Archive | August, 2009

5 Stable Patients

31 Aug

I had one of those busy (with paperwork and other mundane nursing tasks that we have to do~ the kind of tasks that make me think *i would rather be starting IVs for everyone on the floor* than to do this paperwork.)

Anyway at 7pm I give report to one of the night nurses that I find is so emotionally bogged down into this weird pseudo-relationship that: if you pick me all the time and we are together since we work the same days~i will calm down and not be a total nut job while your trying to give me report (that is night nurse). So it has been a while seen me and emotionally bogged down night nurse and I have been together. Together= we both work 3 shifts in a row every week on the same days and sign out to each other, making the whole report process much quicker: just updates. Me and nut job night nurse on day 1: I give report on 5 stable patients. It takes 43 long minutes of our time. Then we do rounds. Rounds=we walk into the room, I introduce you, you see the patient is in no distress, I leave, end of story. Well nutty decides to have a conversation with all 5 patients while I am impatiently huffing under my breath, trying to be polite but oh so irritated.

I say good bye and nutty frantically shuffling papers says out loud: oh my night is so busy I wonder how many of these people are going to code tonight.

What?

You have got to be kidding me or you need a new job.

5 stable patients.

1 nutty night nurse.

census senses

28 Aug

Well…it is that time of the year again. The census is low. I am not complaining: I mean less sick people should make us happy right?  Of course. I am not sure if there are less sick people or that people are on vacation and get sick elsewhere than where my happy hospital happens to be located! One day I just might have the strength and energy to do the research on why every summer the census of inpatients drops to an all time low. They say: that you can not get sick from cold weather, but why is that every winter our beds our filled and every summer half the beds are not filled?

Anyway: I hope my shift gets cancelled tomorrow! I could use the day for fun!

End of Shift Guilt! Please Vote!

16 Aug

Oh it got cut off…it should say..”the night nurse informs you as you are leaving (really walking out the door with your bag in hand)”

I mean I never know what to do in these situations. And I always feel guilty!

The Float Nurse

15 Aug

The float nurse treats us as we treat them.

I love my co-workers and would never let them down but I have seen this first hand on numerous occasions:

Charge nurse needs to make up a group for the nurse getting floated to our floor: She needs 4 patients.

So charge nurse asks 4 nurses: “Who can I take out of your group?”

Every nurse gives up the sickest, most demented, most completely confused heaviest patient.

Float nurse gets the group with the highest acuity, most likely to have a fall and ripped out IVs and Catheters all-night-long.

It really seems unfair.

So one day I get report on one patient from said float nurse: we round on the patient, found sitting in bed, confused, and bleeding from the IV that she just ripped out because: I am going home today, my husband is waiting for me. Right, you have not lived at home for years and your husband is dead (I am thinking).

Float nurse leaves and I do not give her a problem.

I start a new line and let her go.

Beef

13 Aug

While cooking dinner tonight I realized that the raw ground beef smelled similar to the Stage IV pressure ulcer infected with MRSA  that I just packed last week with like my whole hand inside someones back.

I know I am ranting off about this again. I am not a wound care nurse: I would never ever want to be. I am much fonder of surgical wounds: even infected surgical wounds as opposed to wounds related to bed bound patients unmoved for lengthy periods of time resulting in tissue death.  

Maybe I am so perturbed because luckily in the 2 plus years I have been at this nursing life I have only encountered a few of these huge deep pressure ulcers. (whew)

Next time I will not do it alone.

Anyway I still ate my dinner.

Pressure

12 Aug

I was going to post another picture of a Stage IV pressure ulcer but I opted not to as I find it so disturbing.

One of the main reasons for me not ever wanting to work on a medical floor: wound care.

I just do not like dressing, packing, crying over sticking my whole hand inside someones back to remove and repack these deep wounds.

I like telemetry where the average length of stay is so short pressure ulcers do not have time to develop. I will be on it from now on with my bed bound patients, turning them every two hours: is not a plan of care developed by administrators in white coats. Patients who can not move need to be turned by you, the nurse; unless you find yourself able to ensure your support staff complies with your plan and actually carries it out.

I am always so upset by these type of wounds.

Just reminding you in case you forgot.

Interventional Radiologist you do not rock

6 Aug

Unbelievable. I had always heard stories of those maniac, big baby doctors who throw charts, curse out nurses and generally act like big brats. I have had some brief experiences with jerky– like MDs but nothing to the point of actually becoming upset about it until most recently.

Last week I get a patient from the night nurse who received the patient from the ED around 0300. The patient is emmaciated, chachetic, dehydrated, hypotensive but with a normal mentation and normal heart rate.

The problem: the patient has no intravascular access and not a vein in sight ANYWHERE. Great for us, there is an order for a PICC line insertion in the morning. What? I would think that the ER doc should of at least put in a central or given us some type of access.

Anyway the patient also needs a lumbar puncture as the patient was immuno-compromised with a history of meningitis just last year.

So the interventional radiologist is consulted for the lumbar puncture.

PICC line nurse is as the bedside all sterile and ready to insert the line. The sign on the door reads: Sterile procedure in process, DO NOT ENTER.

So I am in the room across the hall with another patient and I see the interventional radiologist pound on the closed door with the clear warning sign. He opens the door and demands that the IR nurse stop what she is doing and bring the patient down to specials immediately for the lumbar puncture.

Ha! Who the hell did he think he was? She told him no, I am inserting right now and will be done in less than 30 minutes.

The jerk comes to the nurses station. Demands in a loud manner to see the primary nurse (me) and when I reveal myself he begins to tell-me-off, verbalizes that my supervisor should be fired, and if the patient is not down in the specials dept in the next 15 minutes—he is leaving! All of this done by him in a HUGE rant about how he has other places to go, things to do, his time is valuable, he does not need this crap, why are we (nursing) so unorganized?

I begin to tell him that…the patient has no vascular access and did he really want the PICC line nurse to stop the procedure and send the patient to him like that? He says put in a peripheral, I says if that were possible the patient would not be getting a STAT central line. He says it should of been done earlier. I says sure in a perfect world, but you are more than welcome to insert the central line yourself and then do the lumbar puncture if-you-like. Oh that tickled him pink, he was boiling mad. Then I says do you want the attending on the phone, we can call him on his mobile phone if you like and then you can explains yourself that you-are-gonna- leave without doing the lumbar.

He storms back to his little department where he can apparently abuse the interventional rad nurses and techs.

Ewww*vomit in my shoes* … apparently he is well known for these outbursts of immaturity.

He made an ASS of himself in front of all the cardiologists who were at the nurses station–working.

They were all like wondering who the hell was that jerk? And I gladly told everyone his name! That was Dr. Nasty Pants Interventional Radiologist.  No-More-Consults-For-You-Dr-Nasty! At least not from any of the Doctors that witnessed your immaturity on that day!

Dude you suck!

Anesthesia you rock

4 Aug

Listen to this nice calm narrator. Ahhhh.

 

Acute Respiratory Distress at change of shift:

A rapid response is called. We start ventilating with the ambu-bag which brings the saturation up and of course the patient needs immediate intubation.

So the RT attempts twice and does not get it in.

Another RT tries twice and does not get it in.

The MD tries twice and does not get it in.

STAT Anesthesia is paged: He strolls in all calm in his surgical scrubs and bandanna, we give him the stuff and he slips it right in, and strolls on out of the room, happily and calmly.

The pet orthopodita

1 Aug

This morning while purchasing coffee from my favorite local deli, the deli man asked me, “What kind of nurse are you? Did you say cardiac?”

My response was vague: I mean yeah I work in progressive care, most of my patients are: in CHF,  Heart Attacks, post heart cath, Atrial Fibrillation, some type of arrhythmia, a bad pneumonia or COPD exacerbation, PE, septic, acute bleed, or some other condition that requires every 4 hour blood pressures and assessments. Or the patient is a post operative patient with NPO status requiring vasoactive medications that can only be administered to patients on cardiac monitors. Drugs are given in PCU that can not be given on medical floors such as cardizem, amiodarone, hydralazine, and many others. So yeah it is a mixed bag thay lay somewhere in the middle of medical and intensive care although we are classified in the critical care arena as labeled by the American Association of Critical Care Nurses.

I am quite pleased with this arena, this circus riot that is progressive care. I am happy with the adrenaline rush, the fast turnover of patients, and the edginess of it all.

Being so pleased with this arena I stroll into work today to find myself being pulled to a medical floor for the shift: the orthopedic floor. Oh noes!

I get report in the morning on 6 patients. I happily receive the first two patients both medical diagnosis in nature. Then panic sets in: the next four patients: orthopods. 3 total knee replacements and 1 hip replacement. All post operative day 1. I nearly lost my mind.

The pain medications and assessments around the clock. The continuous passive motion torture devices with prescribed schedules: on 2 hours off 2 hours. The PRN medications in between. The hemovac drains, the foley cath removals, the painful walks to the bathrooms, I mean it was frightful!

When 12 noon and 4pm rolled around I did not know what to do as I normally do blood pressures and reassess at this time! wOOt a  non-invasive hemodynamic breather!

And the doctors: Who were they? Orthopeds I never met, and I did not see one cardiologist all day and of course I am biased towards Cardio, pulmonary MDs…who were these bone crushers?! Ew!

I am happy to say that I made it though, it was an experience but I am ready to get back to PCU.  I would much rather give cardiac drugs, assess hemodynamics, monitor strict intake and output. Give lopressor every 4 hours even rather than give pain medications, chasing pain medications all shift long. Give me dysrhtymias and NSTEMIs all day long. Heart failures, lasix, and morphine to decrease resp rates and vasodilate in flash pulmonary edema. Give me bipaps on and off all day!  Give me titrated heparin drips! Just keep me on telemetry……..please!

Oh but the ortho nurses found me charming!

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