Roller Coaster

Today was a Roller Coaster. I took 5 patients. That went smoothly...it took me forever to finish my charting but I got it done and was still out of there on time.

It started off low:

Me...half asleep, grumpy, listening to our "Voice mail" reports.
One started out like this:
" Yeah, um, this is _____, calling report for the guy in room ###. He's got some ......uh.....Liver Problems..and some.....uh.....Lung problems. He might have a PICC line but I'm not sure. Yeah, and he's uh, taking Vicodin for Pain."*End of Report*
Really....no joke...this was almost word for word.
This particular nurse on nights scares the beJesus outta me. Seriously....I don't want to follow her because her laziness and incompetence might cause something to go wrong on my shift after she leaves. I hear she's had numerous complaints from patients and staff but the boss hasn't done anything about it yet.

Then the day went High:

Man, I was busy....5 patients....2 were total care with an ORTHO (Broken Hip and Femur)thrown in (We are not an Ortho floor and I know nothing about traction!) But I did good....missed my lunch....but I did good.

Low:

My Daughter's babysitter (Late hubby's cousin) told me she could not watch Ari when I go to NY in September. (I can't tell you how hard it was for me not to start crying at that point) I thought she was my last hope....read on for more.

Another Low:

Charge Nurse calls me on my way home to ask me if 2 meds were given at 1400 to one of my patients. I tell him I didn't know about the meds, no I didn't given them and apologized profusely.

High:

I get home and look at my Med list (I still make them...habit from clinicals) Those meds weren't ordered on my shift......so I call him back and tell him. Apparently they were new orders written about the time my shift ended so I didn't see the order and couldn't have missed those meds! Charge RN kinda teases me for being silly about worrying about it. (But it was my first real day to prove myself!)

Another...Extreme....Mountainous high:

My last ditch effort. I call my friend....the one who watched Ari for me all those years in RN school. She agreed to watch Ari for me for the NYC trip!
She's now my Hero.

(Also just found out my sister-in-law....my late hubby's sister, whom I've never met, is moving to NY next week. I hope I can finally meet her there!)

So now I'm feeling a little queasy-exhausted from my roller coaster ride.Watch me pass out early tonight....since I don't actually have to be anywhere tomorrow.

Listening to: AM Radio: Coast to Coast with George Noory (These People are nuts!)

Change of Shift #3

Change of Shift Number 3 is up! I was a contributor to Numbers 1 and 2 but slacked off for 3. Please check it out!

Insomnia, Stress, Anxiety

I called in sick for my first time as an RN yesterday. Luckily since I'm still on orientation (Not officially taking my own patients yet ALONE) nobody missed me. I still let them know I wasn't coming.

The reason I called in sick was because I had a terrible bout of insomnia Sunday night. I was literally up and down, side to side all night. When 4:30 am rolled around...The time I get up for work....And I had accumatively gotten maybe an hour's sleep, It was time to call in.

I could list a dozen reasons for my stress induced ails Sunday night but I don't want to whine too much in this post.

I've always been one to handle mental stress pretty well IN MY HEAD. My physical body seems to suffer from it and it's not until I've reached the Hindsight 20/20 phase that I realize what the cause of the ailments were.

My boss says I'm off orientation next week IF I feel ready. I told her I wasn't sure. 4-8 weeks is usual for most new grads on my floor. I'm in my 4th week this week. I've taken 4 patients max. Our day nurses get 5- 6 (rarely 7). I'm going to take 4 patients tomorrow....and 5 Thurs and Friday.To see how I feel about it.

I can say, I do like being with someone else...Having 4 hands...Someone to consult. I should enjoy it now while it lasts, right?

But....I'm bored. 3-4 patients isn't enough to keep me completely busy (depending on the patients of course...Sometimes it only takes one difficult patient to keep you runnin')

So I think I may go ahead and cut the boss's apron strings next week. We'll see.
*****************

Since we're talkin' about Stress.... Here's a story.

Patient is in good spirits. In for an Acute illness, entirely treatable. History of Anxiety and Depression. Medicated with Zoloft and claims it is managed well but her dosage is less in the hospital then what she is used to.

She tells MD she feels fine but would like to talk to someone about her anxiety and wants to talk to Psych. MD says OK and calls a consult. 30 minutes later BRAND NEW GRADUATE Social Worker walks in to discuss funding and follow up. Patient sees this as an opportunity to open up and "Talk to someone". Social Worker sits and listens to her woes. (Keep in mind I'm in there messing with the IV for most of the conversation)
Patient makes HUGE mistake by saying " Sometimes I wish I could just stick a knife in my head to stop the pain" in reference to the anxiety related headaches. She follows that up with " But I would never do anything to hurt myself" seeing the expression on the SW's face.
SW leaves room and asks me if I heard all that. I say "yes, sounds like she's frustrated with her illness and she has some anxiety issues."
Also....keep in mind......everytime I asked how she was doing during the shift she responded with "I'm Blessed."

Then I go to Lunch.

When I come back from Lunch I find out my patient is freaking out because the SW won't let her leave the room and has called the MD to get a 24 hour sitter on her for Suicide Ideation.
I calm patient down. Call the MD and express my feelings about what I heard and actually told the MD that I thought the SW over-reacted. MD says she agrees with me (She had met with patient that AM) but just to be safe, sitter can stay until Psych team comes.
Fortunately, Psych team came fast and discontinued the sitter promptly.
Pt has less anxiety by end of shift and the new SW is not making new friends easily.
***********
Listening to: "Lonestar" by Norah Jones

The estranged

I'm on day 3 of a 4 day weekend. I took off Friday because it was my birthday. 31....Thirty-one......Three--one. I'm seriously considering lying about my age from here on out. I want to be twenty-something again.

Things at work have been good. I love my preceptor. She is probably one of the best nurses we have on our unit and I know that's why my Clinical Manager made a point to tell me to make sure when we are on the floor together that I'm with her. Because she works some weekends, I sometimes get stuck with someone else though. My boss doesn't want me on weekends until I'm off orientation....She doesn't want to pay me the weekend differential. I understand...She's been getting a lot of flack for the staffing budget.

It's Ok with me since I still haven't found anyone to take my daughter on the weekends yet.
******
I've known our unit was unusual as far as the type of patients having a colorful history but just didn't realize until recently how prevalent it really was. Every shift that I've worked, My preceptor would get 5 or 6 patients and I will take 3 or 4 of them. On average, 25-50% of those patients will have drug or alcohol abuse in their history. The first week I worked I had 6 (out of 12 total for the week) patients going through DTs. (withdrawal)

As an aide, I never really knew the whole story with these patients. I could guess, but we didn't listen to report. Now that I hear their histories....It's just amazing the amount of chemically dependent people we get.

On my lunch break (Yes, I actually got one) on Thursday, I ran into 2 of my former RN school instructors in the cafeteria. We chatted for a few and one of them asked where I was working now. When I told them, one of them actually said I picked the hardest unit in the city. I told her I didn't feel that way...Been there for awhile....I guess I was used to the clientele.
And I am....It's always interesting, albeit, a little sad.

There's another thing. When I was in clinicals at the sister hospital, almost every single one of my patients there had family members constantly at the bed side. Or constant visitors.
On my unit, it's rare for our patients to have family or visitors at all. I guess it's the percentage of homeless or drug users who's families are estranged. Some of these patients are very very sick and will probably die soon and yet they have no one to call, no one to visit.
I find that incredibly sad.

Listening to: Wait by Sarah McLachlan

Rights of Passage

Wow!
What an awesome week!
I have done so much in 4 shifts.
I hit many rights of passage for a new RN. I've compiled a list even! (Ain't I creative?)

1. Getting yelled at by an MD for no good reason
Seriously! On my 2nd day! He yelled at me because a patient with MRSA had too many "Contact Precaution" signs on his door! (which I didn't put there...and what's wrong with telling people to wash their hands more then once?) Really! Sheesh

2. Earned the respect of an MD by saving his ass.
Different Doctor. I stopped him from leaving after he made some notes in my patient's chart. I had to inform him that she had been experiencing epigastric abdominal pain, nausea, vomiting, Her eyes were going yellow and her Bili was elevated. He had missed all that. He thanked me several times for telling him, said something about miscommunication with the On-call doc over the weekend, and then made a point to lean over me to see what my name was on my badge. This morning, He said "Good morning Jo" to me...he knew my name.
He's now my favorite doc. heehee

3. Taught my precepting RN something she didn't know.
Nothing big here...I just taught her how to add a narrative into the computer charting system.

4. Gave my Clinical Manger a new idea for the good of the unit. (This one I stole)
I just suggested that we start putting BP machines (Datascopes) into each room if we could find it in the budget. Our sister hospital was doing that in clinicals and I thought it would cut down on infections.
She said she would seriously consider that one in the next talks about budget.

5. Started a unsupervised IV with 1 stick.
Ya'll heard about that one!

6. Made a difficult judgement call for the good of the patient.
I decided a pt who had been hallucinating all night who was no longer hallucinating could be trusted to no longer be in restraints. It was a good thing too, she needed a central line put in and we found out a few hours later she had endocarditis and was throwing clots (all while withdrawing from crack) She was off to the ICU after that.

7. Delegated to an Aide.
No biggie here. I asked my aide to take my pts' weights for me since they weren't done on the night shift like they were supposed to. Just kinda cool, since I used to be the one grabbing the scale.

8. Calmed a family member.
Had a family member freaking out about the patient not eating. (AIDS, Pneumonia)
It had only been one day since he'd eaten.
I just explained that he wasn't going to starve and the most important thing was his electrolytes and we were watching them and controlling them with IV fluids. I also suggested ways to get him to eat.
That actually seemed to work!
**********
Listening to: "Sanctified" by NIN

Thanks for all the congrats!

It feels good to have it behind me now.

My first day on the unit was Friday. There we start out with our preceptors as a "team". I was assigned to an RN and we had 5 patients. Three of them were going through DTs (Detox from Alcohol). That was fun!

I started an unsupervised IV with one stick. Yay!

Did most of my preceptor's charting...... Seriously

I love her. She's an older RN who's been there for decades and who also hates that we just went live with computer charting 2 weeks ago. She hates the computer, "doesn't get it", and let me do most of her charting for her. She REALLY knows her stuff though...This computer thing is just "slowing her down".

I got razzed a little by my co-workers for coming in as an RN. A few of the CAs asked me not to be mean to them (Of course not!) The RNs acted like they had too much faith in me. (I'm new to this....Help!)

All and all..it was a pretty fun day that went by really fast. I love being on the floor now and out of those boring redundant orientation classes.

Tomorrow will be more fun.....my favorite charge nurse is on. If he wasn't gay....I'd so be in love.