Archive | September, 2008

The Food Tube

30 Sep

When I am 92 years old and I tell you that I do not want to eat, please do not force me. When you shove applesauce and pills into my mouth and I refuse to swallow and you have to suction it all out with the yankauer, please do not force me. When the MD orders a nasogastric tube, a feeding tube into my nose that travels down into my stomach and I pull it out over and over, please do not force me. When I have been in a nursing home for years and there is noone to come and advocate for me, when the doctor is just trying to do his/her job, please do not force me! I am going to keep pulling this tube out over and over again. You will have to restrain me if you really want to feed me like this!

I really felt ridiculous trying to feed a patient that would not talk to me except to say “no”. I mean when is enough, enough?

Report from Super Nurse

30 Sep

I had the unfortunate experience this weekend of trying to work and communicate with a night shift nurse who thinks, and verbalis”es phrases that would lead one to think that this particular nurse is the only nurse in the whole universe filled with nurses that does the job right. I have had the same run in with “Super Nurse” before. Somehow every IV saline lock has infiltrated on “her” shift and she had to change them, (that is somehow your fault even though they worked fine all day), every tubing needed labeling (she said but in reality she only changed one set), she could not understand that the patient from the cath lab did not need a sandbag because angioseal was used, she explained to one of our patients how every nurse has a different practice,” with what must of been with a negative connotation as the relationship greatly changed from one day to the next. Words like, “I was so busy all night,” and “I never like to complain,” (as she complains non-stop) Those are the words!  The actions are worse….Grabbing all the patients charts, getting up to find charts while I am trying to give report. Stopping to look up lab values, looking through orders….it is all so very distracting! All I want to do is give report and go home after 13 hours….is that to much to ask? Apparently so for that spastic Super night nurse.

I still love my job

29 Sep

Another crazy weekend at work is over, and I survived. It goes by fast.  I am always learning something new. This weekend taught that when a person has sinus tachycardia there is usually a reason for it that needs to be resolved before the tachycardia will resolove. Giving IV Lopressor q 4 hours is not going to fix the underlying problem.

Trust and Transfers

24 Sep

After reading this posthere by Braden, I realized the missing link between the ED nurse and the floor nurse is trust. It seems the floor nurse in this post was unprofessional and flighty by description and this post is not about that particular situation but my own experiences.  How many times have I had that sinking feeling of what condition will my patient be in this time? I work on a telemetry floor and usually have anywhere from 4-6 patients at a time. The ED nurse calls and gives report to the nurse and the the ED technician will transport the patient to the floor.  I never have a problem with receiving patients and I always take report as soon as I am called, I know it is busy.  What I can not stand though is when I hear that a patient has a SPB hovering in the low 90s after multiple fluid bolus, no admitting orders, no work up done by the attending, and when the patient does get to the floor you find the patient lethargic, no urine output, no orders for fluids, the blood pressure dropping and your patient is probably septic has not been worked up yet after hours in the ED. So now my 5 other patients have to wait on me while I attend to this obvious septic patient getting urine cultures, blood cultures, lactate level etc…If that was worked in the ED the patient would of went to ICU for a lactate level > 4 if the patient were to have been worked up.  Then when you get the results back from the lab you have to work on getting the patient off the floor and into an ICU bed transfer the patient etc…

Or the ED nurse tells you in report the patient is in respiratory distress with a rate of 44- the patient is cool and pale and diaphoretic. You ask the ED nurse, ” should this patient really transfer to telemetry?” The ED nurse tells you that the ED doc is sure the patient is ok to transfer to tele.  The patient gets to the floor and a rapid response has to be called because the patient is in  obvious resp distress, and ABGs are obtained, Stat portable chest x ray is obtained and the patient has severe CO2 retention and needs to be intubated. Again another delay in care for a patient that should of been admitted to ICU instead of telemetry.

This is not the usual but it does happen alot. I also know that patients are sick or they would not be in the hospital to begin with, but sometimes I see inapproptiate admissions to the floor; then I just have to work a little bit harder to get them the bed where they belong for the best care for that situation.

Finally- I smiled.

22 Sep

Sometimes all it really takes to feel better is to know that you are not the only person feeling dark and depressed. It is true that our feelings are our own unique experiences but sometimes it takes someone else feeling the same way and expressing it in a way that you could not seem to find the words for to help you identify that deep dark hole in your gut that squeezes your chest. I identified that place today over at Nurse Seans place…a dark place.

I seriously thought about quitting my job. I thought about all the jobs I had before I was a nurse. Could I go back to graphic arts? Could I afford a career change? What about all the years of schooling, the student loan debt?  I graduated nearly 2 years ago and started working on telemetry right after my first intern rotation. So I have been working non stop telemetry for 14 months now without any time off when this darkness set in. I loved it at first!  I learned so fast. Every night I came home and read and read learning the medications, arryhtmias, the heart, heart failure, gas exchange, I just loved learning. I studied for ACLS and got certified. I worked overtime. I loved my job. I was always ready to help out.  Then the darkness set in.  I am not sure why or how it managed to sneak up on me, a dark shadow in a dim lit back alleyway.  It did. I could not write. I could not read. I was filled with dread the night before work. I slept on my days off all day and all night. I watched television alot! I got to work filled with anxiety and complained about the system, administration, and everything that is wrong with all things hospital related. I kept asking myself, “how did I get here?”  It seemed as though I had one bad shift after another.

There is noone to talk to about your job. Even if you are in relationship such as marriage or the like, when they ask you, “How was your day?” Can you really sum it all up in a few meaningful sentences that will be coherent to the other? No! You can not.  Who will understand what you do?  What am I doing and when will I get better at it? How can I explain what it is I do when it goes so fast sometimes that I even wonder…what did I do today? Intervention after intervention.

Then the personal unrelated to work depression sets in. The questions. Am I able to retain long term personal relationships? Can I really maintain that? Closeness. Have I ever really let that happen? The past is an old movie playing in my head like a VHS tape that I taped over with the new movie. The past is like an old hard wood floor with generations of family cats and dogs, pooping and urinating, and spraying on it till the finish is gone and the wood turns black and the edges shrink leaving cracks for dust and dog hair and sometimes flea eggs in them, and they start to creak in certain spots, the floor can not be removed because the house, like the past, like the floor is to large. We can just cover it up with a nice new carpet with the lots of padding underneath.

Finally, I used some of my vacation time that was just building up to be ultimately cashed in at the end of the year if not used. I took two weeks off. Still depressed. I slept for two weeks. I started to read. I slowly crawled out of the shadows. My first week back was still emotional, and crazy, but I managed fine. I felt myself getting better and I even started smiling! It was weird to feel my facial muscles twist up into that silly grin with my crooked teeth.

Next time faster.

9 Sep

I had a another one of those self esteem bashing last three shifts. One of my goals as a new nurse is to try and utilize my resources and start pulling together the knowledge that  I know I have into my assessment and judgements to act faster. Now that I am home I see the situations in a different light. My first patient was lethargic and just really sleepy. The family member was insisiting that it was from the anti-emetic that was given to the patient earlier, the pulmonary MD was sure it was from the allergy medication that the patient was taking, and the attending was sure that the patient was just tired. I let it go even though in my gut I felt that something was not right, but I just did not pull the judgment or the knowledge together. Finally when I could no longer let this lethargy continue I asked the attending for ABGs–sure enough it was bad news. The patient was severely acidotic and retaining CO2. He needed to go to ICU and be intubated I was sure! However the pulmonary MD wanted her to stay and have bipap and ABGs again in one hour. I just knew it was not going to be right, but I said ok. A half hour later on bipap she was completely unresponsive even to pain and a rapid response had to be initiated. That got him to the unit in time.  Next time I think I will be faster.

Another patient that week came from the emergency department to telemetry when I just knew inside that the patient should of went to critical care. The patient had all kinds of issues going on–one problem was coagulopathy–the patient was on 2 different types of blood thinners for some reason and came in with hematomas everywhere. The other problem was acute renal failure–the patient got to the floor bleeding from where the central line that was placed in the ER. It took me a half an hour to stop the bleeding and then I could not get a blood pressure on the patient I could not even palpate a radial or brachial pulse! I had no way of knowing how the man was oxygenating because the pulse oximeter could not pick up a reading! I had to get ABGs and found out the patient was in severe metabolic alkalosis. So again I transfered another patient to the ICU which is where the patient should of went the from the first place. I mean even before knowing the ABG result the patient was severely sick. I made an attempt to plead the case to the nursing supervisor right after I got report to try and stop the wheels of this inappropriate transfer before it happened…to no result. It was just a delay in care for the patient.

The lesson I learned this week is to stand up for my patients better, louder even, faster.

It has been a while

4 Sep

I have not had the creative energy to write anything for a while now. I have been in the dumps lately; the work has been getting me down! I am trying to get back now!