Charge

I’m a charge nurse on my unit. I actually wasn’t comfortable taking on that role but my coworkers thought I would do well so I said ok.

Some days I regret that decision.

Don’t get me wrong, I do enjoy having new responsibilities. I like seeing nursing from a different perspective. I rather enjoy the decision making that is left in my hands.

I do not enjoy the stupidity that I encounter. For instance, our OR and ER are fully aware that because of the way EPIC is set up, we need an admission order placed by the physician so that bed center can place the patient on our bed board. If the patient is not on our bed board then we cannot pull them onto our unit list and thus we cannot get into their chart once they arrive to our unit. If we can’t get into their chart then we can’t see their orders. If we can’t see their orders then we can’t carry them out. They know this. It never fails, however, the doc will call us to tell us they need a bed but not put in the order. Once they arrive to the unit, they want to look at us crazy because we can’t start carrying out their orders and draw admission labs. It is now to the point that if the admission order isn’t in then we just don’t take report. Why? Why do we have to go through this!

I also do not enjoy the micromanaging. There is a list that charge nurses have to carry out each night. I have to check and see if everyone’s admission database is done, whether each patient has an up to date blood band, whether each patient has ICU and blood consent, whether each patient with restraints has an up to date restraint order, and whether or not each patient has a daily weight. Because heaven forbid we hold nurses accountable for their patients! I understand some of the list. I know when I have patients I rarely check the admission database. There are typically too many other things taking place for me to worry about that at 0034 in the morning. Consents though? As the nurse, I should be checking those. I feel like it’s micromanaging. More importantly, how are nurses going to form the habit of checking for consents and active blood bands if I am always doing it for them? It is my least favorite thing to do and everyone knows it.

Overall, I am still glad that I decided to become a charge nurse. I have a greater understanding of why assignments are the way they are sometimes. I understand how difficult it is to decide who is getting the next admission. I understand the frustration involved with moving patients out just to make room to get patients in. I realize now that the reason I am just learning of the admit I am getting, because ER is on the phone to give me report, is because the charge nurse is just learning of the admission as well. Things that I used to take as a personal strike against me no longer bother me. I realize the charge nurse doesn’t have the time to spiteful. It’s too damn busy for all of that. Being in charge has given me a whole new perspective.

Advertisements

Nursing and mental health

Nursing and mental health go hand and hand. Nursing is hard. Nursing is hard not just physically but emotionally. We hold everything in because we are the ones that are supposed to help. We heal. We often forget that we can sometimes be the ones that need healing.

I was diagnosed with depression years ago, years before I became a nurse. I was placed on meds that I no longer take, I’ll explain why later on. Nursing school didn’t help, it just kept me so busy that I couldn’t take a moment to acknowledge the depression. Nursing, especially in a hospital that I hated, added anxiety attacks to the picture. I would wake up at night in a panic without being able to pinpoint why. That made me feel worse. I felt like an idiot for panicking over nothing, which made me hate myself even more. It was a downward spiral.

Before nursing school, when I first voiced suicidal ideation, my parents sent me to therapy. That is when I first received the diagnosis of depression (my mother died when I was 16, I watched her take her last breaths, I shut down big time). I was placed on trazodone and Zoloft. I hated it. I went from feeling depressed to feeling nothing at all. So I stopped taking both of them (don’t be like me) and instead stuck to therapy. It worked for me. She helped me come up with other ways to manage my mental illness. It worked for quite a while. Then enter nursing school and full-time nursing. I ended up back in therapy but due to my schedule I just couldn’t keep up with it. Hey, I’m a nurse, I can figure this out on my own. I’m tough. I’m a fixer. I’m a healer. I help everyone else so why can’t I help myself?

I am my own worst enemy.

I wear a smile for my patients and my coworkers. I am happy Fred the nurse. I’ve got a smile and a joke. My patients love me. My coworkers love me. Everyone believes I am ok. I look like I’m ok. I also spend most of my off days sleeping, I’m talking 12-13 hours. I don’t want to leave the house unless it’s to get food. I isolate myself from my friends, my brother is my roommate and he may not see me the whole day. I have dark thoughts that I know I should not be having. I wake up with my heart pounding feeling like some unknown thing is wrong and if I don’t fix it the world will implode. I am Fred the nurse and I have depression. I am Fred the nurse and I am not strong enough to battle this alone. I am Fred the nurse and I am strong enough to know that I need therapy again. I am Fred the nurse and I will get out of my own way. I am Fred the nurse and I will be ok.

 

So many diseases!

I had no idea there were so many diseases until I became a STICU/transplant nurse. Our unit takes care of surgical and trauma patients of all different types (except cardiac, we have dedicated units for that). While trauma is not easy, it can sometimes be a little more straightforward. Most of the time, if it’s bleeding make it stop. If it’s broken, fix it. Every trauma case is different of course but the path you take is typically easier to identify.

Surgical cases are a whole different story. I have come across so many different diagnoses that I have never even heard of. My first time hearing about Budd-Chiari syndrome was with a liver transplant patient we just treated. I have had to spend so much time looking up things on the internet trying to figure out why my patient has 70cm of small bowel left. I have learned about spinal disorders, blood disorders, neurologic disorders. I spend a lot of time asking our specialties to explain this diagnosis or that surgical procedure.

I love it!

Granted, I can’t tell you half of what the hell was explained to me. I can’t remember a majority of the diseases I have looked up. I have “nurse brain”. I know it for as long as I need to know it and then I purge it with alcohol to make way for the next round of sh*t I need to know. No shame. I plan on doing what I see some of our med students and residents do. I am going to get me a small notebook that I can leave in my locker at work and document the diseases that I come across. I haven’t decided if I am going to just list the name of the diseases or try and include a description with each so I can look back through the notebook and learn. It’ll probably be the latter.

Hopefully, I can start sharing some of these diagnoses and diseases with you all.

Gory Glory

I’ll admit it, I like the gory stuff that nursing involves. We recently had a crush injury admitted to our unit and when they took down the bandage I was all up in there! I wasn’t the only one. My coworkers were all up in it too.

The gory things never really bothered me. I have always been great at doing wound care. The bad wounds were the ones I really got into. I think that is why I really wanted to get into a trauma ICU at a true trauma center. I wanted to play in that fun stuff. Blood is just a part of the job. If there is blood coming out of the body I just need to replace. I can do that. Foot falling off? No problem. Blood spurting everywhere? Let me apply some pressure. Ribs cracking while I do chest compressions? Well, that just means I am doing a good job.

And then there’s mucus…

I HATE MUCUS. Nothing turns my stomach like the sound of a trach that needs to be suctioned. I don’t know why it bothers me so much. But that’s not the worst of it. When there are mucus bubbles popping up around the trach… Grossed_out

Before I go into suction I definitely have to take a moment to get myself together.

giphy (1)