Turn The Page

I did it! I submitted online applications to two hospitals. That was on a Tuesday or Wednesday. I had the weekend off, but then had two absolutely HORRENDOUS days at work that led to crying and midnight panic attacks. On Wednesday, I was driving home from a yoga class (needed to learn how to breath again), and thinking about calling the hospitals to ensure that they received my applications.

No need as they had called me. Woop woop!

The interview though wasn't until the following monday. At the end of the interview I had a verbal offer ("I like you, the staff likes you, so what shift do you want? Do you want start in two weeks or in 4 weeks?").

Tuesday I had to go in and turn in my two weeks notice and then return to an awkward day of work Wednesday. Some people enjoy working at smaller hospitals because of its size (people know who you are), but I'm not fond of the gossip mill. I was amazed to come in on Wednesday morning to know that nearly everyone knew I was leaving (day AND midnight shift). By the following week people on different floors were aware.

It wasn't until this past Monday (last week) that I signed the papers at my new hospital-which is why I haven't posted anything...I was worried I had turned in my 2 week notice too soon, but no worries (husband didn't mind...he has been wanting me to quit/resign/move on for awhile now).

Orientation at the new hospital has already begun-it's two weeks long! Then I should have about 4 weeks on the floor to get orientated/precepted before being cut loose on my own.

I know the grass isn't always greener on the other side (however a nurse I worked with said it might grow faster and taste better). The grass might be just as brown on the other side. But from what I can tell in orientation (and people in the community), I've made a good step in the right direction.

I'm proud to say that I got a job at this hospital!

For Real

Applying for new jobs.

Another hospital has to be better-and safer-than mine.

(Ok, I'm sure there are worse places to work at, but.....I'm tired.)

I'm tired of six patients when I should have four.

I'm tired of having six patients, getting my accuchecks, delivering meal trays, collecting menus, collecting finished meal trays, obtaining vital signs, all while trying to BE A NURSE (assessments, medications, basic care, communicating with physicians, educating patients, helping them get, you know-BETTER).

(and should I mention I'm orienting a brand new RN to the hospital? me, who has only been at the hospital for 7 months)

I'm tried of patients saying to me, "Are you the only one working here?" or "Don't you have a nursing aide" or "Shouldn't your tech be doing this?" or "I know you don't have help, don't worry about me; I know you're running around" (and I wish I could say, "we don't have a tech" or "I'm not sure what or where our tech is-and management doesn't seem to care"

It kills me that we can be so incredibly short (and incompetently) staffed when according to news reports there are so many people out of work.

For the first time since entering nursing school, I want to leave the nursing profession. And I know it's not the profession but this hospital that is making me think this way. Longer commute be damned; if it's safer it's worth it.

(Side note: I know this is more about the hospital than the profession; According to the new US News report, the hospital I used to work at is 3rd in its region (out of 90+ hospitals) -and that truly was a hospital I was proud to be associated with, even on the very bad days.)

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.

Survival

Another nurse at work turned in her 2 week notice.

That would be 5 nurses that we've lost in a two month period of time (three on day shift, two on night shift). That brings the total to 9 or 10 since I started working there a few months ago...

Anywho; this evening, just prior to leaving the house to meet up with the running club, my director/pseuo-nurse manager (another story) called to ask if I would be willing to come in tomorrow and pick up an extra "critical need" shift.

I normally don't mind picking up a half a shift (and only for the first half). Sadly, I'm already scheduled to work tomorrow. Here's hoping I survive tomorrow.

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And because this blog needs to incorporate something other than my job.....

Tonight's run was painful. My left great toe has been bothering me on and off lately. Yesterday after work it ached (as it did this morning). Hypochondriac that I am, I'm convinced I'm developing a bunion. After nearly turning around on the way to the run (the weather looked miserable), only a handful of us were actually there to run.

My toe ached, and then, just 1.5 miles into the run the rain really began to come down hard. My partner and I looked at each other and said, "let's turn around."

Glad we did; by the time I started my car and pulled out of the lot, it was pouring. Thinking of taking the weekend off and hopefully getting a new pair of running shoes.

Hope everyone has a happy friday!

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.

Dirty Little Needle

A few days ago, at work, I was administering insulin to a patient who is known to have hepatitis C.

I was giving the patient the insulin in the arm when I felt something sharp in my left hand.

Somehow I had stuck myself with the dirty needle.

It's bad enough to have stuck myself with a truly filthy dirty needle, but it was as if my employer had no idea how to handle the situation (that's another story).

Mentally, I'm a mess. The data is overwhelming, and maybe because I'm such a mess, I haven't dedicated a lot of time to doing any serious research. Since I was never given the opportunity to speak to a doctor at my facility (I work a hospital for goodness sake!), I called the base. Then I called the base ob/gyn.

This was going to be the year to get pregnant. (Serendipitously, the day after the exposure, I received in the mail my referral for a fertility doc off base.)

The ob/gyn nurse on base called right away, spoke to the doctor, and called me back within a half hour. The verdict: "no baby making for 6 months. Practice safe sex. Use a condom. I'm so sorry and good luck."

Information on the internet is confusing; the CDC's website has my head spinning.

Statistically there is a 1.8% chance of seroconversion.

The CDC states that health care providers exposed to HCV (hepC) don't need to take special precautions to prevent transmission during the follow up period (6 months). While I 'should' (i.e. won't) be donating blood, plasma, etc in the next few months, the CDC states that the exposed person (me) does not need to modify sexual practices OR refrain from becoming pregnant.

HUH?! but the doc on base said otherwise....

I think I also read that 5 out of 100 babies are HepC+ when born to HCV moms.

Maybe the CDC says I don't need to refrain because the combined factor of 1.8% chance to seroconvert and the 5/100 odds.

But still. I wish I was in school again and could talk to someone about all this (better yet, I wish I could go back to Wednesday night and redo that insulin shot).

I'm doubt that I'm even interpreting all the information correctly (there's a 1.8% chance, but a range of 0%-7% to seroconvert....what does that mean??)

For now though, I sit and wait. My blood will be drawn again at the 6 week, 12 week, and 6 month mark. And I will sit with my fingers crossed, hoping.

Recovery & Splits

Who doesn't love negative splits on a run? This morning's five miler was a perfect example of 5 negative splits. It goes without saying that it was a good, strong run; I felt myself getting faster without trying, and by the last mile I just ran with it.

I can't exactly say the same thing for marathon weekend...But I'm still pretty happy with my overall performance (especially when compared to last year's marathon). My slowest mile was at mile 2 (battling crowds of walkers) and my last mile was faster than the first few miles.

The splits:

5K: 31:51

10K: 1:03:45

15K: 1:34:17

20K: 2:04:21

HALF: 2:11:09

25K: 2:33:57

30K: 3:04:57

35K: 3:35:54

40K: 4:07:41

Finish: 4:21:28

Not sure how-or why-I did so much better than last year. The last half was in April. In the meantime, there was mild surgery (x2!) and a move from cool, breezy Delaware to hot & humid Florida. Training started late, and when compared to other marathon runners, I certainly wasn't ready to even begin training (nor was I training enough). For some reason, I barely ever averaged 30 miles a week.

As for recovery....well, what recovery? Last year, I remember running 2 miles about a week after the marathon: a long and painful 20 minutes. This year, my first post race run was with the running club; a 5 miler that I ran without difficulty. At first I thought it was a fluke, but I ran 3+ with the Tuesday running group and then this morning's early solo 5 miler.

Going back to work on the Tuesday following the run was helpful. Nothing like walking the halls of hospital floor for 12 hours to stretch out the legs. Speaking of which...

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The adjustment of moving from a large teaching hospital to a small, private, for profit hospital has been quite the challenge. More often than not, I come home in near tears. I didn't come home in tears last night, but I did leave 30 minutes late. And still, as I was laying in bed getting ready to fall asleep, I suddenly remembered two things that I forgot to complete before leaving work. It's got to get better.....

Four

just worked my second set of twelve hour shifts without coming home and crying.

That's four tear free work days.

I hope I can keep this up!

Saturday Morning Fever

I experienced my first code this past weekend.

I worked in a hospital for nearly two years and never once saw a code on my old med-surg floor. It could have been the patient profile, the nursing care, or an incredible RRT system.

(RRT stands for Rapid Response Team; at my old hospital, when you knew something just 'wasn't right' with your patient, you would call an RRT via the paging system. A respiratory therapist, Medical ICU nurse, and resident would come and evaluate/care for your patient while you cared for your other patients. The RRT was used to prevent a code....and did so for many cases on our floors.)

Saturday I got report; was looking through my patient's labs and medications when I heard the charge nurse call for another nurse saying, "Come in here!"

I didn't even look at my preceptor; we dropped what we were doing and ran. I didn't understand what was happening, even though I saw the code cart being pushed in. The four of us, plus the respiratory therapist were in the room. The head of bed was being lowered and the bed was being raised. I was told to push the code button; my preceptor was removing the headboard from the board; the charge looked at me and said, "you've never done chest compressions; start!"

And I just put my hands down and started compressions.

The only other time I've done compressions was on a dummy.

The feeling and sound of the first two compressions (or the rest for that matter) are nothing like that of compressions on a dummy.

I eventually handed off compressions; and I stepped back to watch and help however I could; there must have been 15 staff members in the room: one running the code. 3 RTs. nurses. finally, a doctor.

I know it won't be, but I hope it's my last.

Lesser of Two Evils

Would you rather follow a per diem nurse and have a 45 minute plus dressing change? or follow the nurse who gives poor reports and leaves things incomplete or incorrect?

I chose the latter. (tired of all these dressing changes we've had!) Tomorrow should be interesting. oye vey.

Start

Today:

Get to work 4 hours early for competency check lists and class.

1455: rush onto floor (class ended late). run into bathroom because goodness knows there won't be many chances to use it later.

1500: meet with nurse I'm following, start report

1505: interrupted

1510: restart report. Have to move chair due to multiple noise conservations at mini-station

1516: interruption

(repeat x2. you get the idea)

10 minutes after getting report, receive word from nurse downstairs that one of my patients (who is downstairs for some tests) made comments akin to suicidal ideation. .

it was crazy. It took a while for the vitals to get completed and entered into the system. my tech became a sitter, a patient returned from OR completely out of it, hypotensive and with nausea. fix one problem, and then open up another. Once I thought I was done getting everyone comfortable, another rings and says she can't breathe. No tech, post op vitals, strait caths, oye vey, I'm glad to be home.

beat

The past couple of days I had it pretty easy at work. And at the start of yesterday's shift, I only had 3 patients (although two open beds left open the possibility to be slammed with two admissions). Because the census was so low, there was a shuffling of patients and nurses (I think some were canceled) and I ended up with five patients:

Patient 1: peg tube, trach, vegetative state due to traumatic brain injury, etc. complete care, turn every two hours to prevent skin breakdown.
Patient 2: quadriplegic needing pain management and to be turned every two hours.
Patient 3: transfer from surgical critical care unit. needs to be turned every two hours.
Patient 4: pt needs assist of two to get up out of bed. Pain management; Thankfully turns self.
Patient 5: needing pain management, IV antibiotics, thankfully, patient can get up by himself.

Thankfully, by the time I transferred one patient (not listed) and got patients number 2, 3, and 5, most care had already been completed (dressing changes, etc). If I remember right, admitting diagnosis for patients (in no order): wound infection, cellulitis, pneumonia, GI bleed, Cancer, rule out goat. The other days I also had pulmonary embolism, cellulitis, and worsening pneumonia in an immunosuppressed patient.

Reason I mention this? A friend, who desperately wants a job in shock trauma/critical care is working at a small community hospital on a medical floor. She enjoys some of the people she works with, but is bored at work. She feels like she isn't being challenged and she states she knows how to care for pneumonia and congestive heart failure like no other.

I heard this and thought, "wow, I suck." I still question myself (and ask others a ton of questions). I've had some CHF patients. I've had my share of pneumonias. But last night I realized, I don't have those patients every day.

While I sometimes dislike the field of nursing I am in (medical, which is pretty broad as you can see from my the patient profile I've had the last few days), I can't help but think, "wow...I am seeing A LOT." still might not know a lot, but I'm learning. Sounds silly, but writing this out, despite the amount of complaining we all day on our floor, it's pretty damn cool that we see so much!

Danger Zone

This week, at one point in time, I had two obese (or morbidly obese) patients.

Another patient is "demented" (MD's word, not mine). The patient is dubbed a complete patient as she/he can not turn her/himself, feed her/himself, etc. She/he can, however, punch. Patient is highly combative.

Yesterday I got a new patient who is a heroin user. Last time using was sometime on the 24th (per patient). Heroin withdrawal begins to occur 48-72 hours after last use. And while the patient slept most of my shift, I think she/he was in the early stages of the withdrawal at the end of my shift.

I don't regret going back to school, and I don't regret the career I have chosen. Here's hoping I can leave work today with a healthy back and without a black eye.

Catching Up...

Somehow, I forgot I had my own blog!

Best news: Husband is coming home soon :) It's about time...the cats are dying of loneliness and the yard is looking a little sad. Me? I'm missing talking and sleeping next to my best friend. Sure, I'm sleeping with the things I love (clothes and books have taken over your side of the bed hun), but things can't replace a living, breathing friend & lover.

Work has been...well, stressful I guess. I'm finally on my own, off orientation. For a while, I was gaining a reputation for all the RRTs I had. This week, I may have actually avoided an RRT. Hopefully some sort of nursing intuition is being to develop, although no doubt it will take a few more months to kick into gear. I'm still asking a ton of questions, probably to the annoyment of the other nurses. Not sure I've found my niche quite yet, but getting there. It's incredibly stressful and at times, a little scary.

Running....is getting HARDER. I'm going to try for 14 today. in fact, I better get moving or it'll be rained out! wish me luck...

Third Time's a Charm

Officially off orientation right?

Day 1: RRT

Day 2: RRT + patient with critical lab value

WTF?! I broke down in a fit of tears yesterday afternoon (at home). I did not want to.go.back.to.work.

I'll be the first to admit. I was scared. The little confidence I had was lost.

Day 3: NO RRT! FINALLY.

Granted...there was still another critical lab value, but it was taken care of; handled, and hopefully solved.

Here are some more fears: Am I forgetting something? what if I'm not thinking ahead? what if I'm leaving the next nurse with a mess/black hole? I begged the nurse following me to let me know if she had any issues that i could have addressed on my shift prior. Any sort of thing that I could have done so that she wouldn't have an issue on her shift. She told me not to worry about it, but I do not want to be that nurse that people dread following.

That, is a goal i'm setting for myself, and one that may be easier said than done.

Please tell me that it's going to get better...

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.

SHRIEK!

I shrieked today at work.

loudly.

I just couldn't help it.

I was in the fishbowl (area of station surrounded by glass, usually utilized for the MDs) when I happened to log onto a certain website that said: "Registered Nurse: Active"

I shrieked so loudly that another nurse outside the fishbowl jumped out of her seat.

Holy crap, I passed. I'm not sure how, and I'm hoping that it's not all an awful mistake (I've checked 3 times since learning that I'm now a licensed RN). For 27 hours after finishing the test, all I wanted to do was Thelma & Louise it off a cliff. Coffee, chocolate, and alcohol didn't help.

So anyways, It's official! There's still a lot to learn and I still feel incredibly incompetent at work (will that ever go away?). Thank you for the well wishes....maybe now I will start blogging more often :) No more questions to practice, no more chapters to review. What to do with myself now that I won't have to come home and answer 150 NCLEX style questions each night? I'm going to catch up on some reading and get ready for this and this.

Oh boy oh boy

Boards on Monday.

Keep your fingers and toes crossed for me!! here's hoping I rock it and not vomit or pass out :)

tired

so tired. so tired I can't even write fun sentences to give updates...obviously work started. work, plus my study class = little sleep. I only worked an 8 hour shift, but I feel like so tired, so incompetent that I just want to sleep.

But instead
I will
get off my ass
and go for a run.

To clear my head.
and prep for the 1/2 marathon that
I'm unsure how I'll manage
to train for, now that
I'm working.
and studying.

Apologies for not commenting on fellow bloggers pages! I'm still reading through my feeder...although half the time I"m so tired I skim. One day soon I will return :)

More soon..