January 13, 2012
Shew… today was quiteeeeee a day, day 3 of work, but I wanted to write about my Friday before hitting the sack. Ill write about Saturday (14th) and Today (15th) tomorrow when I get out of my “class” (i.e. hospital orientation that I should have taken in September lol). Oooookay!
Patient #1: This funny little spanish man was a trip. He had a laproscopic sigmoidectomy with cystoscopy with stent placement (in English: surgeons went in through 4 tiny surgical sites and a larger incision in the abdomen and removed a portion of the large intestine, but he did not have a ostomy [or an opening in his abdomen where feces comes out into an appliance] so they obviously were able to reattach the colon to the rectum, and then looked inside the bladder then placed tubes between the bladder and the kidney). Not too sure why he got all that done… possibly chronic kidney stones… it obviously was something that led to the inability of the urine to travel from the kidneys to the bladder. Anyways. We were just waiting for him to have a bowel movement (BM), he had been in our unit for 3 days and that is all we were waiting for. He was a funny man who was wayyyyy too concerned about his blood pressure lol. His family came in towards the end of shift and we all joked and laughed. He was never on his call light, no pain, just no BM. FINALLY! It happened! He had a very small BM and since he had abdominal surgery, his BM was mainly really dark, old blood. He, freaked, out. I tried to explain to him that this is totally normal. He seemed to understand. So I call the GI doc on call and tell her, she rounded on him and said he could go home that day if he wanted to. He at first was like, “YES!” and then he started changing his mind and told the doc “I cant go home until at least next thursday because his ex-girlfriend was at his house…………… what? Doc tells him, “We cant keep you here, especially not until Thursday, just because you dont want to face your ex-girlfriend.” All of a sudden he didnt have a ride so we decided to keep him for one more day. Sigh. Its alright… he was a super easy patient… I wasnt going to argue.
Patient #2a: This was a very, VERY blessed young woman. She was in a motor vehicle accident, unrestrained, with rollover. She was found conscious in the upside down car on the inside roof. She didnt hardly have a scratch on her… she said all she could remember was singing a song and then came to in our unit the next day. I cracked a joke that its because she was listening to something epic like Lady Gaga lol. She was a wonderful girl, had a beautiful baby, and a loving husband. She was trying to go to nursing school and I got to sit with her for like 45 minutes and talk about the ins and outs of getting into nursing school and what it involves. She was great, I was sad to discharge her.
- New Knowledge: She had a Panorex done first thing in the morning. I thought it was going to be a rough day because I had to BEG the transporter to stay because I couldnt get her to get out of the shower and get dressed fast enough. I thought the transporter was going to kill me because the test was STAT (in other words, drop every effing thing you are doing and get this shit done!) and if she left, it might have been another 30min-1h to get another one to come get her. ANYWAYS! I had no idea what a Panorex was, but essentially its pretty much what they do in a dentist office. Its an xray of the upper and lower jaw. They wanted to make sure she didnt have a jaw fracture. She was fine, got discharged later that day.
Patient #2b: Pretty much as soon as we got her out, report for my new patient was called. This woman, another lovely lady, had a stapled hemorrhoidectomy. This is where they insert a device through the anus, the enlarged hemorrhoids are then stapled at the based and the enlarged hemorrhoids surgically removed. She was supposed to go home that day, but we kept her for pain control. I got report and the lady in postop was telling me that the pt was stating she was staying in a pain level between 9 and 10. I asked her, “Is she like a crazy, out of control, 9 or 10 or is she a calm 9 or 10?” Apparently she was a calm 9 and 10…. I was pretty hesitant because usually postop straight LIES and the patient that is a 5 comes to my floor in an utter effing pain crisis that I trying to control for 3 hours. But, nope, came to the floor, calm as can be, rating her pain a 10. She too was an easy patient that was never on the call light. She just chilled in her room with her PCA, and her and I chit chatted back and forth for a while. I joked her friend needed to make a food run for us. Pick me up some Panera. I gave him a really long, complicated order, he laughed and says, “Yeah, okay, you got money for that?” I say, “MONEY?! I SAVED HER LIFE! THAT DESERVES A FREE DINNER!!” lol Plan was to discharge her the next day.
Patient #3: Thissss guy. He was a really nice guy, and so was his wife, was omg. Anxious and a big ole baby. He was first admitted into one of our sister hospitals and then transferred over to us. He was admitted with Cellulitis of his legs (a bacterial skin infection). He was edematous all overrrrr and after he had a procedure done, he was able to eat. Well the doctors ordered him a Regular Cardiac and Diabetic diet. In other words he got a diet of regular food that was low sugar and low sodium. Oh boy, that pissed him off sooooo bad. I tried to explain to him the diet, so what does he do, has someone bring him a salt shaker and then orders whatever food he wants. *sigh* Not gunna fight him. But every time he would move he would, like, scream… but not like a scared scream, like a high pitched, tiny-baby scream. I had never heard such a thing. So his main problem was that he was having numbness in one of his hands, a consult had been ordered with a neurovascular doctor who ran a test and then never followed up……. like an asshole. So I am blowing up this doctor’s nurse practitioner to come explain the results of the test to the patients. The wife was talking about getting upper management involved so I made sure things happened. Finally, another neurovascular doctor came up, explained the results, ran his own test and then agreed to follow up outpatient. Crisis averted. But on top of his cellulitis, his edema, and ulnar neuropathy….. he had a superficial vein blood clot. I got orders for warm compress to his arm…… yeah, he wouldnt let it happen. We told him he needed to elevate his arms and legs and decrease his sodium, he wasnt down with that either. Ack. Well, if he wasnt so nice, and if his wife wasnt so nice, I probably would have been soooooo over this guy. But he wasnt a tough patient either really. Good day with him and his wife.
- Little Info: If a person has edema, they need a diet low in sodium. Water follows sodium, so decrease the sodium in the system, you decrease the sodium that is follow the sodium in the extremities therefore decreasing the edema.
Patient #4: My first day of 3 with this patient, he looked really rough. He had a PCA, he was nothing by mouth but hard candy, BP sky high, no BM, not passing gas, poor pain control, difficulty getting out of bed. He was so pitiful. He and his mom were so, so nice. He was cracking jokes with them, trying to cheer them both up. He had been admitted with Short Bowel Obstruction (obstruction in his intestine) and was so sick. Turned out his intestine was obstructed with a large malignant tumor (a deadly cancer growth). We were doing everything we could to get him to at least pass gas, he had been admitted on the 8th and we couldnt really do anything for him until he passed gas or had a BM. Kinda like the first patient. So my first day with him, all I could do for him is make him laugh and force him to get up and walk around, to get the bowels moving and relieve some gas pain. The crapper with this patient, some nuclear medicine tests were ordered, but we didnt have the correct equipment… I had to call the doctor and give him a crap ton of choices…… guess who didnt call me back… idiot doctor. That kind of pans out the next day. THEN a 24 hour urine was ordered for a 5-HIAA which is used to detect tumors in the digestive tract. My tech explains the damn procedure to the patient SOOOOOOO wrong which led to me having to correct EVERY single thing the tech said…. leading to confusion, which led to a repeat of the test. Damn it.
- Little Info: if a patient is not passing gas, the BEST thing for that patient to do is get up and walk. A little exercise is the best way to get the bowels movement, to move the air in the intestines and, of course, pass gas. He was nothing by mouth except hard candy and gum. When chewing gum, you swallow air, typically, this is not a really good thing (as his mom pointed out, its a horrible idea with gastritis) but the goal of the doctors hope was this swallowing of air would push air and gas through the bowels and force it out.
- New Knowledge: I had done a 5-HIAA test once before so this isnt really new knowledge. For MY hospital, this is the procedure. We have to go to the lab to get a specific lab container. If begun in the morning, the first urine goes into the toilet and then the rest of the urine is collected for 24 hours. Our containers contain a specific chemical for the test and the container must remain on ice. So the patient urinates into a new urinal, and each time they urinate, they call us to put the urine into the container and we keep the container in a bucket of ice. Remember, if a urine is missed, the test is ruined and has to be started all over.
Patient #5: Now THIS guy and his wife were the MOST interesting of the crew! haha. Wonderful, wonderful, wonderful people. They were just so kind. But the patient was the most anxious person EVERRR! His wife was very calm and collected, that is… until he got anxious, then it would make her anxious, which would make him more anxious and they anxiousness would steadily increase until it was almost panic unless I intervened. Okay, so he had a *deep breath* cystoscopy with stent placement, colovascular resection, and repair of splenic flexure *catches breath* Okay… lets place that in English. Again, he first had a tube placed between the kidney and bladder to route urine from kidney to bladder; separation of colon from bladder; and correction of the right side of the colon that was distended. So want to know WHYYYYYYYYYYYYY he had this surgery??? Im going to start off saying that this man is probably the last person on this Earth that deserves ANYTHING adverse to happen to him. Same with his wife. But…….This is probably the coolest thing I ever heard. He was having groin pain for about a year and a half. Shortly before his admission of over a week, he began urinating FOOD….. I mean that is what was given to me in report, but it had to have been urination of feces. But holy ish…. that was nutssss. A fistula was formed between the bladder and the colon (which is actually pretty common in patients with diverticulitis), the colon and the bladder fused together and an opening between the two occurred which eventually led to the right side of the colon bloating, bending, and/or twisting. When I got this patient, he was attached to remote telemetry, 2 JP drains, and a Foley in place X9days. All morning we had been having trouble with the remote tele box. I had been on and off the phone for several hours with tele department trying to find a fix. The box was saying a lead was off, I had replaced all the electrodes, the remote tele cables, and the batteries. Nope, fail. The tele unit sends me old school cables… extra fail. So I tell the telemetry woman to give me a little while, Im going to call the doctor and see if I can get the tele order discontinued. About 5 minutes after I tell her this, I get a call from my assistant manager that he had been off tele for over an hour…………………….. no shit? Handling it. Finally, we get the order discontinued and he and his wife are stoked. Our next goal was to get the foley catheter out. Now with this patient, we were also waiting and waiting and waitinggggg for him to have a BM… just couldnt get it to happen (Happened the next day…… thats a good story too. Stay tuned). At the end of my shift I FINALLY get the order to pull out the Foley! Yayyyyy! He was so happy… he had been pacing all over the place, almost in tears because he still had a foley in and his two JP drains (which should have been pulled out several days ago because they were having absolutely no output). So anyways. I walk in and say, “YAY! I am going to get the stuff I need to pull out that foley!” The patient looks terrified, the wife, in all seriousness says, “The doctor is not going to come in and pull it out? Doesnt the doctor need to do that?” I know I made a crazy face and dumbfounded stumble through, “um… no… a doctor never pulls out foleys really, usually the techs pull out the foleys.” They continue to look terrified. I try to console them and explain I have pulled out a bazillion Foleys before and which seemed to calm them down a little…. just a little. So I start explaining how I pull the foley out in, step by step, very detailed. So I deflated the balloon, I showed him all the fluid I pulled and squirted it out. Then made another attempt to pull out more fluid despite the fact I just pulled out 9.5cc of fluid and show him again that there is no fluid in the balloon. So I take the foreskin of his penis in one hand and the foley in the other, I tell him Im going to pull a little to ensure the balloon is deflated then pull it the rest of the way out. I pull a little, no resistance, then go to pull the rest out….. he screeches! Which scared the hell out of me and I let go. He jsut keeps screaming “STOP! STOP! PLEASE STOP!” I try to explain to him that the foley had been in for 9 days, its not as lubricated as a 2 day old foley, that this happens sometimes, he is okay, I only have about 1.5 inches left. His wife is hollaring, “We should have lubricated it before pulling it out!!!!” I explain to her, and I cant believe I had to explain this to someone, that is impossible. She just keeps saying it. Im trying to calm him down and dont even notice her leave. She goes and gets another nurse. I roll my eyes but explain what is going on to my friend and coworker. She tells him and her the same exact things that I do and tries to calm him down…. and again explains to the wife that it is impossible to lubricate a foley while it is in. I get her to go get his ativan, valium , dilaudid ANYTHINGGGG! She leaves. The wife goes, “Dont they have catheter removing specialists?!” Losing my patience I say, “Yeah, my tech.” He starts begging me to go get the charge nurse. I tell him, she isnt going to do anything but do what I need to do and that is PULL IT OUT! He insists so I just say okay and get the charge nurse. I tell my charge what happened and she is like, “wtf?” By then the night charge is there and she too is like, “wtf…” They both come with me to the room. They go on to explain to them exactly what I and my coworker did…………. and again……….. explain that a foley can not be lubricated after insertion…….. *sigh* My day shift charge leaves the room, the patient is like crying screaming “YOU’RE LEAVING?!?!” The night charge is like, “Im a charge nurse too, now lay back, lie still, and lets get this thing out!” He is so tense his entire body is shaking. I keep telling him to calm down and he just wont. The night charge, totally over this, pulls the rest out. The guy and his wife are like crying tears of joy. I, on the inside, am like, “what……. the…….. fuck?!?!” I give them both a hug and let them know I will be back the following day. Ohhhhhhhhhhhh, and wait till you read about the next day. *Sigh* If they werent so nice I would have lost it.
ANYWAYS!!!! That was my day 1 of 3. I got some good stories from the past two days that may have you keeling over laughing a bit. Patient #1 fighting discharge tooth and nail. Patient #2 replaced with a gun shot wound victim that has wayyyyy too much baby mama drama. Patient #3 making the stupidest demands. Patient #4 making sooooo much progress to the point of getting ready for discharge. Patient #5 continued shenanigans. And a brand new patient that was involved in a motorcycle accident with no helmet. Stay tuned!
Ashley BSN, RN
January 6-9, 2012
Well, Friday through Tuesday were absolutely hectic… not because of my patients but because of the unit itself. First they ask me to pick up a shift for overtime on Sunday, I get up at 0400 and get a call at 0500 telling me “jk, dont need you!” damn it, but okay, I got two days off. Then get a call Sunday night asking me to come in on the 9th. I say, “Okayyyy if I actually work! I dont want a call tomorrow morning after I have gotten up retardedly early saying nevermind.” Charge Nurse swore I would be coming in. I go in on the 9th and I planned on being there again on the 10th, I get up retardedly early again and AGAIN at 0500, get cancelled.
JANUARY 6-7, 2012!
Patient #1: This guy has been in our hospital since, like, October. Our hospital has a patient first model which I agree strongly with, but when we get put in a tough spot because a patient wants to be completely noncompliant and it leads to a patient being stuck inside our hospital so nurses can be their glorified drug hustler, we all got a problem with it. This guy came in with abdominal pain and increased output in his ileostomy. He has chronic pancreatitis, which is the most painful abdominal issue EVER! He was ordered IV and PO Dilaudid (7.5x more powerful than morphine) leading to the nurses having to be in his room EVERY…EFFING…HOUR while he refused any other care or medication. We call this noncompliance. Since he has been in the hospital this has been the case, along with several staff members witnessing him misusing the medications he was being given. We realized that he was cheeking his PO Dilaudid (acting like he was swallowing his medications, but actually sticking them in his cheek and after we left taking the med out of his mouth to save for later), crushing the pills, and using the normal saline syringes we left for him to do his own surgical dressing changes to shoot the crushed up Dilaudid into his PICC line (A PICC is a very long, heavy duty IV catheter that runs up the arm and ends outside the superior vena cava). This lead to him developing septicemia because he, of course was using dirty syringes to do this. We were stuck with him. Have been stuck with him ever since. Now his septicemia has resolved, but his ileostomy is putting out between 3-5L/day but refusing to take any medication to fix that problem and refusing to eat anything, just drink sugar filled drinks. All we need to get him out is for Home Health to come to his house and give him the things that he needs (IV fluids, tube feedings, medications, etc.) but Home Health wont take his case because of the accusations that he is abusing his medications plus his noncompliance. So what do we do? We got Social Work, Home Health, Head Managers, Leadership Teams, Risk Management, EVERYONE involved… but we cant do anything because we cannot safely discharge him. Now, we have him on just PO Dilaudid, check his mouth every time we give him his pain medication, offer him his scheduled medications every day, and hang his fluids. He is just taking up a bed now, and there is nothing we can do about it. Nothing. At least he isnt a pain in the ass =/
Patient #2: This lady was a trip. She came in for a laparoscopic appendectomy which is usually just an in and out surgery, but hers had perforated which led to her having a JP drain that was draining a very, very scant amount of this thick cream color. Leading to us believing she had a pretty bad infection. We did a CT scan and sure enough, she was developing abscesses that were not near the JP drain which they just wanted to treat conservatively (i.e. not do surgery, just give IV antibiotics). Now the two days that I had her, her blood pressure was through… the… roof and NOTHING would help it. I would give her vasotec and hydralizine and she would just get worse. We have a doctor that, legitimately, everyone hates. I saw him walk into her room and I walk in and tell him about her BP, she uses my computer that I am logged into, I try to show him her vital signs, but he doesnt care, he just looks at her input and output (how much fluid she is taking in and how much she is urinating) and was just like, “Oh she’s fine!” Um… no… her BP is high enough for her to stroke. So what I decided to do was ask the patient to stay in bed and relax, I had given her both her PRN (as needed) antihypertensives and she kind of came down, then I gave her a Percocet to try and lower it. I eventually got her around 153/76 by the time the night nurse came in and on the second day, she maintained in the low 150s/high 140s systolic. So now the humorous part of this patient: She had a few screws loose but in a funny way. She would keep saying she was stuck to the wall because of the IV pump. Despite us telling her over and over and over again that she can unplug the machine from the wall and it still work she would still call and say she needed to use the restroom but needed to IV pump to be unhooked haha. Then, then woman was totally ambulatory, but insisted on using the bedside commode. My tech was becoming irritated at constantly having to go in there and empty the commode when the woman was capable of walking to the bathroom. So I told the tech to go ahead a remove the commode. The patient starts pitching a fit. So I walked in there and told her that she was not to use the bedside commode anymore, made up some reasons why and essentially told her to get over it. She did, but begrudgingly, she was insisting we were taking something away that was convenient for her lol. Then she kept telling me she was a line dancer (this lady was like 78+ years old) and at one point, her blood pressure shot up to 205/105, I freak out and ask the tech what in the world was the patient doing! Apparently, she was doing squats in her room. lol She would ramble on and on and on, sometimes making absolutely NO sense at all. But she was a sweet, sweet, sweet woman. I loved her.
Patient #3a: He was a man that had just been diagnosed with pancreatic cancer that had metastasized to his liver, lungs, and spine. Why he was on our floor and not the oncology floor I did not understand. He really just slept all day, acted like he understood every word I was saying when legitimately he spoke no English. Now, the thing that happened with him infuriated me! It wasnt the patient, it wasnt even the family that pissed me the hell off. It was the night nurse. This night nurse, as fun as he is to talk to and be around, he is the laziest mother effer EVER! He had left me with 3 bad IVs, no IV fluids hanging, labs not drawn, etc on January 6th. I did not complain because NURSING IS 24 HOURS A DAY NOT 12 HOURS AT A TIME!!! Please remember that. For some reason on my floor day and night shift have this war going on where they think we are lazy and we think they are lazy. The fact is, night shift has more patients because in the day we have to deal with 1. management team bugging us, 2. doctors coming in and bugging us, 3. patients awake the entire team usually because they are typically awake in the day, 4. family there all the time, 5. other departments talking to you all the time because they are there in the day only…. etc. etc. etc. Day is absolutely crazy, but seriously, night is too because they typically have 6/7 patients. Whatever. ANYWAYS! So I took care of everything this night nurse did not take care off without too much complaint, I had been so busy that day and had been waiting for other doctors to come and see this patient that I just did not get around to doing this guys discharge papers. It was already 1945, and after I gave report and walked around with him helping him start his day, I did all of the discharge but the medication portion and the education. I ask the nurse that night (same one that left me a shit ton of stuff to do) to please finish it up for me, I was exhausted and had to be back the next day. He starts throwing a temper tantrum telling me to finish it. I tell him, “No” and leave. I did not care that he was pissed. He left me with so much to do that made my life harder that day and all I wanted him to do was something that would take him 10 minutes. Suck… it… up… and shut… the… hell… up!
Patient #3b: January 7th this was my new patient. A love girl that had Excision of Apocrine Glands. Essentially this means that she had her sweat glands in her armpit removed. She had this done about a year ago to her other armpit. Her sweat glands became infected and inflamed and had developed into abscesses. What they do in this procedure is they remove the abscesses and the sweat glands in her armpit and graft skin from her thigh (or take skin from her thigh) and place it in the area they removed the skin and sweat glands in her armpit. The tech and I asked her how she knew she needed to come the hospital again. She said she knew it was happening again in her left armpit when she realized she had stopped sweating in her left armpit. Soon the skin becomes very bumpy and VERY painful. She said she came in soon after she realized she was no longer sweating in her left armpit. Okay, so this night nurse that had left me with so much to do and bitched, moaned, and complained about me leaving him a little bit of discharge paperwork gives me report on this patient. First he starts off giving me report saying that the patient, his family, and all of night shift hate me for doing this to him. Whatever I dont care. He starts telling me about the surgical sites and tells me that the surgical dressings are dry and intact and that neither site is draining. How was he SO WRONG?!?!?!?! It led me to believe that he had not looked at the dressing his entire shift. Adorable. Because when I went in to do my first assessment, I lift up the sheet and she is serosanguineous (clear and bloody) drainage all over her dressing, all over her sheets, all over her gown, all over the damn bed. What the hell? I reinforced her dressing with, firsts, two rolls of kurlex and she drains through. I then reinforce it with another roll of kurlex. It yet again drains through. So I call the surgeon and tell him. He gives me a one time order to change the dressing. Her dressing consisted of xeroform (which is a petroleum, fine mesh gauze that is bright yellow) and kurlex. I put another layer of xeroform on top of the original layer of xeroform, several layers of 4x4 gauze, and wrap it in two rolls of kurlex wrapped tightly. The rest of my shift she did not drain through. She was on strict bedrest which, for a young lady, is a nightmare. But she was so, so pleasant. A true sweetheart.
- For Your Information: A surgical dressing, or the first dressing that was placed by the surgeon in the surgery room is NOT to be touched by the nurse UNTIL the surgeon comes in, takes down the dressing, looks at the surgical site and places orders for us to change the dressing every X hours and as needed (or PRN). This is ESPECIALLY the case on areas that they have placed skin grafts because removing the dressing could remove the grafted skin. So MY hospital’s policy is 72 hours after surgery is when the surgeon comes in and takes down the dressing, ensures everything looks good, and ensures the skin grafts have taken (or have adhered to the area that it was placed and not died or anything) and then we start doing the dressing changes.
Patient #4: I effing loved this lady with my whole heart. Here is the irony of her situation. She had a condition that led to her blood clotting and developing blood clots often, but she came in with a GI bleed. BUT we had to ensure that she would not clot up all over the place so we had to put her on a heparin drip (which is a continuous infusion of heparin which is tightly controlled based on her aPTT lab results) and up her dose of Coumadin because her INR was critically low (I will explain coagulation labs below). Now, despite having her on a tightly controlled heparin drip, we could not get her aPTT within therapeutic range. It would sky rocket to >150 and then plummet into the low 30s. When I was getting report from the night shift nurse that left me a bazillion things to do and whined about the guys discharge, he informed be of this. The lady had a midline (very similar to a PICC line but the catheter is not as long), it was where the heparin was being infused. This nurse told me her aPTT results were 108, which was a DRASTIC different from her results for the past 2 days which were like 58 and 63, so he drew it again. We can draw blood from the midline which is where he was getting his labs and the second results came back 115. I still could not believe these results. They were just wayyyy too different from her normal results. So since her results were 108/115, we had stopped the heparin drip. Before I turned her heparin drip back on I flushed her midline with 20mL of normal saline, then withdrew 1mL of blood, wasted it (or threw it away), and drew another 5mL of blood and sent that to the lab. It took me a little time to draw up the blood because her midline had very poor blood return so I withdrew it carefully and restarted her heparin drip on a slower rate. Results: 32… sure enough, critically low which could cause her to clot. I call the doctor and he gave me orders. I go in there and tell the patient, she informs me that the nurse had not stopped the heparin drip for 15 minutes before drawing blood and she didnt think he flushed it with enough normal saline before drawing the labs. So this guy drew the labs wrong TWICE! This lady could of developed a clot, under my watch, which could have led to a pulmonary embolism (a blood clot developing and being sent to the lungs) or a stroke (a blood clot developing in the heart and being shot up to the brain) because he is a moron. January 7th I come in and the same shit is going on with her lab results despite me telling him how he had screwed up and how to prevent it from happening again. So since her aPTT was again sky high according to labs he drew and the midline was having poor blood return I had to stick her with a needle and draw blood, the results: 39. AHHHHHHH! This guy is an IDIOT! Luckily this woman was an amazing, wonderful person and I enjoyed having her because she was stuck here because 1. her aPTT was giving back crazy results because the night nurse was pulling labs incorrectly but mainly 2. her INR was still low. I enjoyed my days with her, even though I was having to increase and decrease her heparin drip all through these shifts.
- For Your Information: When drawing labs, first, pay attention to what you are doing. Obviously, since the heparin drip was going into her midline and that is where the night nurse was drawing blood, he should have paid attention to what he was doing which led to incorrect care. Second, if a lab is being drawn from a midline/PICC if the blood return is poor, do NOT pull back hard on the syringe plunger. Doing this can lead to damage to the blood that is being drawn d/t the force that you are creating by pulling back hard on the plunger. Also, blood starts clotting after 30 seconds, so if you are having sit there for several minutes trying to get enough blood, the results will be altered because there are already micro clots. FINALLY, careful with your shortcuts. This night nurse, when putting the labs into the vial, he would just pop the top off the vial and put the blood in directly into the vial instead of using the vaccum. 1. this could lead to a blood spill and 2. the “chemical” that is placed in the vial for the lab, the results may be altered if the vaccum is not used. Just do labs correctly without shortcuts, especially labs, because our treatments are very much based on lab results and the treatment could lead to injury. Also, its important to look at lab trends, if the results of yesterdays potassium is 4.0 but today’s results are 2.0, QUESTION IT! It would hurt the patient AND your license if you are overloading this patient with potassium than it would to just stick the patient again and make double sure the results are correct!
- New Knowledge:The Prothrombin Time (PT) represents how long it takes for a blood sample to clot and the International Normalized Ratio (INR) is used to monitor the effectiveness of Coumadin; for my hospital, the therapeutic range for INR is between 2.5-3.5, but the therapeutic range varies largely between institutions and whether a person is on Coumadin or has a history of heart problems. Activated partial thromboplastin time (aPTT) measures the clotting time of plasma, and is used to monitor HEPARIN therapy, normal range is between 25 and 38 seconds (depending on your labs procedures).
- New Knowledge: I had never dealt with a heparin drip before so this was a new experience. A heparin drips rate is completely based on aPTT results, our orders have very specific orders based on rates and whether the heparin is being established or continuing. Be VERY careful when reading these orders. Also, blood draws need to be done every 6 hours for the aPTT. Remember when drawing the blood, if you are doing a stick, draw it from the opposite side that the heparin is running. If drawing it from a midline/PICC, remember to stop the heparin drip for 15-30minutes, flush with 20cc of normal saline, draw up 1cc of blood, waste it in a waste vial, and draw up enough blood to place into 1 or 2 vials. NO SHORTCUTS!
Patient #5: This patient, legitimately, was my favorite patient. This patient had a lapraroscopic hemicolectomy with gastrojejunostomy (removal of a cancerous tumor from the colon with connection of the stomach to the second section of the small intestine). She had a perc drain that was draining a small amount of tan drainage (its not quite like a JP drain but same concept of removing fluid, a JP drain has a larger catheter and uses suction to removed fluids; a perc drain uses a smaller catheter, free flow drainage, and I believe is place directly into the area it is draining where the JP drain lies outside the area that is draining). Perc drains have to be flushed which means you disconnect the drainage collection bag, connect the 15mL flush and push 15mL of normal saline through the drainage tubing. Sometimes you aspirate what you just pushed in, sometimes you just push the normal saline in and allow it to free flow out back into the drainage bag. I had to chase her BP all day too, luckily her BP responded well to antihypertensives unlike my patient #2. But me and this lady laughed and joked the entire time. Why we had to keep her, though, for longer than needed, she could not tolerate her diet, i.e. everytime she ate something she got nauseous and sometimes vomited. I almost couldnt blame her, she had a regular mechanical soft diet. This diet in hospital form, not so yummy. This lady and her daughter loved me and I loved them, we joked and laughed the entire time. She and her daughter we so upbeat and funny which made me upbeat and funny!
January 9th, 2012
I walked in and looked at my assignments and I had the same patients EXCEPT MY PATIENT #5!! I, was, devastated. I did end up with a lovely, lovely patient that I have had before that was so sweet… I was still upset I lost my favorite patient. She was getting discharged that day, so I made sure that I went in and saw her before she left and gave her and her daughter a huge hug goodbye. They told me I was the best nurse they had during her stay. Those compliments and patients like her are what make me LOVE my job! You dont get those compliments in writing too often, and 9.5/10 your managers are never told how much your patients love you, and nothing is put into your file… but just by my patients telling me that I was an amazing nurse, the best they had, made every second of nursing school and every stressful day on the job totally worth it!!! <3
Patient #1: Same story, different day. Refusing all medications but his pain medications. No chance of getting him out. I spoke to the social worker and she was arranging a meeting with the Manager, both the assistant managers, social work, and his doctors so we could all get on the same page. Social work essentially ran the meeting and I think she went about it the wrong way. She, in a roundabout way, told the doctors they need to just discharge the patient and the doctors, in my opinion, rightfully said they could not safely discharge the patient and we needed to understand that the patient comes first. Which is true……….. *sigh* just got to deal with it.
Patient #2: The night nurse had a the same problem and had to deal with the same doctor. She calls him about 0200 and he says “call someone else.” There is no one else. She has a primary care physician that is in our hospital system but he was not on the case. So the night nurse calls him anyways because there was no one else to call and luckily the doctor gives orders to control her BP. He also gives the night nurse an order to have the day nurse call him at 1130 with the BP. So I did and he gave me additional order. Now, giving me orders led me to believe he had been consulted and was on the case. Later on, close to the end of shift on the second day I had her, her IV goes bad, I had already started 3 IVs on her but her veins were just so fragile they would not last more than a day/day and a half. So I paged her PCP to see if we can get an order on antibiotics by mouth. About the time I paged her PCP, I see the surgeon walk into her room. So I walked into the room. When he was done talking to her, I walked out of the room and told him about the IVs and he said he would discontinue all her IV medications and leave her IV out. Okay. Fabulous. About the time I sat down, he PCP calls me, I tell him, “Nevermind, the surgeon came in, her IV keeps going bad and all her antibiotics are IV, but he gave me orders.” This damn doctor goes on to yelling at me! “You guys keep calling me but I am not on her case! I was called at 2 in the morning and I gave orders in good faith because she said she had no one else to call. Then Im called today and AGAIN I gave orders. I am not on her case! Until I am consulted I will not give anymore orders for her!” Oh hell no. I say, “Well doctor, the night nurse didnt have anyone else to call, and we appreciate your orders. But there was an order under YOUR name to call you today, so I did.” He says, “Im not just going to take over this case without being consulted, so do not call me again for orders until I am consulted!” I say, “Well, now that I KNOW that you are not legitimately on the case, I will call the doctor and either consult you or have someone else consulted. Thank you.” *click* Go Screw Yourself. So I call the doctor on call for the surgeon and tell her everything that has been going on. She just laughs and says to go ahead and put in an order for a consult.
- Advice for the Novice Nurse: For some reason, all novice nurses and even older nurses are terrified of calling physicians or talking to physicians. I never have been because in my opinion, which I 100% believe to be correct and FACT, you as the nurse and the doctor are a TEAM! You work together for the well being of this patient. Without you, that doctor cannot safely do their job and without the doctor, you cannot do your job. A doctor yelling at you is unacceptable. For one, the only people that I would allow to legitimately yell at me is the head honcho that does the hiring and firing and the person who signs my checks. There is absolutely NO reason for a doctor to disrespect you just like a nurse should not disrespect a doctor. The nurse should realize that you know more about that patient than the doctor. Why? Because you spend 12 hours a day with that patient. The doctors spend a max of 15 minutes a day with that patient. So do not let a doctor yelling at you upset you. Let them stomp their feet and yell like children. But at the end of the day, who cares? If it is something that you did wrong, take what their saying to heart and learn a lesson so you can give better patient care next time. But do not cry, do not get upset over a doctor yelling at you. They are NOT your boss and they are NOT paying you. Demand respect and give respect. And if a doctor is a real douche bag, do NOT hesitate to write an incident report.
Patient #3: The night nurse gives me report on this patient. The night nurse I got report from is quasi new but she is a good nurse! I ask about the drainage on the thigh, asking if she needed to reinforce the thigh dressing. She said, “No, there is some drainage, serous in color, dried on the dressing, so I didnt need to reinforce it.” (Serous drainage is drainage that is clear in color). So on my first assessment on her, I check out her thigh dressing and there is clear drainage all over the dressing, all over her gown, all over her sheets and bed, all… over… the… place. I look at the patient and say, “I was told you hardly had any drainage, why are people SO WRONG?! Ill be back in a little while and reinforce it again.” fml. She was getting discharged the next day though, she was really excited.
Patient #4: Same story, her aPTT was all over the place and her heparin drip was still going. Fortunately, her INR, which is what the doctors were looking at a determining whether she could be discharged or not. I could tell this patient was so over being in the hospital, she was as bubbly, wasnt laughing as much to my jokes. She was just over it. I told the doctor that morning her INR yesterday morning was 1.9. For some reason, no one put in an order to have her INR drawn that morning so I just placed the order and drew it with the 6hr aPTT. I told the doctor that her INR has been rising steadily since Friday, that even if her INR isnt 2.5 or greater, that we should discharge her if it is above 2.0. He agreed with me, told me to call him with her INR results. Luckily her INR was 2.9! I discharged her and she was so happy to go home!
Patient #5: I had this lady a week or two back. I believe I actually talked about her in my last post. She had a stroke at home and was found unresponsive in her house, they were unsure how long she had been down. She had one-sided paralysis and expressive aphasia (could not speak d/t her stroke). She could nod her head yes and no and had strong grip. Last time I had her, she had a dobhoff which was now gone and now she had a pegtube where she had continuous TPN running and that was where we put her medications through crushed and an ileostomy. Her family came in and it was wonderful to see them again. Her back pressure ulcer was looking so go and I got a good look at her saccral pressure ulcer with the wound nurse and it looked so, so good. She was getting discharged that day to a SNF (short-term nursing facility; we pronounce it “sniff”). She was obviously getting progressively better because right before she got picked up, I got to hear her say a sentence. In the morning, her GI doctor (a doctor for some reason nobody really likes, but I <3 him) came in to say bye he said, “I hear you’re getting discharged today!” She shook her head yes. I then made a joke saying, “She is SUPPOSED to go today, but she is refusing to go today because she has me as her nurse!” She got a big ole smile on her face and shook her head yes and pointed at me! I was so sad to see her go, but at the same time, really happy because her progress was pretty rapid and now she was going to a place that was one step closer to her going home. I hugged her family goodbye and they told me I was one of the best nurses their mother had and hugged my patient goodbye, letting her know I would miss her dearly. Her family told me I should come and visit her sometime, I told them I would definitely try =)
I was supposed to go in the next day, the 10th, but at 0530 I get a call saying I was cancelled because they found a float nurse, and thanked me for offering to come in. Huh? I tell the nurse, “Um…. I didnt pick up today, today was my scheduled day in.” She goes, “Well, maybe you can pick up an overtime shift later.” I… was… so… pissed. Because, yet again, I get up stupid early, get a shower, and just about ready and I get cancelled. I will be having a convo with the assistant manager tomorrow and I dont know if I will ever offer to pick up a day to help out again because my schedule then became whatever they wanted it to be. So pissed.
Well… sorry it took me forever and a day to update this blog! I have been a big ole bump on a log for the past 2 days. Trying to recover from getting up so early and either going in or being cancelled. I decided to be a lazy ass. Well, Im going to get off of here. I gotta go be productive, I will be working essentially for the next 5 days. FML. 3 straight days on the floor, then a half a day of a class at the hospital, then another day on the floor. Im going to feel like death. Hopefully on Monday I can write about my 3 days on the floor after my class!
I wanna end this with a few reminders for my fellow novice nurses:
- We are told in nursing school that shortcuts are the devil and we should never use them. Reality is that shortcuts are sometimes a necessary evil in order to get things done that need to get done. Shortcuts are sometimes wonderful but shortcuts should only be used if THEY ARE SAFE! Rule of thumb, if what you are doing guides or could change the care of that patient, do not use a shortcut.
- The night nurse who was screwing up all the labs felt like it was okay to push all of the patient’s antibiotics because “they did it in the old days and the people were fine” Please dont push anything over 1 gram! What you are pushing may need to be further diluted in 50-10cc putting it in 8-10cc of normal saline may make the antibiotic too potent.
- I cannot stress this enough. Do NOT be scared of doctors. And do NOT let a doctor throwing a temper tantrum upset you! And definitely do not cry in front of said childish doctor. You are a team. They are not better than you. Both of you went to school, both of you have a license. Without you, they cannot do their job! You are equivalents working towards the same goal which is helping a person become healthy again. These doctors, in the hospital, are NOT your bosses and they sure do not sign your paycheck. But if a doctor is disrespecting you, do not disrespect them back, two wrongs never make a right. Just nod your head and if necessary walk the hell away. There is no need for you to stand there and be verbally abused. Write an incident report, get your managers involved. I, personally, if observing a doctor throwing a temper tantrum, cross my arms, get a REALLY annoyed look on my face, tap my foot, say “mmmhmm” a couple times, and when they are done say, “Oookay doctor” and leave the room. I want to hear what they are saying, I want to know why they are upset so I can fix what is wrong for the sake of the patient, but if a doctor starts to upset me, I walk the hell away! I mean seriously, what are they going to tell my manager, “I was yelling at her and she walked away from me!” Excuse me? If a doctor is yelling at you on the phone, set the phone down if need be, try not to hang up. I yet again do the “mmmhmm” a couple times and then say, “well doctor…” or “Oookay doctor.” We all throw temper tantrums in our line of work. We depend on so many people to get our job done. But disrespect and hatefulness is NEVER EVER EVER okay! Stand up for yourself. Abuse is not okay in any way shape or form.
Enjoy this long post. I will post another one soon!
Ashley BSN, RN
January 2, 2012
Today was an all around damn good day despite the typical drawbacks that try to ruin my groove.
Patient #1: Sweet little ole lady. Stroke with expressive aphasia (i.e. due to her stroke she is unable to talk) and left side paralysis. But boy she would get jiggy with her right arm, grip like a lumberjack. I went to tell her goodnight as I was giving report to the night nurse and she wouldnt let go of my hand. Family was lovely too. With this patient, I administered medications through her Dobhoff which is a teeny tiny tube that runs from the stomach out of the nostril. I found it kinda crazy putting pill form medications through the Dobhoff crazy to begin with because the tube is so small and can get occluded so easily.
- Trick of the Trade: if you have to administer crushed and dissolved medications through any tube, crush the hell out of those pills, place the crushed pills into a cup, microwave for a FEW seconds, stir. You’ll see that the pills dissolve a lot better and will decrease the incidences of occlusion. Cool with plain water and administer
Patient #2: Alcoholic 1; diagnosed with alcoholic hepatitis. Resident walks up as I am getting report and says “Patient is going home today!” Alright, sweet… oh, oh, wait…fail resident. She proceeds to tell the family that this patient is going home, no doubt about it. Leaving for sure. Discontinues the remote telemetry (a monitor that works like a 5 lead heart monitor that is monitored on a unit 3 floors below me), and discontinues the fluid. She then proceeds to tell me in front of the patient, “You can go ahead and pull out the IV too!” I hated to correct her in front of the patient but for my hospital we dont discontinue IV access until that patient is about to walk out our doors, and I had to let her know and the patient know that I would not pull out the IV. I mean, seriously, what if the patient Codes (i.e. goes into a deadly arrhythmia)? This resident was a talker boy, she would just not stop talking. Didnt stop talking enough that as she was preaching discharge that she failed to notice this mans stomach was the size of a 9 month pregnant woman and his potassium was 5.4 (a normal potassium: 3.5-4.5) which could also cause a deadly arrhythmia. So what happens, I make her go back in there and tell him that he was, in fact, not getting discharged today… I wasnt about to deal with that backlash. But luckily he was totally okay with it. He went down for an ultrasound of his abdomen which showed a tremendous amount of fluid buildup in his stomach. I told him to get comfortable, he was here for at least another night.
- New Knowledge: Remote telemetry is used on recovering Alcoholics because when a person is withdrawing from alcohol their heart can go into a deadly arrhythmia (along with tremors, seizures, hallucinations, Delerium Tremens, etc) so if you have a patient that is a recovering alcoholic and their rhythm is not being monitored, ask the Doc whether there should be remote telemetry placed on the patient.
Patient #3: Alcoholic 2. While I was patiently waiting to get report on my last 3 patients. I was informed that the woman giving me report was a forced float from another floor. First thought that came to mind: “fml” Now, I dont hate on float nurses, in fact, I appreciate them especially when forced to leave their floor. But unfortunately, when a person floats when they typically dont, they usually are unprepared for the insanity of our floor and Im left with a larger list of to-dos than necessary. And I soon figured out why it was 0745 before I even got started on getting report on my last patients. This woman starts rambling on about crap I dont care about. Like medications these people are on, even when the medication is only given during night shift. Buh. And how this person can speak English and Spanish and so can her family but a translator is not needed because she can speak English fluently and read English fluently and so can her family. Shut… up… So this person was also with us due to alcoholic hepatitis so also on remote telemetry. She says that this patient was so anxious she could barely handle it. I meet this woman, and within 30 minutes of talking with her, Im calling her “Mama.” Awesome lady. She had refused to take her Humalog insulin which was on a sliding scale (i.e. at certain times we prick her finger, get her blood sugar and based on those results, I look at a set scale that tells me how much insulin to give her). 0800 blood sugar: 342. fml. So I draw up her insulin expecting her to throw a temper tantrum per night nurse report, and she gladly took it which babbling away about her 30 year old son dating a barely legal girl. Adorable. Anyways. So the doctor comes up and says “Discharge!” and so I do, sadly. She was crazy enough to keep me entertained. I dont think she was all in her right mind. Sometimes she would say things that didnt make sense and went on for about 30 min about her socks. She was adorable though. I hearted her.
Patient #4a: Alcoholic 3; float nurse says, “Oh lady was wonderful, never got on the call light and calm as she can be. I have no idea why she has an order for Valium.” ………………………. holy ish, why were you so wrong? See, in my hospital, nurses and nursing assistants get their very own phones and we are SUPPOSED to place the numbers to those phone on a dry erase board so the patients can get a hold of us directly. The smart nurses and techs do NOT place their numbers on the board and hand out the number selectively. Why do we do this? Because patients, bless their hearts, do not know what the nurse does and what the tech does. Now I will run water and assist to the bathroom any time that I have a moment and my tech is swamped. I am not above tech duties. But when I have a patient calling me for every tiny thing and I am insanely busy, it makes my life a little hard. Patient #4a, turned out to be one of those patients I should not have given my direct number to. The story with her, according to her, is that she was drunk and fell on some glass… fell so hard that she gashed herself about 5 inches deep and about 7 inches in length which required a wound vac (a machine that is placed over a wound that sucks the drainage out) and eventually, after enough healing, a JP drain (I call them hand grenades because that is what they look like when not collapsed; it is a collapsible suction device that is placed within a wound to suction the drainage out from the inside, usually from abscesses or with gastric surgeries). I call shenanigans, but whatever. First she says, “I am so scared to leave with this drain” then it was “I need to hurry up and be discharged,” then it was “Can you hold off on the discharge for a little bit until its time for my next pain medication because I dont have the money to fill the prescription,” then it was “IM ABOUT TO WALK OUT OF HERE!” Then it was, “oh no I’ll wait,” then “Why arnt my discharge orders in yet? Im ready to leave, the doctor told me I should get dressed and get ready to go,” then it was, “I cant leave without seeing the social worker.” This went on for a few hours with her calling me directly and with Valium on board. I was ready to just say GOOOOOO! If she wasnt so nice, I would of said, “We have discharge orders, therefore you must go, we cannot keep you.” The lady was homeless, I had social work set her up with a bus pass back home. I gave her the best dressing material I could find so she could keep her JP site clean. I gave her an additional hygiene kit and 2 pairs of socks. I felt sorry for her, really. She was so kind. Then I walked her to the discharge area myself so she could get her bus pass. And as we said goodbye, we gave each other a huge hug and she said “thank you for being so kind to me,” and she teared up a little. It made my day that I made her day.
- Word of Advice: In a trauma center, a LOT of times we get patients that ended up in our hospital doing something they shouldnt of been doing. This lady was homeless and an alcoholic, but I didnt know her background story. You never know a person’s background story and how they ended up homeless. A lot of people look down on the homeless and their addictions with disgust. But alcoholism and drug addiction is as much a mental illness as schizophrenia or ADHD. Sometimes these people can be a pain in our asses when they are our patients. They are needy, greedy, and dont trust anyone. But seriously, when you are homeless on the streets, do you honestly think that you can trust anyone with your only possessions? And these people will go for a long time without any REAL food and any food at all, so hell yeah they order food and juice and soda all the effing time, because once they are discharged, they dont get these things anymore. Treat these people with respect, they too are humans… a kind word can go a long way and kind gestures go even further. My actions probably touched that woman so much she will never forget me… my name and face may fade from her memory, but my actions will not.
- New Knowledge: Well, this knowledge is only fairly new… I learned this a couple months back during my orientation. The most important part of a JP drain is ensuring that the bulb stays collapsed, otherwise, the sucker is worthless. If the JP drain is not suctioning the drainage because the bulb is not kept collapsed, this can lead to sepsis, a very serious blood infection.
Patient #5: I had this amazing girl last week. She looks my age but is slightly older. Sweetest thing ever. Her boyfriend even started warming up to me today and we even threw a couple friendly insults at each other. First of all… she had a PCA (patient controlled analgesic, patient pushes a button and a specific dose of pain med is administered, you can push the button a billion times but a dose will only be administered once every X amount of minutes and you can only have X amount of the medication an hour, therefore decreasing the chance of overdose and medical error plus giving the patient more control of their pain) which was set at a crazy dose (Dilaudid is usually set at 0.2 mg/dose…. hers was set at 0.3 mg/dose which made mathematically determining how much meds she was getting a nightmare for my math challenged brain). Second, the float nurse didnt replace her potassium so the patient had a potassium level of 3.3 which meant I was going to be hanging IV potassium all… damn… day… and I couldnt write an incident report because I legit just couldnt do that to the poor float nurse. She didnt come off as lazy, just out of her element. I was also informed that her IV had been in since 12/29/11… an IV should be changed every 3 days. Float nurse says, “there is an order to keep IV as long as it is asymptomatic because she is a really difficult stick and will need the PICC team to place it.” (PICC team: the damn IV professionals) As soon as she said that I thought to myself, “so while I pull her meds I need to gather IV start kit and supplies.” Why? Story of my life: as soon as IIIIII have the patient, that IV is going to go to shit and not only with THAT IV go to shit but any other IV they have will and then the IVs in 2 of my other patients will too. Sure enough, Im hanging bag 2 of 4 of potassium on my patient and her IV goes. fmlllll. Well, at least Im a good IV started….. lord knows I gotta start enough of them. I get a new one going right above her wrist with hardly a problem. Right before change of shift she informs me that she is having severe gas pains and I check out her stomach and its distended. Damn it. Call the doc, she orders Maalox. As I am getting the order from the doctor she keeps asking “What is the antigas medication they give kids? I want to give her that. What is it?” *crickets chirp* Me: “Hell if I know, I work with Adults for a reason.” Maalox it was! Then……. she starts feeling nauseous. So as I go to grab her Zofran to help with her nausea at 1820… my groove is thrown the hell off and I get ready for flip my shit on ER personnel…. Enter Patient #4b.
- New Knowledge: When hanging IV potassium on a patient, run the potassium CONCURRENTLY with normal saline, do NOT piggyback it. If you piggyback the potassium, you are administering potassium bareback into the vein. The vein despises potassium. Its a very irritating electrolyte. So run the potassium through primary tubing and run the NS through primary tubing on a different pump. Dont blow the vein or anything, just run the NS at half or even 1/3 the rate of the potassium. It was decrease the irritation, extend the patency of the IV catheter and vein, and wont cause as MUCH harm if the vein blows/infiltrates.
Patient #4b: As I merrily and calmly stroll to the med room to pull out the Zofran for my lovely patient and gather the equipment to do a blood draw on patient #5 to see how well my patient’s all day potassium replacement went and thoughtfully praising myself on how well organized I am for a novice nurse which would undoubtedly lead to getting out of work on time, I walk past a transportation guy and the unit secretary at our middle nursing station. The unit secretary then proceeds to tell me, “Your new patient just got here from the ER.” All my joy and praise quickly evaporation and turned into utter rage. I start loudly telling the transporter and the unit secretary and the charge nurse and anyone else within 5 ft of me, “WHAT?! I DIDNT GET REPORT! I DIDNT EVEN KNOW THE GUY WAS ON HIS WAY UP! I KNOW NOTHING ABOUT HIM! THIS IS BULLSHIT!” The transporter tells me that the ER nurse told him that they tried to call me and I didnt pick up and that it was MY fault that I didnt get report. Complete horse shit. These ER nurses hold on to their patients until shift change and then try to call report in the middle of us giving and getting report which inevitably causes them to wait to call report until we are done. This person just decided to make up some crap because they knew they would have to stay late if they tried to call report at that moment. So I quickly scramble to try and get my patient settled in. Its an unwritten rule on my floor that if a patient shows up after 1815 that the night nurse has to do all the admission paperwork and such but its the day shift nurse’s to get the patient settled in for the night nurse. So I had to walk into the guy’s room, and sound like a complete dumb ass asking him why he was here because ER’s paperwork isnt worth a damn. I had to get the guy on isolation because he came in for a reoccurring infection of an surgical intervention from a motorcycle accident and the guy stated he was having chills so they admitted him with pending blood culture results to rule out sepsis. Then the patient starts getting irate with ME because they doctors have not put in an order for antibiotics for his infection yet. How about you get into your gown and stfu? kthx. The night shift nurse, who is superrrrr nice, looks at me as I give her report and says, “So the PDSR isnt done?” (the PDSR is our admission paperwork which must be done asap once a person is admitted to our floor and it is a pain in the ass to do.) “Um… no.” Luckily before I left they ordered him some IV antibiotics and I was able to give the guy the good news. Have fun night nurse… you can take it up with the ER assholes who decided to ignore hospital policy and send up a patient without giving report.
So THAT was my day. It was a good day overall, it really was, despite the end of shift shenanigans.
Now this is for my fellow novice nurses. I would like to share my ways of organization which has helped me avoid having to stay retardedly late to complete my charting. My fellow novice nurses that just came off orientation have typically had to stay until 2100-2130 trying to finish up their charting, which I have not had to do yet because I am stupid organized.
- My hospital policy and procedures allows us to pull more than one patient’s medications at a time IF the medications are separated by a sealed and labeled container. So as SOON as I get my report from the night nurse, I immediately start pulling out all my meds out of the Omnicell (the machine that holds all of out medications) and place each patient’s medications into a clearly labeled (I place an IV bag label with the patient’s room number and last name on the outside), clear, sealed bag. By the time I pull all of my meds and verify that they are correct, I have gotten calls from my patients that they need pain medication and lab results are in which tell me whether electrolytes need to be replaced.
- Based on the timing of my meds, the urgency of the medications (pain meds take top priority on our unit), and the diagnosis of the patients, I begin to see my patients. I assess and pass the medications. Afterwards, I step outside the room and chart my first assessment completely which always takes the longest. By doing this, I am COMPLETELY done with my morning to-dos no later than 1000.
- I get made fun of for this, but I have a to do list that I use every shift that I made at home. There is so much to do throughout the day and having 5-6 patients can sometimes lead to me forgetting pertinent things that I need to chart and do. I have it split up into three different times 0700, 1200, and 1500. Ill see if there is a way to attach it, if not, type it out into a post on one of my days off! Feel free to use it although your hospital’s computer system and your unit’s requirements may be far different from mine, you’ll at least get the point.
Well I hope you enjoyed the stories of my experiences with my patients today. This was actually a very calm and quiet day compared to most days (my poor coworker had to deal with her patient hoarding his oral pain medications, crushing them up, and snorting them… adorable). I am now going to snuggle up to my fatty cat Noir and go to sleep. I got the next 3 days off and I will enjoy every minute of it!
Ashley BSN, RN
New Year… New Crazy Experiences… You Gotta Hear This Crap.
You hear people say “I went into Nursing because it is such an awarding career”…………………………… That is, for the most part, utter crap. Just about the only rewarding thing about nursing is the fat ass paycheck I receive every other week. But one thing that IS really rewarding is the stories that I walk away with and the things that I learn every, single shift.
I am in the throws of my first year of nursing. I am fresh out of my orientation and am in week 3 of being on my own without a preceptor and having my own patients. I work on a trauma surgical unit in a large hospital, and as often as I want to take my stethoscope to the side of someone’s head every shift, I really do love my job. I am kept entertained by my patients, the dumb residents, and my coworkers.
I have been looking for a place to put all my stories because sometimes they are just too good to keep to myself. I am also hoping that nursing students and other graduate nurses will find my blog and realize that their craziness is not their own. I hope that my fellow novice nurses will learn from my blog tricks of the trade. And, finally, I hope people who are not in the medical field will find my blog and learn what nursing is really about……. and if God forbid they end up in the hospital wont be a pain in our lovely nursing asses. Not to mention I hope EVERYONE will get a kick out of my blog and will get a good giggle just like I did when I experienced the event.
I WILL be posting about my patients, residents, and coworkers but names and any other personal information will definitely be changed……. you know, to satisfy all those HIPAA nazis and all. But seriously, learn from my posts and above all, enjoy my posts! =)
~Ashley BSN, RN~
PS: Relearning to write the year on our paperwork is going to be a pain in my ass… I am gunna have to go ahead and print out 2 sets of consent forms for a while… I mean, hell, I was still writing “11” for the month! Im screwed.
