Good morning to you too ūüėí

Hi management, how are you? It’s nice to see you all bright eyed and bushy tailed. You’re coming off of a full nights sleep. You have quite a bit of energy huh? Sure you do. 

I don’t.

I just finished 12 hours of getting my ass handed to me. I’ve done two CT trips tonight. I got a sh*t show from the OR. I got yelled at by a doc for labs not sent from the previous shift. I finally ate this morning at 5 am and that was at the desk. 

You would know this if you came in and asked me how the night was instead of complaining about the cup at the desk without a lid. No, I haven’t read the email you sent because I haven’t had the time. Yes, the EKG machine is sitting outside a room. You know what else is outside that room? The code cart. It’s been that kind of night… But you wouldn’t know that because instead of inquiring about your staff you came in with complaints.

Maybe, just maybe you could say “good morning” first. Maybe you could take 10 extra seconds to get a feel for the unit and how the night was. Maybe you can look at what we accomplished instead of what we missed. Maybe you could manage to come in with a little positivity… Maybe….

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Unprepared 

What’s the one thing you wish they would have taught you in nursing school?

For me, it’s definitely time management. I feel like nursing school and the NCLEX gave me this belief that I would have all the time in the world to do everything I needed to do for each of my patients. WRONG! I have 12 hours to provide my patient(s) with the best care possible. That’s it. 12 hours. It sounds like such a long time but sick ICU patient or 5 med/surg patients can take that whole 12 hours and then some. 

It was a big reality check for me when I first hit the floor after graduating. My first nursing job was in a very busy med/surg unit at a level one trauma center. I rarely had less than five patients. I went out on the floor with the idea that I could spend ample time with each patient and still get all my charting done and have my meds passed on time. LIES! ALL LIES! WEB OF LIES! I was one of the ones left behind charting long after my shift was done because I just didn’t have the time management thing down. It took me a little while to understand that I needed to learn to prioritize what was important. Before I could stop and chat with one patient, I needed to have seen all of my patients. I needed to learn how to delegate to my care tech some of the small things so I could do the big things. 

I just wasn’t prepared for nursing in the real world. I was lucky that I had an amazing set of preceptors to teach me how to actually be a nurse. 

Web MD is the thorn in nursing’s side

Web MD is the devil. It is the bane of nursing’s existence. There is almost nothing worse than a patient that has researched their symptoms on Web MD and¬†knows what they have. Thank you for that. Really…

It’s cancer. It’s always cancer.

Somehow the cough that you have isn’t a cold. It isn’t even an upper respiratory infection. It’s lung cancer… with mets… to all the organs ever… because Web MD said so. Even better, we nurses just¬†love when you argue with us on the fact that Web MD can’t actually give you a definitive diagnosis.

Look, people, I know being sick is scary. I know you want to know what’s wrong as quickly as possible. Web MD is not a doctor. Yes, “MD” is in the name but the website is NOT a doctor. The symptoms you are having are generic and could probably apply to anything. You really haven’t figured out what you have, you have just freaked yourself out. Now you are paranoid and plotting out your funeral.

Stop.

Step away from your computer. Put the phone down. Schedule a doctor’s appointment. Get a real diagnosis. Please.

 

 

I’m (not) a people person

I’m a people person… until I actually have to deal with people.

I know, I know, I’m a nurse. Dealing with people is pretty much all I do. However, I am an ICU nurse. I want my patients sedated and intubated. I want the families gone home for the day by the time I get there at 1900. I want to get my patient bathed, medicated, and ready for sleep by 2200. I want to be able to keep my patient comfortable and repositioned for my shift and up in the stryker chair by the morning.

I don’t want to talk. Am I good with families? Absolutely. Will I answer questions and make sure the family has a good grasp of the medical situation? Absolutely. Am I rude? No. I just really don’t want to do any¬†unnecessary talking.

I don’t care that your daughter is a CNA (congrats to her by the way) and told you what to be “on the lookout for” because you should “only trust doctors”. I don’t need to you come up to the nurses’ station to tell me the monitor is beeping, I can hear it. It’s beeping because he keeps taking his oxygen off and his sats are low, tell him to stop taking his damn oxygen off. I don’t need you to wake up out of your dead sleep in the chair in the corner every time I walk into the patient’s room to ask 14 questions that must have¬†obviously been really important. It’s great that you know *insert important person here*¬†but you don’t need to try and name drop every time I come in the room. I get it. You are the beautician of the CEO’s wife. Ok… I am not going to treat you any differently as I give¬†all of my patients A-1 care.

I really, really just want to be left alone to take care of my patient. Is that too much to ask?

Bad news

Yay, she is eating more today!

(We have some bad news)

She managed to walk from the room to the nurses’ station!

(We have some bad news)

Her labs look a whole lot better today. I think the bleeding has stopped.

(We have some bad news)

I think we may be able to move her out of the ICU today.

(We have some bad news)

She looks like she might be able to be discharged today!

(We have some bad news)

The cervical cancer is back. It’s stage four and its’ metastasized to the liver. There is nothing we can do. We can give her palliative chemo which may give her another 3-6 months or she¬†can go palliative.

She chose to go palliative. She came home and passed away months later in her bed. I was 16. She was 41. She was my mother. October 18th will make 18 years since she passed away. It still hurts just as bad now as it did then. Fuck cancer. Fuck how it destroys people. Fuck how it destroys families. Fuck the pain it causes people. Fuck how it attacks old and young. Fuck cancer.

 

Alarm fatigue 

I am legitimately over it. We have new GE monitors and they beep for EVERYTHING! Apnea is a triple beep but an arrhythmia isn’t. It doesn’t read the respiratory leads well so everyone is either tachypneic or breathing 6 breaths a minute.   There is something beeping every minute it seems. It’s getting to the point that we are starting to ignore the alarms because there are so many of them. 

This is what they mean when they refer to “alarm fatigue”

Look at your labs

You have drawn blood, or phlebotomy has come and drawn blood for you. Great. Labs are sent and you go on about your shift. The lab doesn’t call you with any critical values so you figure things must be ok.

And then your patient starts to have more ectopy. His rhythm has definitely changed. Or maybe her blood pressure seems to be lower than normal. Maybe he is more altered than he was.

What’s going on?! This doesn’t make sense. Then you look at your labs… Four hours later…

The values weren’t critical but they are abnormal for your patient. His potassium is 2.9. Her H/H is 7/21, a full three points lower than it was on her last set. His glucose is 61 and he normally runs in the 200’s.

Oh. Ohhhhhh…. Well, shit.

That is four hours that your patient has had abnormal but totally treatable lab values. That is four hours of treatment that your patient did not receive. That is four hours too long. When you send labs or have labs sent for you, you need to remember to check the results. Do not assume that the lab will call you if something is wrong. The lab is responsible for calling when the values are critical or dramatically different than the previous set. However, for some patients, it does not take a critical value for them to exhibit changes. Each person is different, while a hemoglobin and hematocrit of 7/21 may be totally fine for one patient it may be too low for another. One patient may function totally fine with a glucose of 61 while someone that lives higher may exhibit altered mental status. This patient may show no signs at all that their potassium is 2.9 while that patient begins to throw all the ectopy EVER whenever their potassium is less than 3.3. Each patient is an individual and should be treated as such.

Your patient and their labs are your responsibility. Take the minute to give them a check, that minute could save a life.

Story time no. 8

I decided to actually check my work mail box. Amongst the numerous papers that I’ve totally ignored I found lots of little shout outs and even a few gift cards from patients and coworkers.

I don’t think people realize just how much little things like this mean. It makes us feel appreciated. It makes me feel appreciated. It shows me that I’m doing something right…

Dear medical student…

Dear med student,

Hi. I’m the nurse that had been taking care of this patient for the last 12 hours. I am the nurse that charted every med given or not given over this shift. I’m the nurse that verified all those vital signs. I’m the nurse that put in that progress note last night. I drew the labs this morning. Yes, I know my patient.

You do not. That’s ok.

While I do not mind you asking me about my assessment, I will not do your assessment for you. You need to check the pupils. You need to check a neuro status. You need to check the lab results. You need to look over the vital signs. You need to look at the meds. You need to know this patient so that you can give your information during rounds.

Walk in. Introduce yourself to the patient and I, the nurse. Put on your gloves and get hands on. Ask questions, we don’t mind. We nurses understand that you are still trying to get your footing. We were there at one time as well.

Understand that ultimately, you still have to assess your patient yourself. Take these moments to build your communication and assessment skills. Each moment of patient contact is a potential moment for learning. Get all up in there!