Rage against the ME

9 Dec

The start of this blog the tone is one of an insecure new nursling taking bits of learned information, inherited through repetition of the same diagnosis and the treatments that follow them around like a broken record.  What have I become? A bitchling nurse? I will fix me.

I will never forget as I doubt any nurse can forget the first patient that arrested cardio-pulmonary fashion. I was on the telephone, receiving report for an ICU transfer to telemetry when my patient coded and as the code blue was announced on over the intercom, I was like: I better call you back, I think that is my patient coding. I did not know what was going on with the patient. No: I do not know what the K+ level is today, No: I do not know if the INR is therapeutic yet for the DVT treatment, No: I do not know shit: except I do know that the patient is sick and just had a TEE done at the bedside and I think they said that the central line was found to be inside the left atria somehow and that they found vegetative growths on the heart explaining the blood stream infection that never went away.

What about all those transfers to ICU especially during my first year as a fledgling nurse, on my patients that I had no idea what was going on or wrong with them. My report sounded something like this: Fave ICU nurse much like: (a cynical nurse): Why is the patient coming up here? Me: I dunno, the patient is sick. #FAIL.  Or the end stage cancer patient: dehydrated to the bone, with no blood pressure palpable: I started the dopamine gtt as per the internal medicine MD (like a good little monkey nurse) never bothered to ask the MD for some IV fluid resuscitation first, not knowing that the dopamine will do jack crap if there is not any fluid volume to work with. Fave ICU nurse: Did you try and get the pressure via doppler? Me: how do you even do that? #FAIL.  What about the patient, lethargic, pasty, pale and waxy looking:  septic soaked from head to toe in urine, hypotensive, hypothermic and limp by the time that patient gets upstairs. Fave ICU nurse: This patient is soaked with urine. Me: Yeap, I guess I did not realize how sick this patient really was till I got no blood pressure during 1200 assessment and vitals, while I was running around tele all morning doing tasks of a lesser priority. #FAIL.  What about the patient in status epilepticus transferred to ICU. Fave ICU nurse: Did you give the patient the seizure medications? Me: No the patient has been either having a seizure or appearing post ictal, so I could not give any medications by mouth, so every time the patient has a seizure, I  just give the IV ativan. Fave ICU nurse: Did you call the neurologist to change the oral meds to IV to prevent future seizures? Me: No, I just keep giving the ativan, but the blood sugar is ok. #FAIL.

With the above paragraph in mind it should be noted that this ICU nurse in description never really made me feel inadequate or embarrassed about my knowledge deficits, instead of that: each experience was a learning experience that I put in my pocket for the next time. If this nurse never asked me the questions to which I had no answers, I would have never even thought about it for the next patient that needed it. When I can not get the blood pressure with a manual cuff: I just get the doppler! When a doctor asks me to infuse dopamine on a patient that is dehydrated: I stop and ask for IV fluids too.

And that being said: I would like to rant on ME because of my inappropriate behaviour the last few times I received transfers from a medical floor where I acted like I was all knowing and the nurse was all not knowing. A few examples: Post-operative patient has a fast heart rate, they do not know the rhythm on medical they just tell me the heart rate is 130-150 and that the MD wants the patient transferred to telemetry and a STAT cardiology consult. Me: Does the patient have a fever and what is the hemoglobin? Medical floor: No fever, the hemoglobin was 12 before the surgery, not sure what it is today. Me: *sighs* I go pick up the patient in sinus tachycardia white as a sheet. I give the patient the lopressor 5mg and do a STAT cbc, the lopressor does nothing and the cbc comes back with a hemoglobin of 6. I transfuse a few units PRBCs and the tachycardia goes away and the patient turns from white to pink and I rant off in the nurses station about the medical floor nurse being an idiot. Another one. Me: Why is this patient coming to tele? Medical floor: I dunno, the doctor said so. Me: What doctor? Medical floor: I dunno. Me: What is the problem? Medical floor: Change in mental status. Me: Did you do anything for the patient. Medical floor: Like what? And then I rant off the whole time under my breath as I push the bed with a co-worker all the way from the medical floor to the CT room for the STAT CT of the head and then all the way to tele after that, all irritated and sweaty.

Then I get home and think about it with guilt. I took an irritated tone plenty of those times while receiving medical transfers to telemetry, mostly cause I was probably busy in my own chaotic world of spinning tele packs, and now I have to figure out what is going on with the new patient to my group and half the time worrying that if they want the patient transferred to tele, the patient might be even to sick for tele and might really need to go upstairs to critical care: but instead of the nurse calling in the whole picture to the MD they just call for one thing: like the tachycardia,  and the patient gets sent to telemetry to get sent to ICU a few hours later like a roller coaster ride or lets play musical beds and waste resources. So I am guilty of the rant factor, and now I can stop to think about all of my transfers to ICU when I did not know what was wrong with my patient, just like the medical floor not knowing what was wrong either. And I stopped to think how lucky I really am to be able to learn something every time I transfer a patient to ICU, and next time I will not be so condescending to the medical floor nurse.

I mean what I am trying to say is that we are all working for the patient, right? And some of us are in this to keep learning too, right? I might have the care for: chf, afib, sepsis, copd, pneumonia, stroke, and NSTEMI down to a theatrical performance after 2 1/2 years post orientation on telemetry but I am still lost with those basic concepts like just how does the fluid dwell in the abdomen of this ETOHer all yellow in liver failure as my brain tries to figure it all out as I clean up the poop that fills the bed from the lactulose for the 12th time this shift.

After all: we are all special in our own ways: I have seen ICU nurses pulled to telemetry freaking out as to how they will assess 5 patients in the same fashion they assess their 2 in ICU.  I have been pulled to medical and freaked out over how can I assess, medicate, manage tube feedings, change all those dressings, on 7 patients like I do 4 or 5 on telemetry. I have seen the surgical nurse pulled to telemetry and fearfully asks Fave Cardio about a patient he just wrote discharge orders for: “Are you sure I can give all these cardiac medications at one time?” and Fave Cardio tells her, “Sure give the patient all the meds, if the patient does not pass out, discharge to home.”

With all that being said: I need to take out the professional whip on myself because I have been freaking out way to often at work. Some nurses act crazy and inappropriate on my floor and I do not want to be like them. Just last week I freaked out on a lazy nurse as she tried to move around the patient assignment and break up my group at shift change while she was not in charge AND I was bedpanning 2 of her patients all day because I had the neighbors of her patients and could not walk away from their toileting requests. Little See Jane Nurse went ballistic till she put everything back the way it was on the board. I got what I wanted at the expense of looking like those who I have the often occasion to laugh at: laughing my panties wet at nut job nurses having meltdowns and temper tantrums over stupid stuff and lately I just did the same exact thing. oh noes.

So part of this fixing me at work is just knowing what I do not want to be: that mean nurse that feels superior to other nurses, or that nut job nurse that freaks out and throws a rage over minor details, or the nurse that nurses numbers and computers. I want to be the nurse that keeps on learning via cool ICU nurses and continuing education, I want to get what I want at work via professional verbiage and I want to share what I do know with others instead of hording it to myself and making someone else feel inadequate. I want my attitude to the medical floor nurse to be like: hey, I know you are busy over there with 7 or maybe 8 patients! and we can figure it out together, and I am coming over to pick your patient up, okies?  Cause hell, I know well how good it feels to drop a sick patient off to ICU and feel relieved because the patient is sick and things are spiralling out of control and I have 4 other patients to care for, knowing that the sick patient is now in a more appropriate place to get the care they need.

Since this post is longer than I originally intended I will go study the cardio portion of the PCCN prep course that I have involved myself in. Cardiovascular is 36% of the exam, I finished studying: pulmonary, neuro, nehpro and even professional caring and ethical practice as outlined by AACNs synergy model for patient care. After cardio I have left to study: heme, endocrine, multisystem and behavioral. Okies I am rambling now but imagine if I pulled this off to my charge nurse: According to the AACNs synergy model for patient care, the acuity of my patient assignment is complex according to the patients characteristics of: read them here.  Rambling, I think I will go pen some cardiac haiku or something that will surely lead to my fame and fortune as a writer, nurse, fake poet.

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6 Responses to “Rage against the ME”

  1. Nikkie December 10, 2009 at 02:57 #

    I really enjoyed your blog! I totally pictured myself as I read that post. I am a new grad about 10 months into working and I’m guilty of being all stressed out. I hope to work on that or maybe telemetry is not for me =/

    • seejanenurse December 15, 2009 at 02:37 #

      It gets better, (sometimes) hang in there, I have my days: I love the telemetry pacing but then sometimes I get frustrated by the system, usually related to short staffing etc, I am teamwork orientated and sometimes it feels like I am drowning alone on tele: not because my co-workers are not ready to help, but they have sick patients too and just “can’t”. I do not foresee myself spinning on tele for the long term, so I just keep learning and will see what happens! Do you blog about your experiences? Let me know Nikkie!

  2. keepbreathing December 20, 2009 at 03:48 #

    I don’t tend to freak out but I do spend an inordinate amount of time mocking others for their lack of knowledge. Frequently, my mockery is followed by a humiliating experience by which I learn something…and I’ve been doing this for almost six years. They call it “practice” because you are always learning something!

    • seejanenurse December 23, 2009 at 16:28 #

      well I will keep on at it! ❤ and I will try to freak out less because it really is most un-becoming of me.

  3. Babs November 30, 2012 at 22:51 #

    I really enjoyed this post… I think we all need to take a professional whip to ourselves from time to time… We forget what it’s like to be new to the field… Babs

  4. Naomi Bowman July 24, 2014 at 19:29 #

    I too really enjoyed your blog. I am a fairly new nurse…9 months to be exact. I laughed when I read this because I’ve said these same exact things…and it is reassuring to the new nurse that all this is normal and that she too will find her way.. Thanks for sharing!

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