Value

When I have a patient, if they suddenly show blood in their urine, I call the doctor. Especially when it is new and unexpected. It's what you should do as a nurse. Anything new or unexpected-like blood in the urine- typically warrants a call to the doctor.

If you are an employee-or ahem, nurse- at my place of employment, and you suddenly notice blood in your urine, you're told:

'I can't afford to lose you right now. Let me see if the pharmacy can get you an antibiotic and some pyridium. In the meantime, drink lots of water and cranberry juice'

Employee: "So I can't leave to go see a doctor?"

Charge: "No, I don't think so....we can't afford to have you go."

Employee: "The last time this happened it turned into a kidney infection. I can not make it through the day without going to see a doctor."

Charge: "I'm sorry-my pharmacy connection doesn't get here until 1:30pm. In the meantime, just keep drinking lots of water and cranberry juice."

Issues: (Besides the obvious-you know, the issue of blood being where blood shouldn't!) I already drink 1-2 liters of water during my 12 hour shift. Hardly think I'm dehydrated. Every morning begins with a small glass of cranberry juice. While we're on the cranberry juice comment, drinking cranberry juice is not going to stop or reduce the amount of infection -or blood- in one's urine. It's not going to stop an infection from traveling north to my kidneys when, after a matter of one hour I went from discomfort to blood tinged urine. (which is exactly what happened in college: it went from mild discomfort to a trip to the ER and a full out kidney infection in a matter of hours.)

Had they sent me to see a doctor (it is an acute care facility and they do employ medical doctors and have a pharmacy), I would have been able to start an antibiotic and pyridium before noon, AND I probably would have been able to work in the afternoon.

Instead, it wasn't until 12:15 that I was able to find someone higher up. At 12:45 I was given the go-ahead to leave and get treatment. At 1:15 I was in my car. My doctor's office couldn't get me in for an appointment and had already referred me to an urgent care center (35 minutes away-the irony). I spent 20 minutes waiting at the urgent care center, 10 minutes in the exam room waiting for the doc, 5 minutes with the doctor, before leaving with a prescription in hand. I dropped off my prescription at about 2:45, and my "20 minute wait" was more like 45 minutes. I finally took my first dose of antibiotic at 3:45 pm.

My symptoms started around 9:45am. I couldn't find my charge nurse. I found her at 10ish, told her "I'm getting a uti, I need to see a doctor." I found her again at 10:30 to say, "I have blood in my urine." Not to get all TMI and all, but by the time I made it to the urgent care center, it was certainly more than blood tinged....as evidenced by the comment I overhead the nurse made to the doctor.

I understand that my charge was upset that she would have had to give everyone six patients. I don't think she realized how urgent my situation was. Had I not mentioned it to 4 other people and some 'higher ups,' I don't think I would have been able to leave and seek treatment, but would have had to be treated much more aggressively as I would have been much sicker, and then off the floor for an extra day.

I value my health. If I am not healthy, I can't do my job well or care for my patients adequately. If I can't care adequately for my patients, they are at a greater risk of missed lab values, missed orders, gaps in care, etc, all leading to an increased length in stay. Had I not been able to go and get treatment, I have no doubt that I would have had to miss out on a couple of days of work.

My husband, impressed by the stellar treatment of their employees, asked what would have happened if I had cut off my finger at work.

I don't know. But I imagine they would have told me to put my finger on ice and go to the ER after work.

Another One Bites The Dust

Another RN is leaving my floor!

to work at a doctor's office!

more tomorrow; newest malady I believe I suffer from:

tension headaches.

Dwaddle Day

Just finished working 3 days in a row, and on day 3 three I started with 6 patients. SIX. On a so called 'stepdown' unit.

And, when a physician did not call back regarding a patient's discharge medications, my charge nurse and I agreed what medications the patient would probably go home on. We had no order. It's obvious the patient would not go home on IV medications yet I had no order and there were a couple of other medications in pill form. I made it clear: "I can't just write down what I assume the doctor will want."

but she did.

I can see her point of view....there was a patient who wanted to get out the door, and more importantly, there was a patient on a different floor who needed a medication NOW that could only be administered on our floor or the ICU.

So after my charge did a 'telephone order read back' and signed the discharge papers, my guy went home and the new patient came up.

The physician never called back. I left one voicemail, and had tried calling after about 45 minutes, with the call being forwarded to voicemail. The kicker? I called the operator to do an overhead page.

And the operator says....

"ok, but I don't think our overhead paging system is working." (it didn't work)

This is where I work. Six patients when I should have 4. Physicians routinely don't complete discharge orders and not return phone calls. And an overhead paging system that may or may not work.

Thank g-d I didn't have an emergency on my hands: the doctor wouldn't have called back or would have then been unreachable, and the overhead paging system to alert the attending, the ER physician, the intensive care nurse, the respiratory therapist, and the house supervisor would not be able to alert anyone at all.

Today and tomorrow I'm off....and I woke up this morning to the pitter pattering on the gutters. It's a good day to lay in bed, under blankets and look for a new blog layout, don't you think?

Dirty 4 letter word

W-O-R-K

Today:

33 patients on the floor. each nurse has 5 patients. charge nurse has patients. one tech. (and this tech, I hate to say, would do better at another job, such as being a greeter at a store).

So assessing five patients. passing medications for 5 patients. sending one patient to a heart cath. trying to discharge a patient (at my hospital, the nurses type out the discharge paperwork....is this normal? because it wasn't done this way at my old hospital...), fixing amiodarone/cardizem drip for one patient, getting my cath lab patient settled, trying to find the medications for amiodarone/cardizem drip patient, still trying to discharge one patient. Run down to pharmacy (for the second time). check heart cath pt's groin. Stop amiodarone/cardizem drip. discharge patient. check groin of cath patient. change open heart surgery patient's dressing. oh shoot, q2 hour neuro checks on my ETOH/CVA patient. groin check. admission! Am I forgetting a patient?

These are the thoughts through my head at work (including the 'am I missing a patient' thought).

I didn't even mention that we (nurses) had to pass out meal trays and collect meal trays.

Teachable moments didn't take hold with some patients. my back is killing me. (no really...hurting; I feel like a misaligned tire rotation).

Home finally at 8:15pm, shower, dinner, comfort food snacks. it's 9:39pm.

Repeat tomorrow, bright and early, at 4:55am.

Maybe I should go into the profession of store greeter.

The Difference Between Here and There

There: Last year I trained for and ran a marathon. Co-workers were curious, and yes, called me crazy. MDs were curious and would talk to me about their running, their training, their races, their race memories, their family running, and how great it feels to run and/or exercise (swim, bike, etc).

Here: This year I trained for and ran another marathon. Cardio-Thoracic surgeon finds out (via other RN) that I ran a marathon and says, "What?! You? Why would you do that? You could die doing that."

*Muffled Cry*

"Um, I'm sorry. I just moved here....so please excuse me. But I don't understand....no decaf after 12 noon?"

This was my response to the Batista at the local Starbucks after he told me that it was a district policy to NOT brew decaffeinated coffee after 12 noon.

Time? 2pm. A brief run down of the day up to that point: drank 1/2 a cup of regular coffee (brewed at home), and made the poor decision to run 5 miles on the treadmill at the apartment complex (which is equivalent to running in a sauna). The 5 mile run was more like 3. There was no juice in the tank. Cool down....lunch...and an hour on the phone dealing with a certain phone/Internet/cable company that has a 'V' and a 'Z' in their name.

Finally, a 30+ minute drive to Starbucks. The goal: Write a letter to the above mentioned phone/Internet/cable company with a 'V' and a 'Z' in their name.

The request: a medium coffee, half regular, half decaf.

Barista: Oh....uh, yeah...we don't have any decaf. We don't brew decaf after 12 noon.

And he then went on to explain that it was a district policy to not brew decaf after 12noon.

Here's the problem...it's a coffee shop. They should have coffee...regular & decaf. I get that times are tough. If it was 0800 am and they weren't brewing decaf BEFORE 12 noon, I might understand the cost benefit of not having decaf early in the morning. I imagine most Starbucks customers want the caffeine, especially in the morning.

Happy to say that I did not shed a tear and go ape shit at the store. But yes, internally, screams...and a delicious, somewhat caffeinated cup of green tea. Seriously. WHERE on earth am I???

funk a di funk funk funk

Marathon is in 10 days. TEN DAYS.



and I'm in a funk. self pity rant ahead....

I should be psyched, but I think I'm psyching myself out.

I tripped and nearly kissed the ground on Monday. ankle pain is gone, but yesterday I did 5 miles and afterwords, my left GROIN area and the back of my left thigh where it meets the butt was aching (a littler over a year ago we were hiking and I fell...ever since that fall, I tend to have mild discomfort in that area where the thigh meets the butt).

I stretched. Last night I put on some tiger balm. Today, I'm supposed to run 2 (my schedule is a little off, I know), but it's 44* and drizzling outside. I'm sitting on the couch in pajamas with a warm cup of coffee (not my favorite mug, since on Tuesday I BROKE my favorite, handmade mug purchased on same hiking vacation as mentioned above).

And my toe. My left big toe nail has been bothering me. I took off the nail polish and sure enough....there's a bit of black in the toenail. I'm not sure if this is from the running or from the oh-so-sexy support hose that I started wearing to work.

And I can't help but thing, "Greeeattt...friends & family know I'm planning on running 26.2. Co-workers are expecting me to run 26.2. I worked so hard to get people to switch weekends with me so that I could run (and not work). AND a friend is flying up to see my run 26.2." and all this! Is it mental? I hope. Because I woke up with a scratchy throat today, too.

This is sounding like a terrible, horrible no good very bad week! Let's hope I get some good vibes soon!

Cutting the Cord

Today was my first day off orientation.

Yeah, I know. I've spent many, many weeks on orientation. More weeks on orientation than for any other typical new nurse on a med-surg floor (most orientations last 8-10 weeks; mine was around 12-14 weeks).

All my preceptors, friends, and co-workers told me that I was more than ready. It was really a matter of me believing in myself (isn't that always the case though?).

Last night, I had a weird dream that I was on the floor without a tech/assistant. At one point, I woke up in the middle of the night because "a patient' had a painful IV site, with an obvious case of phlebitis. Because (in my dream) his IV pole was so far away I told 'him' "don't worry, you'll be fine!" and went back to bed. (note...I don't doubt that I actually said this outloud. I have a habit of talking in my sleep when I'm stressed and tend to experience vivid dreams.)

I woke up this morning and said, "i'm Ok. I'm going to be Ok. this is going to be fine. I'm not doing anything new."

Got to the hospital ridiculously early. Received report at 0700. The night nurse left at 0730. at 0750 I had to call for a RRT, or rapid response team because in a matter of minutes, a patient had gone from being alert and oriented, sitting up, having an appropriate conversation with me, to shaking lips, quivering eyes, extremely difficult to arouse, and when he did speak, his speech was slurred.

I was off orientation for 50 minutes (30 of those minutes were for receiving report), and I began the day with a RRT. Bring it on. Hit me with your best shot. The day could only get better.

As far as I know, the patient is fine. Nobody is sure why his status changed so quickly and so drastically. I'm curious to see him tomorrow. The patient also ended up spending most of the day off the floor, so I really haven't had the chance to talk get his baseline. I can't say we did much for the patient. vital signs were stable, o2 sat was normal. who knows. I'm more than curious.

Hopefully tomorrow goes smoother :) No more RRTs.

Very Difficult

I've been out of school, sitting on the couch for two weeks now and am begining to go CRAZY!

I really haven't been sitting on the couch (although I am now)...I've been studying for boards, going to my board review course (paid for by the hospital!), and even spent one very relaxing weekend up in the Green Mountains.

So about this blog title. My school of nu.rsing just this year started using the N*L*N to help students prep for boards. I finally figured out how to change the testing settings (it was giving me two chances to get the right answer!) and here's part of today's test results:

Total Points Raw Score % Score
Difficulty Level »Very Easy 3 2 66%
Difficulty Level »Easy 12 6 50%
Difficulty Level »Moderate 25 16 64%
Difficulty Level »Difficult 9 9 100%
Difficulty Level » Very Difficult 1 1 100%

Do you think answering all of the difficult and very difficult questions correctly was a fluke? If I had 25 difficult questions, would I have missed more? How exactly should I study for my exam? Unfortunately, when I reviewed the questions, the difficulty level was not included in the correct answer rational.

Fingers crossed that I keep better at answering these questions and pass!

Rant

There's beena lot that I want to rant about lately, but I've decided that those things weren't worth ranting about.

However....if you know that I worked an over night twelve hour shift that began at 8pm and ended at 8am and you want to know the time A Place closes, please call That Place, not me. chances are they can give you the answer. And I can stay asleep.

Thanks.

Weekend in Review

Too much to say, too little time (need some sleep!)

• Friday night Trivia: we rocked it with 2nd place! Followed by a very cold & brisk walk to other local bar for karaoke, followed by brisk and colder walk to friends home for some shut eye.
• Saturday: gourmet breakfast at friend's house, grocery shop, class project, Gator Game (um, YAY!!!!!!!!!!), Scrabble
• Sunday: NY Times @ local coffee shop, Costco (we bought a vacuum), lunch, try vacuum. In disbelief at amount of hair/dirt sucked up by vacuum. Empty canister. Repeat vacuum in same spots. Begin to wonder if the vacuum comes with dust bunnies that are to be released into canister or if vacuum is sucking so hard that the carpet will disappear before our very eyes. Finally, more lazy reading, purchase Xmas tree (complete with ice chips!), decorate, cook, eat, etc.
• Monday: Xmas tree is on floor, in horizontal position. cats are wisely hiding out and no where to be seen.

Toss-n-Turn Post

Can't sleep.

So I decided to quite literally empty the mind.

Here is what's in it now:

Job Fair tomorrow morning. Don't want to wear the typical black pants and blouse. Plus for some reason, I think my body fat is getting re-distributed. Pant crotches are nearly down to my knee (slight exaggeration). Found a great grey pencil skirt in my closet that was thrifted, but can't seem to find the matching grey jacket (I KNOW it 'came' with a jacket). Might be able to get away with wearing a blouse with pencil skirt, but the blouse didn't fit as perfectly as I'd like. Might have to wear the skirt with suit jacket combo, which will make me feel like a recruiter or a politician. Either way I think it'll make me look matronly. Granted the job fair is just for practice. Not even sure if my resume is up to par.

Pediatric clinical starts wednesday. Pray for me.

Peace. I wore my peace earrings today. I've had them for about 3 years and only one person has ever noticed them so much as to actually say something.

My professor (I believe she will be an awesome professor and can possibly be a nurse idol) mentions my earrings twice. Once before class when I ask about the guest speaker (from the career center). the teacher tells me about how the guest speaker will tell dos and dont's of interviews (no sandals, shorts, watch the type of earrings to wear...). (as if I would actually wear big earrings to an interview??)

Then during attendance, I hear my first name and immediately go "here" (I have a seriously long name). She says, "Ok. Are you married?"

I say, "yes"

"newlywed?"

"no...5 years now"

"Ah, ok. " (and then she says to the class) "Her last name has a hyphen. It wasn't like I just knew she was married because she is wearing peace earrings."

HUH?

She either hates me (because of the earrings) or is secretly excited about having me in her class (because of the earrings). I hope not to disappoint. Next week I'll go back to wearing studs, but wait until she sees what I ordered online this past weekend....

I ordered the brown on the bottom left, but now I'm wondering if I should have gone with dusty or tan...

And don't worry....I have enough sense not to wear the shoes with the peace earrings!

Double Standards?

Take it for what it is. If someone can find a video of democratic commentators/strategists doing the same (double standards, etc), I'd love to see it :)

Again...is it really sexism? Shouldn't she just "...work harder. Prove yourself to an even greater degree..."

Case of the Nasties...

There's a certain Cable/Internet/Phone company in the area that I despise dealing with.

I had to call them last week because the one TV that gets basic basic cable, was only showing a picture that said to call the company in reference to some sort of box we needed.

No big deal, but it would have been nice to have been notified about this newly needed box BEFORE we had guests.

I spent about 30-40 minutes between transfers, being put on hold, and talking to a human, and while I still dont' have the box, I'm going to hope that it gets here by Monday and that I won't have to deal with their supposed "customer service."

Today we received a letter, addressed to us personally (not dear customer), and the letter stated that our previous bills were in fact too low and that, while we wouldn't have to make up the difference, our next statement will reflect the correct billing amount.

-blood pressure increases-

The letter didn't tell us anything more, except to call for questions. So I called, inquiring about the billing error in addition to asking about the new correct charges.

Between being bored for most of the day and watching House reruns (a new favorite by the way), I picked up a case of the nasties...that or House mannerisms and just didn't care about other people's feelings.

3rd Employee I spoke with (don't ask)....after being on hold: "Ma'm, you're bill won't be changing at all. That letter was sent to all customers, but you won't be affected."

Me: Even though my name is on this letter? This is a generic letter with my name on it telling me about a billing change, but I won't be affected? And my name is on it?

Employee: Yes, that's right...

Me: Geez. Dealing with Verizon is like dealing with people from Mars.

This was 6 hours ago and I STILL cringe when I think of it. No more House for me...

Won't You Tell Me Your Name?

I realize that I have my blog on the public setting.

I realize that by doing this, anyone has access and can read this blog.

I understand the concept of lurkers. I have a slew of blogs that I read and not comment. But I don't think I visit their sites more than once a day. Sure, sometimes if I have time in the morning, I'll check the blog, and again in the evening. But that's if I have time.

So I'm a little creeped out over the fact that for the past couple of months, someone has been checking out my blog multiple times a day.

We're not talking two or three times a day.

We're talking 8 times today and I believe 10 times yesterday. As in on the weekend! I understand if they are bored at work with nothing to do...then you want to see if the page is uploaded, but seriously, google has a great blogger/reader program that will tell you when pages have been updated!

So here's what I'm wondering...is it possible for a computer from the same IP address to randomly check out blogs? Is your computer reading my blog without you?

You obviously enjoy the blog (otherwise you wouldn't visit 8-10 times a day, on a near hourly basis). Please, if you enjoy, comment. Chances are I'm reading your blog too.

A Letter

Is there anyone out there who can help us?

We’ve been trying to get Verizon FIOS to correct our bill since December 28th. We assumed the problem was corrected but the bill we received on January 22nd showed the problem was anything but fixed. We tried to correct the problem again on the 22nd and the 25th. After spending up to 60 minutes on the phone with Verizon, my husband was told a manager would call us on Monday the 28th because, “all the managers have left for the day…we’re cleaning out the cubicles.”

On the 28th at 4:50 I called Verizon (no manager ever contacted us) and was on the phone for 70 minutes. The manager I got in contact with said he would have, “one of my best guys” look at the case and call me tomorrow (29th). At that point it was already 6:00pm and I guess he too had to clean his cubicle and go home.

The 29th came and went without a phone call from the manager or his ‘best guy.’ After leaving a message with the manager asking about the status of my case, I placed a call to Verizon’s corporate offices, where I was transferred to Verizon’s Customer Advocacy Group. There I was told a case specialist would contact me within 24 hours.

25 hours later, we’re still waiting for a manager in Customer Service to contact us.

Verizon, I have tried numerous times to contact you. Can you hear me now?

At the Grocery Story

Me: Do you have any cod?

Employee: Yes, I was just getting ready to put it out.

Me: Oh, ok. Is it fresh?

Employee: Yes, it just thawed out.

Me: You mean it's frozen?

Employee: No. It just finished thawing out. It's fresh.

Freshly Thawed Fish. Proof that Delaware belongs in the south.

sweaters in august?!

It is currently 64* right now.

64 DEGREES OUTSIDE.

64 DEGREES OUTSIDE IN THE MIDDLE OF AUGUST.

Why?

Why do shoes always decide to fall apart in public? Or is this something that only happens to me?

First let's get one thing straight: I'm a pat rack. Can't throw anything away. Including shoes. Yes, I still have shoes from high school. Why? because they'll come back in style...and I'm sure that my future granddaughter will want to see the 3 inch wooden Candie clogs I used to wear in middle and high school.

Last winter, a pair of Born flat, black Mary Janes broke...the strap just detached from the rest of the sole (nothing that can't be fixed by a shoe repair man, so yes, I still have the shoes). Naturally, the strap of the shoe decided to tear away from the shoe in the parking garage at work in the MORNING. before the day even started. so, like a bum, I was forced to scotch tape the strap to my shoe.

Fast forward to the summer, miserably hot day, with a high of 98. After getting through with a doctor appointment on base, I was standing in line for the pharmacy...10 minutes later, I get close enough to read the sign that says, "Please have your Mil. ID & yellow card ready." damn-I'm always leaving the card in the cup holder of my car. No worries...I just get out of line (umph!) and walk out towards the parking lot. And that's the precise moment when the LEFT strap of flat semi-gladiator style sandal from high school decides to separate from the sole.

I re-attach...walk to car...get ID...begin walking back to building when, as I'm walking up the steps to get into the building, RIGHT sandal strap separates from sole of shoe.

"Are you freakin kidding me?!" The lady trying to get her four kids out of the mini van is having an easier time getting into the building. As I walk BACK to my car, the LEFT sandal strap pulls out from the sole (again), so I'm walking like a bum who can only afford to buy broken sandals from Salvi's or Goodwill.

I ended up driving to the BX and buying a pair of 99 cent shower sandals before returning to the pharmacy, but here's what I want to know:

1. Why didn't the sandals break apart in the numerous trips I had going up and down the stairs this morning?
2. Why didn't the sandals break apart when I was walking out the door this morning?
3. Why didn't the sandals break apart when I had to run back in the house this morning after I realized I forgot something?

The sandals had THREE prime opportunities to tell me, "This is it! It's the big one! I'm not going to make it" before croaking.

Moral of story: Shoes are like cars. No oil, but they need to be replaced, every 100 miles. :)

Hocked on fonics didnt rok 4 me

When I left South Carolina, I thought I was through dealing with incompetent 'eduaucrats.' (educator + bureaucrat= educrat)

One of the first two courses I will be taking for the nursing program at UD is Research Concepts in Healthcare.

Now there is the very real possibility I will have to take a basic, generic, freshman course titled, "Critical Reading & Writing" because my ENC 1101 course did not transfer. There is an appeal process, which I'm starting now, but in order to appeal the course, I need to submit coursework from my ENC 1101 class (which was taken in 1997).

Seriously, who has course work from a basic course like ENG 101?? Does anyone even own the same computer they had in 1997??

They expect me to take Research Concepts AND 'critical reading & writing??'

I'm trying NOT to be a smart ass here, but if I have a degree, and was accepted into an accelerated program, is there any doubt in my ability to read for understanding?

Is there any reason why I shouldn't crack right about now???