have made it without you!
Other people who are getting ready to go home decided to get sick...or get a PE or something. Just what I want to do near the end of the shift.
And my regularly scheduled people? They went with the flow...no whining or no crabbiness.
Even though my back hurts, I ended up having a good day.
More to come...stay tuned.
I never do EKGs and I had to do two today. I am so, so, so happy one of our new (to us) nurses was working, because, with her help, F. and I tag-teamed to get them done right after another when the docs would go from "Hi how you doing?" rounding, to barking this order and that STAT! F., I wouldn't have made it without you!
Other people who are getting ready to go home decided to get sick...or get a PE or something. Just what I want to do near the end of the shift.
And my regularly scheduled people? They went with the flow...no whining or no crabbiness.
Even though my back hurts, I ended up having a good day.
More to come...stay tuned.
Tuesday, August 18, 2009
Please be patient...
God's not done with me yet." -- sign on a door I saw recently.
With the influx of people recently to our unit, I'm reminded that my services are important where I work. Sometimes I get frustrated because I see people working as if we're in an assembly line. Do the tasks, run to break, go back and then clock out. I have to work daily to remember a few very important things.
First, I'm dealing with people, not auto parts on an assembly line. Deviations can, and will occur on a regular basis, because of the all the people involved in the process.
Second, I may have that task list in my mind, but I'd like to do things better and try new things. Many times patients can clue you in to tricks you never may have thought of employing. One patient told me recently, "Hey, I can't move that arm, but if you put it on a pillow, I can wiggle my shoulder some if I need to and that helps me." Hey, I'm no rocket scientist, but if it makes you happy and keeps you from hurting, let's do it!
Third, patients can and will speak if you let them. Sometimes the best thing to do is shut up and listen. Here are a few of them speaking on the internet. I hope you take the time to listen to them. I did and thoroughly enjoyed these stories and sites.
I found Astrid in the Netherlands from my sitemeter log. I was equally impressed that I made her blogroll. She's got a great blog with loads of posts about dealing with blindness and her other diagnoses. Don't miss it!
Patient Dave talks about you owning cancer or cancer owning you amid other interesting posts.
Steve's got lots of information on Adventures of a Funky Heart, as an adult congenital heart defect survivor.
Leslie has a great blog called Getting Closer to Myself. I really enjoyed this recent post called Everyone wants to be a 10, but no one wants to be a 710. You'll have to read it if you want to know what a 710 is!
With the influx of people recently to our unit, I'm reminded that my services are important where I work. Sometimes I get frustrated because I see people working as if we're in an assembly line. Do the tasks, run to break, go back and then clock out. I have to work daily to remember a few very important things.
First, I'm dealing with people, not auto parts on an assembly line. Deviations can, and will occur on a regular basis, because of the all the people involved in the process.
Second, I may have that task list in my mind, but I'd like to do things better and try new things. Many times patients can clue you in to tricks you never may have thought of employing. One patient told me recently, "Hey, I can't move that arm, but if you put it on a pillow, I can wiggle my shoulder some if I need to and that helps me." Hey, I'm no rocket scientist, but if it makes you happy and keeps you from hurting, let's do it!
Third, patients can and will speak if you let them. Sometimes the best thing to do is shut up and listen. Here are a few of them speaking on the internet. I hope you take the time to listen to them. I did and thoroughly enjoyed these stories and sites.
I found Astrid in the Netherlands from my sitemeter log. I was equally impressed that I made her blogroll. She's got a great blog with loads of posts about dealing with blindness and her other diagnoses. Don't miss it!
Patient Dave talks about you owning cancer or cancer owning you amid other interesting posts.
Steve's got lots of information on Adventures of a Funky Heart, as an adult congenital heart defect survivor.
Leslie has a great blog called Getting Closer to Myself. I really enjoyed this recent post called Everyone wants to be a 10, but no one wants to be a 710. You'll have to read it if you want to know what a 710 is!
Not what you'd expect
It was education night again recently. I am always amazed that new patients and new nurses can really get the conversations flowing.
A new patient came to the unit recently. He won't be with us long, but for the new nurses, he'll be remembered. He was slight with salt and pepper hair. He had just arrived and since one of the newer nurses gave report again, we had little to go on, so I headed to the chart. Not much there, either, but I managed to piece together a little story.
Patient is living his life with family in a successful blue collar job and has a "nervous breakdown" and never returns to his job. A few years ago, he gets diagnosed with MS. He goes from walking around house to pushing himself in a wheelchair.
The most striking thing among the new nurses is that they're hot for a diagnosis. "Wow, look at him shake doing xx," one exclaimed. "Are we taking Parkinson's patients now?" No, I reply to NN1 (New Nurse 1 --we have several right now), remember Mr. X has MS."And so education begins...
Where do we start? We comb the chart again, and finally, the docs update the notes. We know he has MS and from the chart and meds, we can tell a few things about him. He's got those tremors because he's had lots of issues going on upstairs, because of the infamous plaques. He's had lots of seizures, and tried lots and lots of meds, most of which give him reactions, so he's been switched around a lot. Next, we see he's on some different treatments, too, which are often used in areas outside MS, particularly in transplant patients. Following that, we reviewed some neuroanatomy. The brain is a wonderful thing. It's got several mechanisms to tell you that something's wrong and generally gives you an idea of where the problems might be.
After we looked at his chart for more information, we headed on over to the MS Society website for more information. This had the new kids going for at least an hour, but I suspect a few of them will keep learning, eager to absorb whatever they can. The Professionals section at the MS Society has an area specifically for nurses. More good sites for information are the following:
The MS section of NINDS the National Institute of Neurological Disorders and Stroke (from the NIH)
IOMSN International Organization of Multiple Sclerosis Nurses
MultipleSclerosisProfessional.org
Neuroanatomy online has lots of MRIs and other graphic information on neurological disorders.
Sometimes an unexpected event leads to lots of learning. We'll see where it goes.
More to come...stay tuned.
A new patient came to the unit recently. He won't be with us long, but for the new nurses, he'll be remembered. He was slight with salt and pepper hair. He had just arrived and since one of the newer nurses gave report again, we had little to go on, so I headed to the chart. Not much there, either, but I managed to piece together a little story.
Patient is living his life with family in a successful blue collar job and has a "nervous breakdown" and never returns to his job. A few years ago, he gets diagnosed with MS. He goes from walking around house to pushing himself in a wheelchair.
The most striking thing among the new nurses is that they're hot for a diagnosis. "Wow, look at him shake doing xx," one exclaimed. "Are we taking Parkinson's patients now?" No, I reply to NN1 (New Nurse 1 --we have several right now), remember Mr. X has MS."And so education begins...
Where do we start? We comb the chart again, and finally, the docs update the notes. We know he has MS and from the chart and meds, we can tell a few things about him. He's got those tremors because he's had lots of issues going on upstairs, because of the infamous plaques. He's had lots of seizures, and tried lots and lots of meds, most of which give him reactions, so he's been switched around a lot. Next, we see he's on some different treatments, too, which are often used in areas outside MS, particularly in transplant patients. Following that, we reviewed some neuroanatomy. The brain is a wonderful thing. It's got several mechanisms to tell you that something's wrong and generally gives you an idea of where the problems might be.
After we looked at his chart for more information, we headed on over to the MS Society website for more information. This had the new kids going for at least an hour, but I suspect a few of them will keep learning, eager to absorb whatever they can. The Professionals section at the MS Society has an area specifically for nurses. More good sites for information are the following:
The MS section of NINDS the National Institute of Neurological Disorders and Stroke (from the NIH)
IOMSN International Organization of Multiple Sclerosis Nurses
MultipleSclerosisProfessional.org
Neuroanatomy online has lots of MRIs and other graphic information on neurological disorders.
Sometimes an unexpected event leads to lots of learning. We'll see where it goes.
More to come...stay tuned.
Saturday, August 15, 2009
A little light cynicism
Oh, it's the latest initiative...put everyone in a room, have them bring their lunches and talk. Yes, they've brought back the famous "lunch and learn" but not on any topics you want to learn about. (I'm just hoping most people aren't bringing this lunch along, or it will probably negate whatever they learn.)
No, our topic is, in a nutshell, "how do we get along and play well with others without acting like primadonnas." Guess we gotta start somewhere.
Thankfully, none of these are mandatory...and many are planned on my regularly scheduled day off. I'll be thinking about the stress relievers as I relieve my stress at home cleaning or at the salon getting my regularly scheduled services.
As they say, charity does really begin at home.
No, our topic is, in a nutshell, "how do we get along and play well with others without acting like primadonnas." Guess we gotta start somewhere.
Thankfully, none of these are mandatory...and many are planned on my regularly scheduled day off. I'll be thinking about the stress relievers as I relieve my stress at home cleaning or at the salon getting my regularly scheduled services.
As they say, charity does really begin at home.
Thursday, August 13, 2009
Nuggets for August 13
There were a whole lot of interesting items out there recently, so here are a few of them for your viewing pleasure.
You've got questions...
They've got answers, and no, it's not an electronics store. ConsultantLive had this great article on the ubiquitous purple urine bag. I've seen it a few times before (also blue) and asked questions about it, and never got a straight answer until I found this article. They also have a number of other articles of interest, so peruse at whim.
Crispy and brown
Feeling burnt out? Need to read something to get you going? Laura Wisniewski has this great article over at www.nursinglink.com called Re-Engage Your Passion for Nursing that has a few interesting points to ponder.
A telling anniversary
It's been ten years (yes, it was 1999) that the IOM published To Err Is Human: Building a Safer Health System.
There are still lots and lots of mistakes happening out there. The Houston Chronicle (a Hearst Newspaper) recently ran a series called Dead by Mistake on what the state of error reporting is in the US, and it's not so hot. Don't miss it.
Study, study, study
I'm still doing some certification study (yes, it seems like forever...) and I ran into some terms I didn't recognize, so I went searching and found some articles of interest.
Glossopharyngeal breathing is used with some ventilated SCI patients. This article explains what exactly it is and how it works.
Figure ground deficit is explained in this Google Book called Neurological Disabilities: Assessment and Treatment.
I always feel weak in my studies of the brain, so I found this article about a particular TBI patient very interesting as an aside. (from http://www.nytimes.com/)
Privacy (or lack thereof)
And you thought a prescription was private (from http://www.nytimes.com/)
I just shuddered reading this article...what will they think of next? I'm sure all you pharmacists out there have some stories like this.
And everything else about bloggers
It seems like life is very electronic these days...with good and bad results. Here are a few articles about various topics related to blogging I've seen lately. And, no, some things just don't need to be blogged or explained electronically, at least not in my little world, thankyouverymuch!
Mommy bloggers and ethical conflicts (from http://www.cnn.com/)
A no tweet, no blog party (from http://www.nytimes.com/)
You've got questions...
They've got answers, and no, it's not an electronics store. ConsultantLive had this great article on the ubiquitous purple urine bag. I've seen it a few times before (also blue) and asked questions about it, and never got a straight answer until I found this article. They also have a number of other articles of interest, so peruse at whim.
Crispy and brown
Feeling burnt out? Need to read something to get you going? Laura Wisniewski has this great article over at www.nursinglink.com called Re-Engage Your Passion for Nursing that has a few interesting points to ponder.
A telling anniversary
It's been ten years (yes, it was 1999) that the IOM published To Err Is Human: Building a Safer Health System.
There are still lots and lots of mistakes happening out there. The Houston Chronicle (a Hearst Newspaper) recently ran a series called Dead by Mistake on what the state of error reporting is in the US, and it's not so hot. Don't miss it.
Study, study, study
I'm still doing some certification study (yes, it seems like forever...) and I ran into some terms I didn't recognize, so I went searching and found some articles of interest.
Glossopharyngeal breathing is used with some ventilated SCI patients. This article explains what exactly it is and how it works.
Figure ground deficit is explained in this Google Book called Neurological Disabilities: Assessment and Treatment.
I always feel weak in my studies of the brain, so I found this article about a particular TBI patient very interesting as an aside. (from http://www.nytimes.com/)
Privacy (or lack thereof)
And you thought a prescription was private (from http://www.nytimes.com/)
I just shuddered reading this article...what will they think of next? I'm sure all you pharmacists out there have some stories like this.
And everything else about bloggers
It seems like life is very electronic these days...with good and bad results. Here are a few articles about various topics related to blogging I've seen lately. And, no, some things just don't need to be blogged or explained electronically, at least not in my little world, thankyouverymuch!
Mommy bloggers and ethical conflicts (from http://www.cnn.com/)
A no tweet, no blog party (from http://www.nytimes.com/)
Wild and wonderful
That's been my story at work lately. The transition from one shift to another sometimes can be wild.
One day, I walk in, get going and the gates of Hades open all at once. Nurse Assistant has a patient who's got shortness of breath and "looks funny". Well, he's not acting funny, but probably is a little shaky from the albuterol he just took. Get him situated, tell docs, do vitals, get more albuterol. In a few minutes, patient looks happy as a clam and is chatting away as the nurse assistant gets him ready.
Another day, the specialists round. They like me. Not only do I get to deal with my patients, I have to help them with paperwork on a couple of others, because I know how to work the computers for that feature, even though, all I do is act as a witness. Gee, I feel so special! Thankfully, boss and company only follow these people around once a week. Other nurses thank their lucky stars that they don't get "picked". I've known the specialist for a while before I came to Madison. He can be loud and obnoxious, but underneath, he's a softie. He just doesn't want any of the nurses to know that.
Doc Specialist is also a running doc. It seems like the specialists drift to one of two categories--they either golf or they run. Our leader is the exception. He's too brainy to do either; although, if I had to guess, he'd probably fall in a lot easier with the runners rather than the golfers.
So after all the wild and crazy antics, I get a phone call. Miraculously, I got a scholarship for grad school. They confirmed I was there to send the fax to me. I looked it over and saw it was for the entire amount of the program. You could have knocked me over with a feather. I'll have some other restrictions and requirements as a result, but my financial burden will be lessened. I was so relieved. I don't have to keep doing number-crunching to figure out how many extra shifts I need to pick up to pay for each semester. Now, I just have to concentrate on getting my work done and my schoolwork done...just like Bubba, who starts school soon. Should be fun getting into school routine after some time away from it.
More to come...stay tuned.
One day, I walk in, get going and the gates of Hades open all at once. Nurse Assistant has a patient who's got shortness of breath and "looks funny". Well, he's not acting funny, but probably is a little shaky from the albuterol he just took. Get him situated, tell docs, do vitals, get more albuterol. In a few minutes, patient looks happy as a clam and is chatting away as the nurse assistant gets him ready.
Another day, the specialists round. They like me. Not only do I get to deal with my patients, I have to help them with paperwork on a couple of others, because I know how to work the computers for that feature, even though, all I do is act as a witness. Gee, I feel so special! Thankfully, boss and company only follow these people around once a week. Other nurses thank their lucky stars that they don't get "picked". I've known the specialist for a while before I came to Madison. He can be loud and obnoxious, but underneath, he's a softie. He just doesn't want any of the nurses to know that.
Doc Specialist is also a running doc. It seems like the specialists drift to one of two categories--they either golf or they run. Our leader is the exception. He's too brainy to do either; although, if I had to guess, he'd probably fall in a lot easier with the runners rather than the golfers.
So after all the wild and crazy antics, I get a phone call. Miraculously, I got a scholarship for grad school. They confirmed I was there to send the fax to me. I looked it over and saw it was for the entire amount of the program. You could have knocked me over with a feather. I'll have some other restrictions and requirements as a result, but my financial burden will be lessened. I was so relieved. I don't have to keep doing number-crunching to figure out how many extra shifts I need to pick up to pay for each semester. Now, I just have to concentrate on getting my work done and my schoolwork done...just like Bubba, who starts school soon. Should be fun getting into school routine after some time away from it.
More to come...stay tuned.
Monday, August 10, 2009
Heard on the unit...
Aw, it's been forever since I've had enough goodies for this segment! But when patients speak, sometimes we just bite our tongues and run as fast as we can to our lunch break, so we can share with the rest of the folks on the unit and with the audience at home.
Situation 1
RN is educating patient about the proper way to use an incentive spirometer. After demonstrating proper technique, patient says, "Oh, that's just like what I do at home with my bong." RN listens as patient describes how marijuana "relaxes my legs so I can get into my chair."
Sorry, remember that non-smoking thing you signed to come here for rehab? Yep, it applies to Mary Jane, too.
Situation 2
RN is talking to patient re: helping himself (He's a lower level thoracic paraplegic, so he can do it) by dressing and turning himself. "Oh, I'm not going to do that (turning) at home. I'll just wake her up." (implying whatever woman happens to be in his bed.)
Nice. My reply, "So since Babe #1 is not here, could you just move the pillows and turn yourself, please?"
Situation 3
From patient who is not really observant about following his intermittent catheterization rules or fluid restrictions.
"Where's my nurse? I missed my appointment." says Mr. Drinks-A-Lot.
"What appointment?" I asked.
"My catheter appointment. I've got a headache."
"Yes," I replied, "and you realize this is a sign of dysreflexia, correct?"
Patient shakes head.
If only Tom and Ray were here to do this...more to come...eventually!
Situation 1
RN is educating patient about the proper way to use an incentive spirometer. After demonstrating proper technique, patient says, "Oh, that's just like what I do at home with my bong." RN listens as patient describes how marijuana "relaxes my legs so I can get into my chair."
Sorry, remember that non-smoking thing you signed to come here for rehab? Yep, it applies to Mary Jane, too.
Situation 2
RN is talking to patient re: helping himself (He's a lower level thoracic paraplegic, so he can do it) by dressing and turning himself. "Oh, I'm not going to do that (turning) at home. I'll just wake her up." (implying whatever woman happens to be in his bed.)
Nice. My reply, "So since Babe #1 is not here, could you just move the pillows and turn yourself, please?"
Situation 3
From patient who is not really observant about following his intermittent catheterization rules or fluid restrictions.
"Where's my nurse? I missed my appointment." says Mr. Drinks-A-Lot.
"What appointment?" I asked.
"My catheter appointment. I've got a headache."
"Yes," I replied, "and you realize this is a sign of dysreflexia, correct?"
Patient shakes head.
If only Tom and Ray were here to do this...more to come...eventually!
Saturday, August 8, 2009
Ironies
There are just some things that are very ironic in my job.
First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.
I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).
Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.
Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.
Stay tuned. More merriment to come...
First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.
I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).
Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.
Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.
Stay tuned. More merriment to come...
Thursday, August 6, 2009
It's that time of day...
...when you can say, "go on and head for the mountains."
Wait, this ain't no beer commercial! Head on over to Man-Nurse Diaries and check out the latest version of Change of Shift. And, I'm not going to spoil it, but you HAVE to read the fine print at the end. MND, you surely had fun with this one...in more ways than one!
Thanks for including me in this edition, and go crack open your favorite beverage, if you're so inclined.
More to come...
Wait, this ain't no beer commercial! Head on over to Man-Nurse Diaries and check out the latest version of Change of Shift. And, I'm not going to spoil it, but you HAVE to read the fine print at the end. MND, you surely had fun with this one...in more ways than one!
Thanks for including me in this edition, and go crack open your favorite beverage, if you're so inclined.
More to come...
Tuesday, August 4, 2009
Cookin'
That's what I'm doing on my day off, enjoying the overcast skies. If I could sing on key, I'd probably pen an ode to my favorite kitchen appliance.
A little housecleaning, a little shopping and a little visiting with friends will make my day complete.
Stay tuned...it's back to the ranch soon, so more fun ahead!
A little housecleaning, a little shopping and a little visiting with friends will make my day complete.
Stay tuned...it's back to the ranch soon, so more fun ahead!
Monday, August 3, 2009
Life and death
I've been lucky this week. Things finally calmed down. My first couple of days were pretty exciting.
There is always a hustle and bustle on one particular day of the week, because it's this day that we get the most patients admitted to the unit. This day also is the day I work my evening shift after a day of rest. Sometimes, I have time to get rolling and other times, I have no time at all and that was the case.
I got in and one of my patients needed blood after the first two hours of the shift. Only no one got his consent, which means I had to track down our doc, who was long gone and out of pager range, then call the local on call doc to get him/her to come over to do the MD portion of the paperwork. Said patient was a little perturbed because his favorite MD never told him he might need blood. Happily, he got over that, and I got the blood started before the end of my shift and even led one of the new nurses in the process so he/she would get some practice, since we don't give too much blood at night. All was good.
The next day, everyone's happy and I'm actually getting into my rooms right after report. In one room I smell something funny. I look and see my quad patient has bursted his colostomy. Get goodies and clean him up. I think the wafer is intact, so I get ready to put the new bag on, and discover it's not. Get all stuff set up and put on new wafer. Three sides are taped with pink tape (because he needs it) and all of a sudden I see a geyser. Thankfully, I caught it with the nearby towel. (Nursing students: never change a colostomy bag without one...if you do, do so at your own risk!) Finish cleaning, finish taping and I kept praying all night he wouldn't do that number again.
Another patient recently asked me about last rites and whether he got them when he was very ill. Since we have an active chaplain service, it was really easy to check the chart. Besides, I told him, spiritual care is also mandated by JCAHO.
One day, I came in to the news that one of our recently discharged patients had died. It was shocking, because, he/she was young and in a way, it wasn't. This patient always denied suicidal ideation, but something about him/her caused a faraway look on their face that made you think they would not be around for a long time. We often talked about ghosts and somewhat about death, because our unit has a reputation for being haunted. Said patient even stated that he/she saw something in one of the rooms he was in that lead him/her to believe that the stories were true--curtains jiggling at night, and a reflection in the mirror when no one was around. He/she wasn't worried, because he/she hoped his/her roommate, who died during his/her time was the ghost hanging out in that room, because it was comforting.
And so the week of work is ending, and the sturgeon moon is on the way. We'll just wait and see how it goes. More to come...stay tuned!
There is always a hustle and bustle on one particular day of the week, because it's this day that we get the most patients admitted to the unit. This day also is the day I work my evening shift after a day of rest. Sometimes, I have time to get rolling and other times, I have no time at all and that was the case.
I got in and one of my patients needed blood after the first two hours of the shift. Only no one got his consent, which means I had to track down our doc, who was long gone and out of pager range, then call the local on call doc to get him/her to come over to do the MD portion of the paperwork. Said patient was a little perturbed because his favorite MD never told him he might need blood. Happily, he got over that, and I got the blood started before the end of my shift and even led one of the new nurses in the process so he/she would get some practice, since we don't give too much blood at night. All was good.
The next day, everyone's happy and I'm actually getting into my rooms right after report. In one room I smell something funny. I look and see my quad patient has bursted his colostomy. Get goodies and clean him up. I think the wafer is intact, so I get ready to put the new bag on, and discover it's not. Get all stuff set up and put on new wafer. Three sides are taped with pink tape (because he needs it) and all of a sudden I see a geyser. Thankfully, I caught it with the nearby towel. (Nursing students: never change a colostomy bag without one...if you do, do so at your own risk!) Finish cleaning, finish taping and I kept praying all night he wouldn't do that number again.
Another patient recently asked me about last rites and whether he got them when he was very ill. Since we have an active chaplain service, it was really easy to check the chart. Besides, I told him, spiritual care is also mandated by JCAHO.
One day, I came in to the news that one of our recently discharged patients had died. It was shocking, because, he/she was young and in a way, it wasn't. This patient always denied suicidal ideation, but something about him/her caused a faraway look on their face that made you think they would not be around for a long time. We often talked about ghosts and somewhat about death, because our unit has a reputation for being haunted. Said patient even stated that he/she saw something in one of the rooms he was in that lead him/her to believe that the stories were true--curtains jiggling at night, and a reflection in the mirror when no one was around. He/she wasn't worried, because he/she hoped his/her roommate, who died during his/her time was the ghost hanging out in that room, because it was comforting.
And so the week of work is ending, and the sturgeon moon is on the way. We'll just wait and see how it goes. More to come...stay tuned!
Happy Birthday Emergiblog!
Yes, today's the day four odd years ago that Kim started her blog, and the multiple minions of the nursing world, myself included, in the big and small cities, megahospitals and clinics, have followed in her much larger footsteps.
How lucky we are, since Emergiblog not only tells you about life in the ER, but also brought Change of Shift to life, which has given the world a little slice of the realities of nursing life out there.
As they say in Poland, sto lat...may you have a hundred more!
How lucky we are, since Emergiblog not only tells you about life in the ER, but also brought Change of Shift to life, which has given the world a little slice of the realities of nursing life out there.
As they say in Poland, sto lat...may you have a hundred more!
Saturday, August 1, 2009
Rain!
That means no weeding for me, but at least, I don't have to water the tomatoes. Busy, busy day. More to come later this weekend...stay tuned!
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