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Posts Tagged ‘Nurse’

The First Day

March 2, 2012 Leave a comment

Yesterday was the first day of a new adventure.

I no longer have a job and I’m OK with that.

I volunteered to be part of a “reduction in force”, business speak for “laid off”. Why? Many reasons, but mostly it was beyond time to leave. Also because I things have become clearer to me with regards to what is important in life. It’s like the axiom goes, no one lays on their death bed saying, “Boy, I wish I worked more.” Work was overwhelming my life, permeating every nook and cranny and luckily I had the clarity to realize that wasn’t what I wanted out of my life and this was the first step in doing something about that.

I woke up yesterday though with an odd feeling of freedom. Nowhere to be I just sat around in my sweats and relaxed. Then the reality set in. I had a momentary burst of panic of when I was going back to work, then realized it was never.

I then had another more sustained burst of overwhelming panic realizing that I no longer had a job.

Then came the calm realization that it was going to be OK.

Things would be OK.

…more to come…

The 501st

November 7, 2011 1 comment

This is post 501.

Yeah, five hundred and one chances to see into the inner workings of a nurses’ mind.

Five hundred and one attempts at humor, pathos, cathartic screaming, ranting, introspection and education.

I’ve been writing a blog of some variety since nursing school, most of those older posts are lost to the Internet ether and frankly, they weren’t any good to begin with so it is no true loss. This blog has been with me though since I started at my current job, nearly five years ago. I’ve gone from wide-eyed new grad praying not to kill anyone to a slightly crispy-crittered, nearly burned out charge nurse.

So much has changed on my floor that I hardly recognize it somedays, just like I hardly recognize myself somedays. I’ve grown and this blog has grown with me. Soon, I will be into another phase of my career, new fresh things to learn, new fresh things to complain about and teach about, and I’ll be taking everyone with me. It is no longer a question of if, but when. Not yet, but I hope soon.

Thank you all for being on this journey with me. As the saying goes, “This is only the beginning.”

Meetings: Not a Prioirty

August 23, 2011 3 comments

To: Unit Manager

From: Wanderer, overworked charge nurse

Subject: Monday’s Meeting

I guess one of the included functions in the Managerion™ 2000 automated management toolset randomly creates meetings and requires our attendance.  This would explain relative randomness and recurring frequency of such meetings and their lack of cogent concept or agenda.  Having meetings just to have meetings about meetings is pointless and a waste of all of our time.

In the last 4 meetings we have decided absolutely nothing, but keep referring to later meetings to “work out the details”.  Would it be so hard to make a decision?  Yes, you have multiple units that these decisions will affect, but sometimes you need to throw caution to the wind and make a decision – call it an executive mandate.  There is something to that y’know?

This said, I won’t be coming to any more meetings.  I’m not going to spend an hour each way commuting in to work for a meeting that lasts 45-60minutes and decides nothing.  It is not as easy as some might think.  Whether I drive or not it is at least 45 minutes in rush hour traffic and if I use transit it is even longer.  Now if we were going to decide something or the  meeting was going to last 2 hours, things might be different.  Also if I didn’t have to come back to work the night shift at 1900 it might be different as well.  But the last 4 meetings have done nothing of the sort.

I realize that it is part of your annual review to see how many meetings you presided over, ran or otherwise were engaged in, and I know management is in agreement that meeting indices are not quite what they should be for this fiscal quarter, but please, enough already.

So unless the next meeting will actually accomplish something, or is held in a local pub during happy hour, I won’t even be phoning it in.  I am a nurse, I take care of patients.  I am not a paper-pusher, drone, meeting junkie or have any aspirations to management  so just let me do what I’m good at – no more meetings.

Thanks!

Wanderer, overworked charge nurse

New Ways to Classify Urine

July 20, 2011 3 comments

Clear.

Yellow.

Frothy.

Red-tinged.

All so boring.  So trite and normal.  There has got to be a better, more descriptive way to classify it.  Hmmm…

How about beer?  Stay with me here.

Cloudy, amber with a slightly frothy head.  Could be a nice IPA or a patient with high bilirubin.  Am I right?  I live in a town that prides itself on its beer.  Hell, we call it “Beervana” and has the most breweries per capita.  We can call it the Portland Urine Scale, or “the P.U.S.”

You have:

Pilsner.  Clear, yellow.

Blonde Ale.  Cloudy.

Lager.  Concentrated, still clear.

IPA.  Amber, hazy.

Stout.  WTF?!

It’s not a perfect system, but it makes giving report more fun.  “Yeah, I’d say it was like a light IPA, not too amber, hazy and it smelled strong.”  Engaging, creative and descriptive, what a great way to share information?

 

Wasting Money at the End of Life?

April 26, 2011 2 comments

Movin’ Meat: Are End-of-Life costs avoidable?.

Yes.  docs need to learn to say, “No.”

Case in point…a 90-something year old patient, recently had a pacemaker implanted for mild tachy-brady syndrome.  They had some occasional mild tachycardia and rare episodes of bradycardia which were non-symptomatic for a big reason: they were never out of bed or chair.  Yes, this lovely patient was completely dependent upon others for every aspect of their care, not to mention completely demented.  If your idea of quality of life is being 100% dependent on your family and having absolutely no meaningful interaction with them, then this is great.

I can understand doing procedures on folks with whom it will make a positive outcome – like the 80-something year old CABG mentioned in the above link.  It makes sense.  But to do these kinds of procedures on those with poor quality of life is just cruel.  It only delays the inevitable.

In this case, the family convinced the doc to do the procedure.  What makes my blood boil more though is that this same family had another member in and out of our facility spending nearly half of the last year of their life in the hospital in multiple lengthy admissions.  They would not accept that this family member was dying and insisted on all measures being done.  And now that there is a new one heading down this same road, it will probably be the same.

End of life costs are avoidable if we as society realize the death is a natural part of life and accept it.  Instead we claw and fight to eke out the last painful years many have, enduring lives of bed sores, PEG tubes, nursing homes and hospital admissions.  For what, a couple more years?  Years that can’t even be enjoyed because of the multitude of illnesses?  It doesn’t make any sense to me.

Scrubs are My Uniform

April 17, 2011 5 comments

Scrubs are pajamas. Initially a simple garment to be worn and left in the operating arena, the scrubs are now available in many a color and pattern to be worn by nurses, billing agents, medical assistants, doctors and anyone else in any way associated with physicians.

The fact that most people have no idea the difference between the girl who takes their copays and the nurse that evaluates them, most people assume they are all “nurses.”…

via The Pajama Brigade makes an Impression | The Happy Medic.

I get it all the time, “Well, you get to go to work in your pajamas.  How cool is that?”  I’ve worn many different uniforms in my work career from slacks, shirt and tie, to industrial workwear and just plain old jeans and a t-shirt and now I get to wear “pajamas” to work.  Sorry, that’s bullshit.  I am required to wear a uniform that happened to have been co-opted as pajamas.  To me, a uniform signifies that it is time to go to work, I call it “getting on my game face”.  Those “pajamas” tell me it is time to work, leave the world behind and focus on my job – my patients.

Now there are those that spoil this for those of us who take it seriously.  Since everyone and their uncle who works in health care  gets to wear scrubs, there are bound to be the one’s who abuse it.  I cringe when I’m out shopping and see people in scrubs, it sets the wrong idea, especially when those wearing them are misbehaving.  It is still bad behavior to break HIPAA whether you are wearing scrubs or not, it just makes it more conspicuous when you are in scrubs.

There are two issues here that get intertwined and blurred.  First there is professional behavior.  It doesn’t matter what you do for a living, you need to maintain a professional mien when representing that job/career/profession.  And yes, health care workers are held to a higher standard, get used to it.  It’s even more important when you are clearly identified by the public (by your wearing scrubs to the bar/lounge/grocery store/porno shop) to be a professional, because they associate scrubs with nurses/doctors.

Acting like an idiot in scrubs makes a bigger impression than it does in street clothes – people notice.  Second is the proliferation of scrubs into so many different fields.  Are they the doc/RT/PT/housekeeping/CNA/RN?  You can’t always tell.  Not to mention those outside of the hospital like vets, dental folks, office staff and the like where this has spread into.  Too many people wearing scrubs makes life confusing.  And due to this proliferation, clamping down and restricting use will be near impossible.  All that is left is some sort of uniform – like our friends in EMS/Fire/Police, or hospital color coding by job function.

As long as the color is not white, I can get behind this.  More so, I think that institutions need to require changing at work.  You get to work, change out of street clothes into hospital uniforms, then do the reverse when you leave.  If we are so worried about the spread of superbugs, why isn’t this a common sense idea?  I leave my work shoes at work and change clothes (partly because I usually commute by bike) on arriving and leaving.  It goes to the idea of getting my game face on.

The lesson here?  Scrubs are every bit a uniform, just like other professions.  Unfortunately there are those that wear my uniform that are unprofessional and act like idiots when in public.  Painting all of us with the same brush is just as bad.

It’s the Little Things

November 12, 2010 5 comments

It is never the BIG things that will drive you mad, it is the little things, those continuous little irritating reminders that get under your skin that make work so damn frustrating.  It’s the little idiosyncrasies of some nurses practices that will drive you up a wall.  I’ve mentioned the “freak out over nothing” otherwise known as Chicken Little, but almost worse is the “I forgot the basics of nursing school.”

C’mon!  The basics, turns, intake/output, taking a temperature with vitals, all in all really easy simple things.  But it is like these don’t matter to a couple of my colleagues.  And lately it seems like I’ve gotten the shit for it.

Case #1:  obtunded patient.  On continuous IV fluids and a crap-load of IV meds.  Intake charted for entire shift:  nothing.  Nothing was charted.  According to the charting, they were incontinent 42 times.  OK, they’re basically hospice, but we have nothing official, shouldn’t we be doing the typical charting as if they were a regular patient?  Thanks for that, when the docs ask me if they had any intake at all during the day I look like the idiot.  Luckily I can point to my charting.  What gets me with this, is that it is the easiest thing to do on an obtunded patient.  If you can’t track accurate I&Os with them, how are you going to capture that on a mobile CHF patients – where it is really important?!

Case #2:  Afib patient, on an amiodarone drip.  Something doesn’t jive in the orders and when asked, they say,  “I don’t know, I’ve never hung amio, just followed what pharmacy wrote on the bag.”  First, I have to explain typical protocol is 1mg/min for 6 hours then a decreases to 0.5mg/min for 18 hours, standard loading protocol.  It’s not like I’m pulling it out of my ass, it’s from the book.  So what that the 1mg/min has be running for like 9 hours?  Second, why didn’t you look it up?  You admitted to me that you had never hung an amiodarone drip, we have a resource book that details floor protocol for initiation and maintenance, it’s all there, black and white.  Again, I get to call the docs, explain the situation and get new orders.  Truly it’s not a big deal, but it is the principle of it all.

If you can’t effectively manage simple situations, situations where you have available resources and ability to follow-up, how will you function when the shit hits the fan?  I now know most of the meds I give on a regular basis, but I get ones where I have no idea.  So what do I do?  Look ‘em up.  It’s not like our patients are crashing and need them now, we have time to be thorough.  I&Os?  Yeah, on our basic patients I don’t always record.  But if they are getting fluids/meds/drips you’re damn sure that’s getting recorded.  I’m not perfect, never claimed to be.  I make bone-headed mistakes and overlook stuff.  Those are the exceptions though, not the normal.  I bitch about it because for some it is normal.  That’s the scary part.  When it happens I try to talk to them, but too often it gets left by the wayside, pushed aside and taken care of.

To me the leaving of the little things (these are just two recent examples – from multiple nurses), tells me that you’re either A.) not paying attention, or B.) don’t get it.  The little things are what differentiates the good nurses from the mediocre.  The little things are the keys to catching our patients before they crump.  The little things are what sets nurses apart and why techs can’t do our jobs.  And it’s the little things that piss you off the most.

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