Archive for July, 2010

Mmm … Donuts.

Why oh why can’t the nurses’ lounge be filled with yummy healthy snacks?  Don’t the patients and their families know that donuts are my one vice (besides Slurpees, that is)?  Don’t they know I can’t walk by a box of delicious, glazed and old-fashioned and chocolate-frosted donuts without having at least half of one?  Don’t they know that I’ll want to devour the entire box during one dinner break?  They stare me in the eye as I eat my blueberries and yogurt and almonds and turkey sandwich and mock me, the donuts do.

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So, after reading over a few of my latest posts, I’ve determined that I’m starting to sound like quite the bitter curmudgeon.  That just can’t stand.  Nope.  Not at all.

As a result of this sudden realization, I’m here to say, I have at least 3 or 4 years before I become a nasty old crusty man nurse.  At least.

Until then I’ll start listing some of the awesome things I love about nursing, and student nursing, and nurse externing.

Number 1:  I love standing in a clean supply closet, gazing at all the shelves full of medical stuff:  gauze, temp-dots, basins, diapers, chucks, etc. etc.  As our nursing instructor once told us, “I could spend all day in a clean supply closet!”

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One thing I’m learning very quickly:

The rising level of your hunger as your planned dinner break of 8:00PM approaches is directly proportional to the rising level of your spite as the people from PACU bring up your post-op patient at 7:52PM.

Ahhh, I love math!

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Two days off here, until back to the floor on Thursday, and then the entire 3-day weekend off!  Woo-hoo!

Was thinking about my post from yesterday before falling asleep last night, and then woke up thinking about some of the things I messed up last night.  And I’ll post ’em here, and then, forget about ’em.  Long gone from memory after that — can’t bring my work and mistakes home with me too often:

  • Forgot to put the bed alarm on that one fella after we got him back into bed.  Hope he didn’t try to get up again after that.
  • Forgot to do the Accu-Cheks on 4 patients at 9PM last night, because I was trying to eat dinner and simply … forgot I had to cover that side of the floor.  Hmm … Before I left, I noticed the RNs had taken care of them.
  • Forgot to go back to Room 3 and take his temperature with the digital.
  • Did my first Doppler pressure last night in a guy with a VaD, and didn’t really know what I was doing, and the patient knew it.
  • Left the woman in Room 9 on the commode probably a little longer than I should have, because I was helping another guy into the shower.

But it was fun to watch the old guy sit in the shower chair and let the water fall down onto him, messing up his hair, and how he smiled and kind of sighed, “Ahhh now that’s just what the doctor ordered.”

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Today was the busiest I’ve ever been.  There were 4 of us to cover 32 beds from 3PM-7PM, but then only 2 of us to cover 32 beds from 7PM-11PM, and the other person is a nursing assistant, and therefore can’t do EKGs or AccuCheks or anything like that.

Translation:  NurseExternKenny didn’t get much of a break tonight.  I started my 7PM vitals at 6:40PM and didn’t finish until close to 9PM — patients suddenly needing to get into the shower with my assistance … patients needing to use the commode with my assistance … new admission in that room over there … etc. etc.  But that’s ok, it all evens out in the end, I’m finding.

It’s not gonna be “every night I have only 5 patients to take care of.”  Most of the time, 16 will be about what I’m expected to handle, and that’s pretty okay most of the time.

The part I find distressing is this:  I’m learning very quickly that I’m starting to hate myself a little more each time I find myself thinking, while standing at a patient’s bedside, “Will you please hurry up and finish your story so I can move on to the next person and get his/her vital signs?”

That kind of thinking is distressing to me, but I know it’s only natural, I’m assuming.

It’s awesome that the 89-year-old WWII veteran is telling me what he saw and learned after he parachuted into Belgium.  It’s amazing hearing a 32-year-old woman tell me about how she already needs a new heart and how she was given her diagnosis right after becoming pregnant with a little girl.  It’s wonderful to hear a family talk about the Grandma in the bed, and all the recipes she’s made herself and passed on to the rest of the family.

I really feel like that’s going to be a huge part of nursing.  So am I becoming jaded already, just hoping that everything will be quiet so I can move along to the next room and the next task?  I sure hope not, but it’s starting to become something I wonder about.  At least for tonight.

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Wow, that last post was written when I was way too tired.  Big mistake.  Sounded for sure like I was “calling out” anyone who doesn’t follow the protocol to a T.

Hmmmm … yeah … not what I was trying to convey.

But instead of just deleting the post, let’s clarify what I meant to write, like now, when I’m more lucid:  I just wanted to make sure I’m not doin’ anything incorrectly … or overprotecting for no good reason … or being inefficient and wasteful … and all that jazz.

Cause I’m all for not having to put on that yellow gown every time I go in to that room.  Besides … then I can’t reach my pen.  🙂

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So, a question for the nurses (and physicians) out there:

As I’ve been going about my business, inevitably, maybe 30%-40% of the time, a patient will be on some sort of precautions:  MDRO, VRO, Airborne, Droplet, Enteric, etc.  Whenever I go into these rooms, I always gown up, put on gloves, and maybe mask (if indicated).  More often than not, the RN or MD assigned to that patient will do the same … but every now and then an RN or MD will enter the room with, say, only gloves, and comment to me, “Oh, you externs and students, always so proper with the gowning up!”

Now, I realize that, sometimes, the patient might be on unnecessary precautions, or the RN or MD might know something I don’t know (labs, etc.), but the question remains:

Why do some RNs and MDs do this?  Is the risk for spreading any pathogens lower than I’m assuming?

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I’m starting to pick up loads of little things.  Such as … make sure everything is done before proceeding.

Like, when you get a new admission, and the patient’s family is waiting in the lounge to come in and see her when she’s all set up in the room … and you’ve put on all the leads on her and set up her telemetry pack and started her on cardiac monitoring … and you’ve set up her call bell and bedside table … and you’ve gotten her vitals … and you’ve gotten her blood sugar … and you’re pretty sure everything is all set up … and she asks to see her family …

And you go out, with a smile on your face, and say, “She’s all set up and ready to see you!”  And the family looks so happy, and they all start to file in, and you follow them down the hall.

And then you see the nurse about to walk into the room with the foley kit, ready to start her catheter, with a look on her face, like, “Why did you let the family in already?”

Oops.  Forgot about that part.

“Sorry, entire family, please go out to the waiting lounge again.  We’ll be with you shortly.”

My bad.

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So, I worked 3PM-11PM again today.  In fact, this is the 3rd day in a 6-day-straight stretch of working 3PM-11PM.  Which is good … gives me a sense of continuity that I think I crave in a strange way.

Around 2:45PM, charge nurse:  “Ken, you’re getting pulled over to another unit to work the floor there.”

I work 3PM-7PM over there … do my thing … meet some new people … get my work done.

Around 7PM, charge nurse:  “Ken, we have a patient in that room over there who needs a 1:1.”

Grrrr …

In fact, 1:1s aren’t all that bad.  You check the patient every 15 minutes, drink some coffee, read a good book, chat up any bystanders, watch the Phillies on TV.  Not all that bad indeed.  But you sorta start to lose your routine and you sorta start to lose your touch and you sorta start to lose your ability to stay awake.  Not to mention, you feel bad watching the other staff rush to and fro getting things done that normally you would be helping with.  Instead, they rush by you as you read that interesting paragraph on p. 43 of your book and sip at your piping hot coffee from Au Bon Pain downstairs that didn’t cost you anything because they were closing and just wanted to give it away!  Woooo free coffee!

Ahhh, did I mention that my 1:1 patient needed the 1:1 because he was 1) attempting to rip out his indwelling catheter, 2) rip out his IV access, 3) take off his sling after having a permanent pacemaker installed (which might result in undoing everything they just did in the OR), and 4) trying to change into his clothes so he could go home?  No, I failed to tell y’all that.

Reason just doesn’t work in that situation, eh?  However, I find that restraints do.  And then he exhausted himself from the restraints and fell asleep within the hour.

And then it was back to my book.

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Went to change a patient tonight, who said he had just gone to the toilet.  This particular patient has been wearing a diaper for the last few days.

So, RN and I head in to change him.  We can smell the poop.  Patient said he had the poop.  So we roll him a bit to get the blue diaper off of him and … no poop.

Where’d it go?

We roll him more, take a peek in every little nook and cranny, and … hmm … still no poop to be found.  We looked and looked and couldn’t find anything.  Not that I was complaining or anything, but yeah, it just … up and walked away.  Or something.

So, all you experienced RNs out there:  where’d his poop go?

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