Full circle

I started working in a hospital on my birthday in 2007. In this particular hospital, there were two separate transportation teams. One did regular transports and discharges and the other only did transports to and from radiology departments. I started as a transporter in the radiology department. The hospital offered a free EMT-B course, all you had to do was pass. Of course I took up that offer! I transported for over a year and in the process started nursing school. That’s when I decided to become a tech. After graduation, I worked on that unit (med-surg) for two years. I hated it. I am not a med-surg nurse. I got frustrated very quickly with all the frequent flyers. I felt like I wasn’t making a difference. No matter how much teaching I did I knew I would see those patients in a month, maybe two. So I left the hospital to take an ICU position in a smaller hospital. It was hell for me to go from a teaching hospital where I was autonomous and a part of the care team to a community hospital where I was supposed to just do what I was told. Yeah, no. They got two years out of me as well before I took an ICU position in another teaching hospital. I loved it. I learned so much and got to be a part of things I had never experienced before. The only drawback was the commute. An hour and a half one way, and I was working night shift.  I managed to pull this off for three years. I kept telling myself I would move closer to the hospital but I never did. I love the city I live in right now. I love the diversity, something that was lacking in the area that particular hospital was in. So, I started the job search again. Guess what hospital and what department were in need of a nurse? Yep, my first hospital and the opening was in radiology! I jumped at the chance and luckily got the position.

Its been a bit surreal. Being back in the radiology department feels familiar and new at the same time. Most of the radiology techs and nurses were there when I first started. They remember me as a transporter from 11 years ago. Now here I am in their department as a clin 2 nurse! I’ve come full circle.  I am getting used to being the new kid without actually being a new kid. Maybe, just maybe this is where I was supposed to be all along…

 

Advertisements

Log off

Log off of your computer, nurse!

I know you’re just going to go into the room of your patient for a few minutes. I understand that you just need to go to the pyxis and grab one more med. Log off.

You have very personal information about your patient visible for anyone to see. EVS, the random med student, the family member/friend in the room (for those of you with bedside computers), they can all see this very personal information.

How would you feel if one of your friends found out that you tested positive for opioids on admission because your nurse left your labs open on the computer in your room? You’re sedated and intubated so you can’t remind the nurse to protect your personal information.

Doesn’t sound fun does it?

Your patient and their information deserve that same respect.

Even more importantly, it’s law. You have been given the responsibility to maintain patient privacy and you should take it very seriously. You’ve heard of HIPAA. You know just how important it is. Understand just how serious it is to your medical facility. Nurses have been written up, suspended, even fired over HIPAA violations.

Don’t be that nurse.

Get into the habit of logging of when you walk away from your workstation. It may seem tedious but it is your duty to protect that information.

That’s so gross

You would think the grossest thing that I have seen as a nurse would involve the patient.

Oddly enough, no.

I can say for sure the grossest thing I have seen is the patient’s family member(s) sleeping on the floor of the room.

DO YOU KNOW WHAT HAS BEEN ON THAT FLOOR?!?!?

I have walked into the room and nearly tripped over a family member sleeping peacefully on the floor. I was immediately freaked out. Like, what makes someone think sleeping on a hospital floor is safe or sanitary?

Oh, you have to get up off that floor honey.

There have been soiled linens, blood, body fluids that I can’t describe, EVERYTHING on that floor. Glare all you want but I’m not leaving you down there.

People think hospitals are far cleaner than they actually are…

Consent and ethics

Nursing is fully aware of consent. We know that we need to have documentation that the patient accepts this treatment. It’s a no brainer. But, what if the patient doesn’t want treatment and the power of attorney does?

Prime example, you have an elderly patient that is obviously letting the family talk them into surgery. To no one’s surprise, it doesn’t go well. They end up sick. They have to remain intubated. They need an art line, central line, pressors, the works. Even on the ventilator they are adamantly shaking their head no to all the things you’re trying to do. They are fighting. They keep trying to pull away. They don’t want this.

Their family does.

The POA is who the doctors decide to ask for consent to treat. They completely bypass the patient. They’re intubated, they can’t answer for themselves right? If course the family wants everything done… So, everything is done. Is that fair to the patient?

Shouldn’t the patient be allowed to say no without having someone else choose otherwise? What is the fine line that decides when a patient no longer has the capacity to make their own decisions? Does intubation automatically take away that right? Does having a POA take away that right? If a patient is clearly communicating, even in the vent, shouldn’t we respect their wishes?

The nurse in me says yes. The nurse in me says to respect my patient’s dignity.

The nurse that’s been at the bedside for almost 8 years knows that that is normally not the case.

I have seen advanced directives ignored because the patient is unconscious and the family isn’t ready to let go. I’ve seen cases like the one mentioned above. I’ve seen doctors watch as the family is almost forcing a patient to go along with treatment and the doc just goes along with it as well. I’ve had to be a part of “moral distress” meetings because nurses were stressed over the ethical dilemmas involved in certain cases. When do we stop?

“Do you have any allergies?”

How often do you ask your patients about their allergies? Better yet, do you clarify and ask about medication and any other allergies?

We get in the habit of trusting our doctors who order the meds and the pharmacy that verifies the meds. However, we may need to get into the habit of asking about food, medication, and “any other” allergies on admission.

When doing the admission database I used to always ask whether the patient was allergic to any medications. That’s all I figured I needed to know… until a patient was negatively affected.

Way back when I was a Med-Surg nurse there was a patient that needed a CT scan. No big deal, he tolerated the scan fine but his kidneys, however, did not. We started noticing his BUN and creatinine creeping up, his urine output decreasing, all for no apparent reason. He just didn’t look as good as he should. He said he has had a CT scan before and never had any trouble. He had no known allergies. He was not a renal patient. It didn’t make sense! One of our nurses happened to be in the room giving him a saline bolus to see if we could get his urine output to pick back up. He was questioned about his previous CT scans again and this time he mentions that one time they “put something in his IV “and it “made him sick and put him in the hospital” but “that was years ago.”

Oh really?

Well, guess who had a CT scan with IV contrast… Mind you, he said he had no allergies. Turns out because of his education level he only considered medications to be the pills he took at home so the IV contrast allergy didn’t register with him. I don’t think he even understood that his reaction was an actual allergy.  He didn’t really know what IV contrast was and since we only asked about meds, he didn’t see a reason to mention it.

facepalm.gif

Looks like we found our problem guys.

Needless to say, that changed how I asked about allergies. I try to keep my patient’s education level in mind when asking questions. I want to make sure they understand what I am asking them. It is my job to keep them safe. As the nurse, we are often the last safety check before something reaches the patient. We block all the foolishness from getting to our patients because we are awesome.

blocked.gif

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.

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)

Helpful hint

So you’ve put in an naso/oro- gastric tube. Great! Did you verify placement? If so, how? Did you immediately get gastric contents back when you aspirated? Did you listen and confirm placement in the stomach? Did you use the CO2 detector that some institutions have?

I ask because I ran into a situation in which an OG tube was placed in the ER before my patient was sent to me. Helpful. Thanks. Except it wasn’t helpful at all. My new admission’s abdomen was quite distended despite the OG tube. I connected the tube to wall suction and got nothing out. I changed the canister and tubing just to make sure it wasn’t something wrong on that end. Nothing. I listened and couldn’t quite say with 100% certainty that I heard it in the stomach. Hmm… Not sure I want to use this…

And then he vomited. A lot. And kept vomiting while I held the yankauer in his mouth to keep him from aspirating.

Nope, that OG wasn’t in.

So, I took it out and decided to try my luck at placing an NG instead of an OG. As soon as the tube hit 60 cm in depth contents start pouring out. No need to auscultate that! Hooked it to suction and in about five minutes I got a full liter of contents out of him. Oh look, his abdomen isn’t as distended now…

I say all of that to say this: verify placement! However you choose to do so, make sure you KNOW that the NG or OG is in the stomach and not curled up in the back of the throat. Have someone verify it behind you if you aren’t sure. If all else fails, take it out. I would rather you send me a patient without a tube than send me a patient with a misplaced tube.

Forever alone

Sometimes I feel “forever alone” when I am around non-nursing people. As a nurse I get to be a part of something amazing. I’ll always be proud I am a nurse. I don’t feel like my profession makes me better than anyone else. I do feel like my profession changed me.

I have seen death first hand.

I have had to hold back tears while a family kisses their 16 year old goodbye. I have watched a person suffer in the ICU because the family guilted them into remainding a full code, and endure multiple surgeries that ultimately wouldn’t fix anything, until they finally passed away in that bed. I have watched families lose hope as the transplanted organ fails. I have had to comfort patients after a devastating diagnosis.

I have had my ass handed to me at work.

I have worked 12 straight hours without being able to eat or even stop to pee. I have dealt with physical and emotional abuse at the hands of patients and their loved ones. I have been talked down to by medical professionals that feel they are above me thanks to a difference in degrees.

I hold it all in when I’m with family and non nursing friends. When people say my job is “easy” since I work nights and everyone is asleep, I just laugh. When people are certain I’m “paid” because nurses make “so much money”, I just stare blankly. I listen to people complain about their jobs intently while they dismiss my complaints because I knew nursing was hard.

It can make you feel alone.

It’s not all family members and not all non-nursing friends but enough to make me not talk about my job unless I am talking to a select few. It’s why the nursing community is so INVALUABLE to me. We can swap stories about the worst of the worst. We can laugh about some seriously dark sh*t with no judgment! We understand each other. The nursing community keeps me from feeling “forever alone”. Sometimes we are all we’ve got 😁!

Good morning to you too 😒

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….