Coffee & Conversation in a smoky room

Good Bye

2008-06-29T19:09:00.002-05:00

Dear Reader,

I am no longer Blogging. You are welcome to stay and read my previous posts, I hope you find them entertaining/interesting/informative.

My reasons to quit Blogging are varied...... I simply have no time, I have nothing to say, I'm an RN working in a close nit clinic and there could be privacy issues, also I'm in a different place in my life right now and simply don't need the blog like I used to.

I've made a few friends doing this blogging thing, and I still visit their sites from time to time. Check out my links to see who I read.

I may be back one day, Thanks for reading.

~Jo

H.R. 4138

2007-11-16T08:33:00.000-06:00

The kiddo is home sick today with a stomach bug. So I thought I would take some time to blog, seeing as I have not had the chance in the past few weeks.
My friend Beth over at PixelRN called my attention to a bill in congress that could be a really good thing for the Healthcare industry.
H. R. 4138 is sitting in congress and if it passes, it could enable the Nursing Staff in Hospitals across the country to determine staffing for their very own units.
I hate to sound cynical but I see Hospitals finding some loophole to get around it if it passes. (i.e. Like hiring one RN to oversee staffing and pressuring that RN to staff scarcely) However, whether it passes or not, it still calls attention to the biggest problem with hospital nursing and could save lives by preventing mistakes, med errors, and give nurses the opportunity to do more of what they do best....caring.
Staffing was part of the reason I left Hospital Nursing. I simply just couldn't do the whole being responsible for 6 patients when more then 3 of them were total care. It's not safe. Nurses burn out.
Hospitals don't seem to get that if they staff well, they lose fewer nurses, therefore saving them money in the long run that they spend on orientation and training.
I hope this Bill passes. But even if it doesn't, it's mere existence is a step in the right direction.

Medical Web

2007-10-20T11:59:00.000-05:00

The Internet has taken the place of so many things in the past decade. We don't need yellow pages anymore, encyclopedias or dictionaries, and according to some of my patients...a Doctor's advice.

You can find all the above with a quick search through a search engine like Google.com or Ask.com from a variety of legit and non-legit type sources.

I have had more then a few of our patients call up our office and question the Doctor's advice because of something they found online.

Now I'm a big fan of research. I've always believed a 2ND opinion wouldn't hurt.

Unfortunately, these patients are finding this information off of crackpot sites or they are misinterpreting the info off of legit sites because they have no medical background and they don't understand what they are reading.

Even if you've found information stating "blah blah blah is best for people with this disorder" That doesn't mean it's best for you.

The phrase "consider the source" comes to mind when these patients call but I remain open-minded because I believe it is always possible they they may have come across some information that might actually help them.

My Doctor is ever so gracious about the info. She actually reads the print-outs her patients bring her but usually sticks by her treatment plans because they actually work. She will tell them to go seek a second opinion from another doctor without hard feelings if the patient is persistent with the new "idea", "drug", or "procedure." She will go to Endocrinology conferences and come back and change her protocols. She's not closed to new ideas or research.

A search through Google for "Thyroid Disorder" produces interesting results. The number one result was the article "Oprah reveals Thyroid trouble" ......gee...didn't see that coming.

The second, was a link to wrongdiagnosis.com.

After that, there are a few more reputable links to info from the Cleveland clinic, Medline (Published by the National Institutes of health) and The Thyroid foundation of America.

The problem is...which links do people go to first?

It's OK to question your doctor....you have to be your own advocate. Just be prejudicial about where you find your information.

***********

I actually won the iphone from www.nursingjobs.org and Nursing Voices!

I won because one of my fellow nursing bloggers who posted the most listed me as her reason for being there!

So, a big Thank-you goes to Beth at PixelRN!

An even bigger Thank-you goes to Shane, administrator @ Nursingjobs.org!

Can't wait to play with my new iphone.

Overtime and Cold Meds

2007-10-01T22:36:00.000-05:00

Job still going well! I've never worked this much overtime before. The days fly by and it's 5pm then 5:30pm and I'm trying to finish up and get the heck out of there. But there's always one more Refill request to Fax, one more patient to call, one more lab result to look up.

I worked through lunch today, with my doctor frowning and and commenting that the reason I worked through lunch was because she went out of town last week. It's all good though. I was OK with it. I like doing what I'm doing and it made me feel better to get a few extra charts off my desk today. I'm like Earl and I believe in Karma...it'll pay off.

**************

There's this new buzz about cold medicine and kids going around. Here's an article.

Personally, I have given my daughter doses of cold medicines and antihistamines in her little lifetime. They worked. She started having pollen allergies at age 3 and if we didn't/don't nip them in the bud early she develops a sinus infection. She still takes prescribed Nasonex so it eliminates the need for Benadryl or Robitussin.

I think the main issue...the biggest problem is that parents are giving these to their young kids without the knowledge of proper dosing (By Weight...not age). They aren't seeking the advice of their doctors or they aren't understanding the instructions. It could be they just don't have the money to have a Primary Physician (pediatric or family practice) and just guess the proper doses when the kiddos get sick.

Either way, what will happen is they'll just take the infant stuff off the market and the children's stuff will advise NOT to give to a child 6 and under.

This is good news for the pharmaceutical companies who provide the prescribed stuff. That's where all that money is gonna shift.

I posted a little about this over at Nursing Voices. If you want to add your comment.

(Slick, eh?)

Nursing voices/Jobs

2007-09-21T19:28:00.000-05:00

I just want to post again about the contest over at Nursing Voices . You see, it's a Nursing Forum where Nurses and other people of the medical profession cal leave messages for each other about Nursing stuff and others. There's different categories to post under so it doesn't have to be specific to just nursing. The highest post this month (Until Oct 15th) and those who make mention in their blogs wins an iPhone. A second iphone goes to the person who named the winner (Hopefully me! ha ha) as the person who referred them. So tell them I sent ya!

Now for you nurses out there looking for jobs, a good resource would be to head over to NursingJobs .

It's worth a look!

Work, Kid, and iphone!

2007-09-21T19:14:00.000-05:00

Work is getting better. Next week, My Doctor is out of town and my fellow RN is taking time off so I get to run the helm by myself for 4 days next week.

I expressed some ahem...anxiety to Doctor about this seeing as I've only been there a little more then a month and I'll be doing treatments, seeing follow up patients, and answering all calls.
She's given me all her numbers...cell, pager...and has encouraged me to text message her with any small questions.

I hope I do OK.

Ari's doing better about school and she's getting adjusted to the idea that this whole school business is not an option or temporary.
She's been getting reprimanded a lot more then last year for "Not paying attention or talking".
They use the Green light system where they have a clothespin on on Green at the beginning of the day and it can be moved to Blue(OK), Yellow(OOPS), Orange(Uh OH), Purple (Trouble) or Black (BIG Trouble).
She's averaging around green and blue and has gotten to Yellow once. A report is sent home daily but she's been honest with me about her "color" when I pick her up.
Another adjustment she's made has been homework. She didn't have any last year besides reading assignments that we could do at our leisure but this year she has daily homework all due on Friday and it;s been hard to get her to sit down and do it all.

too many sick people

2007-09-18T19:09:00.000-05:00

I'm so exhausted today! I came in 15 mins early, only had time for a 30 min. lunch and left 45 mins late and me and my fellow office nurse STILL had stacks and stacks of charts on our desks.

I even offered to pick up my daughter and bring her back to the office with me to get ahead a little but my boss told me to go home.

I honestly think my Doctor has too many patients....and we don't have the man power to cover them all.

Also, I've noticed that the Endocrinology/Hormone biz has the highest maintenance type patients. I spent an hour on the phone today with just one couple....sorting out their issues with this and that.

*********
Daily reminder.......

Don't forget to stop by Nursing Voices and NursingJobs !!!!
Tell them Jo sent ya!
Pretty pretty please! ( iphone.....people! iPhone!)

Sony ImagePOO

2007-09-17T21:35:00.000-05:00

I'm Mad!

Sony Imagestation.com is shutting down in Feb. I have all my pictures on there! That's how I print them, buy gifts, and send them out to my friends and family in one convenient place!

They have a deal with Shutterfly for transfer so I guess that's what I'm gonna have to do.

Still stinks though because I had them all arranged into cute little albums and stuff. :(

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Just another friendly daily reminder....

Don't forget to stop by Nursing Voices and NursingJobs !!!!
Tell them Jo sent ya!
You know you wanna! (Yes I'm gonna keep trying for the iphone)

Emmys

2007-09-16T16:30:00.000-05:00

If I was in charge of the Emmys, these would be my winners:

Outstanding Animated Program (for Programming Less Than One Hour)

Avatar: The Last Airbender
Robot Chicken
****The Simpsons~ You can't go wrong with this classic!
South Park

SpongeBob SquarePants

Outstanding Lead Actor In A Comedy Series

Extras -Ricky Gervais
Monk -Tony Shalhoub
****The Office -Steve Carell ~ This man is a comedy genius
30 Rock -Alec Baldwin
Two And A Half Men

Outstanding Lead Actor In A Drama Series

Boston Legal -James Spader
****House -Hugh Laurie ~ He won last year....I hope he wins again just to hear his speech
Rescue Me -Denis Leary
The Sopranos -James Gandolfini (Do these guys have to win EVERY YEAR?)
*****24 -Kiefer Sutherland ~ I'm torn, I love this character

Outstanding Lead Actress In A Comedy Series

Desperate Housewives -Felicity Huffman
The New Adventures Of Old Christine -Julia Louis-Dreyfus
*****30 Rock-Tina Fey ~ I don't like the show much, but I like her
Ugly Betty - America Ferrera
Weeds - Mary-Louise Parker (I thought this was a drama??)

Outstanding Lead Actress In A Drama Series

Brothers & Sisters-Sally Field
*****The Closer • Kyra Sedgwick- She's brilliant in this show

Law & Order: Special Victims Unit •Mariska Hargitay
Medium •Patricia Arquette (like the show....don't like her)
The Riches •Minnie Driver (I thought this was a comedy??)
The Sopranos •Edie Falco

Outstanding Supporting Actor In A Comedy Series

Entourage • Kevin Dillon as Johnny Drama
Entourage • Jeremy Piven as Ari Gold
How I Met Your Mother • Neil Patrick Harris as Barney Stinson
*****The Office • Rainn Wilson as Dwight Schrute ~ His character is by far the funniest
Two And A Half Men • Jon Cryer as Alan Harper

(Side note....Notice how many former 80s TV/movie stars are in the line up?? weird)

Outstanding Supporting Actor In A Drama Series

Boston Legal • William Shatner as Denny Crane (Capt Kirk is in a show now? How did I not know this?)
Grey’s Anatomy •T.R. Knight as George
*****Heroes • Masi Oka as Hiro Nakamura~ Really crossing my fingers for this lil guy
Lost •Michael Emerson as Ben
Lost • Terry O’Quinn as John Locke
The Sopranos • Michael Imperioli as Christopher Moltisanti

Outstanding Supporting Actress In A Comedy Series

*****My Name Is Earl •Jaime Pressly as Joy Turner ~ I actually know people like this character
*****The Office •Jenna Fischer as Pam Beesly ~ I want them both to win
Two And A Half Men • Holland Taylor as Evelyn Harper
Two And A Half Men •Conchata Ferrell as Berta
Ugly Betty •Vanessa Williams as Wilhelmina Slater
Weeds •Elizabeth Perkins as Celia Hodes

Outstanding Supporting Actress In A Drama Series

*****Brothers & Sisters • Rachel Griffiths as Sarah Whedon ~ Don't really care much in this category, but I loved her in 6 feet under so I vote for her
Grey’s Anatomy • Katherine Heigl as Isobel “Izzie” Stevens

Grey’s Anatomy •Chandra Wilson as Dr. Bailey

Grey’s Anatomy •Sandra Oh as Cristina Yang

The Sopranos • Aida Turturro as Janice Soprano
The Sopranos • Lorraine Bracco as Dr. Jennifer Melfi

Outstanding Guest Actor In A Comedy Series

Entourage • Martin Landau as Bob Ryan
Extras • Sir Ian McKellen as Himself
Monk • Stanley Tucci as David Ruskin
*****My Name Is Earl • Giovanni Ribisi as Ralph Mariano
My Name is Earl • Beau Bridges as Carl Hickey

Outstanding Guest Actor In A Drama Series

Boston Legal • Christian Clemenson as Jerry “Hands” Espenson
*****ER • Forest Whitaker as Curtis Ames ~ Really good plot line, and it's nice to see ER up there again
House • David Morse as Michael Tritter
The Sopranos • Tim Daly as J.T. Dolan

Studio 60 On The Sunset Strip • John Goodman as Judge Robert Bebe
Studio 60 On The Sunset Strip • Eli Wallach as Eli Weintraub

Outstanding Guest Actress In A Comedy Series

Desperate Housewives • Dixie Carter as Gloria Hodge
Desperate Housewives • Laurie Metcalf as Carolyn Bigsby
30 Rock •Elaine Stritch as Colleen Donaghy
Ugly Betty • Judith Light as Claire Meade
*****Ugly Betty • Salma Hayek as Sofia Reyes

Outstanding Guest Actress In A Drama Series

Grey’s Anatomy • Kate Burton as Ellis Grey
Grey’s Anatomy • Elizabeth Reaser as Jane Doe
Law & Order: Special Victims Unit • Marcia Gay Harden as Star Morrison
Law & Order: Special Victims Unit • Leslie Caron as Lorraine Delmas
*****24 • Jean Smart as Martha Logan~ One of the best/complex characters on so far

Outstanding Comedy Series

Entourage • HBO
****The Office • NBC~Probably lose, but most deserving I think
30 Rock • NBC
Two And A Half Men • CBS
Ugly Betty • ABC

Outstanding Drama Series

Boston Legal • ABC
Grey’s Anatomy • ABC
*****Heroes • NBC ~ One of kind...it really should win

House • Fox (Love it but Heroes was better last year)
The Sopranos • HBO (Probably will win since it was the last year)

Outstanding Reality-Competition Program

The Amazing Race • CBS
*****American Idol • Fox
Dancing With The Stars • ABC
Project Runway • Bravo
Top Chef • Bravo

If you are wondering why my picks snub the favorites to win like the Sopranos and Entourage...I personally think the Cable channels should have a category of their own. They're allowed more freedom then the network channels. So those are my picks if I were running the Emmys. :)

[ UPDATE: WOW! Only one of my picks won. Jaime Pressly from "My name is Earl". I knew the Sopranos would probably sweep it. But James Spader??! Really??!!]

$$$$$$$$$$$

Also Don't forget to stop by Nursing Voices and NursingJobs !!!!

Tell them Jo sent ya!

It's well worth the time! (Yes I'm gonna keep trying for the iphone)

Culture shock & Nursing Voices

2007-09-16T00:53:00.000-05:00

There's something of a culture shock with my new job.

I'm learning to get used to working with patients with insurance and money.
None of that at the hospital I worked at before.

I'm having a hard time with my compassion meter when the housewife soccer Mom with the Husband, Lexus, 2 perfect kids from the nice side of town calls me to complain that her Thyroid medicine is not "high enough" for her to keep the pounds off and that she's OK with the heart palpitations and insomnia if it means she won't get fat.

I just have a hard time not thinking about my former homeless patients with nothing who were just trying to keep their kidneys working or their lungs moving.

I keep my mouth shut and feign sympathy. I still like it though...way better then other patients throwing punches at you!

Calling all Nurses, Student Nurses, Wannabe Nurses, or People who just like Nurses!

I have it linked on the sidebar!

I've been spending a lot of time there lately!

If you want to meet a great group of nurses and you are in the medical field (or just want to hear what nurses have to say)

Then check out the Nursing Voices Forum!

Hey Nurses! if ya got the time, also check out NursingJobs.org to find that dream position you've been waiting for. OR... Maybe....just to tweak your resume, check out a great deal on Danskos, or just read a good article. I checked out this site in great detail when I decided to leave the Hospital.

I do love the forum, it's picking up steam with posts and I haven't been apart of something like that since shortly after Mike died. Then...I was a regular on a young widows site. I felt I had to move on from there. No Reason to do that at Nursing Voices though! Great group of gals over there, lots who are fellow bloggers as well.

If you decide to register and join, please tell em Jo over at Coffee and Conversation sent ya!

(Yeah...there's sorta a contest goin on....shameless maybe.....but the prize is an iPhone! Oh and a second iPhone will be awarded to the person who registers and says I referred them IF I win....sweet! )

Patriot day- 6 years

2007-09-11T22:49:00.000-05:00

I went back a year and read again my post from last year paying tribute to one man lost at the WTC on 9/11. It's one of my better posts and I thought I would repost it again.......to remember.

***************
From 9/11/2006:
***************

When I volunteered to write with 2996 on Sept 11, I had no idea how difficult it would be. I researched my assigned person, Gregory T. Spagnoletti for weeks. I found out a little bit about this man who suffered a terrible fate when the World Trade Center was attacked and collapsed in NY city.

I think the best way to pay tribute to him is to share with you what I found out.

He had a great smile.

His friends called him "Greg" or "Spags".

He worked for Keefe, Bruyette, and Woods as a Bond Salesman.

He was the 3rd Brother of Four.

They were all big hockey Fans.

He organized hockey games at Chelsea Piers.

Out of the 4 Brothers, he was called the "responsible" one.

He was known for dropping in to have coffee with his tailor.

He was engaged to be married to Gretchen Zurn.

They had just fixed up their new Apartment on West 72nd st, and he was very proud of it. His family said it would take him 45 minutes to give you the tour of all 1200 sq. feet.

His parents started the Gregory T. Spagnoletti Memorial Foundation. You can donate to it by sending to:
Gregory T. Spagnoletti Memorial Foundation
62 Wolff Street
Waterbury, CT 06708

But the biggest thing I found out about Greg was that this man was definitely loved. He is definitely missed.

He like all Americans had no idea as he got up and went to work 5 years ago that America was going to change that day. He had no idea that those 2 towers, which have represented the NYC skyline for 30 years, could ever possibly be brought down by terrorists. Those Towers would become his tomb. He was on the 89th floor of the South Tower when it went down. It took officials almost 2 years to identify some remains and return them to his family for burial.

Greg,
Five years ago I can say I was thinking about you as I watch the towers collapse on TV. But mostly I was thinking about Gretchen and the future she had lost with you. I was thinking about the children she would never have with you. I knew you were in a better place but I knew all too well the horrible place your loved ones were in. I prayed that God be with them on that day. I want you to know that America won't forget what happened what happened to you and 2995 other innocent people.

To my readers,

Please visit 2996 to find links to 2996 bloggers who have paid tributes to the victims of 9/11.

Crazy Friday

2007-09-09T13:49:00.000-05:00

Friday was crazy and interesting. When I got to work, the first thing I noticed was all the doors are open.

They were open because the AC broke. Knowing the high that day was gonna be in the mid 90s, and how irritable I get when I'm hot, it was not a good start.

Arriving at my desk, my boss informs me that the other nurse was sick and that I will be running treatments and not Triage as usual.

I've gotten comfortable with Triage...I trained more with that. Treatments I've only trained 2 1/2 days for.

Luckily, the nurse I'm replacing (she left the position to go part-time float for school) was able to fill in for triage and was there to answer any questions that might pop up.

Things got sticky when my Doctor ordered an injection for a patient and I had no idea where we kept the supplies or drugs. At the same time I had 4 people in our waiting room waiting to be shown to a room (a lot for us). Prior Nurse saved me there too, she showed me where the supplies were and offered to give the shot while I got the patients into rooms.

At least I know I can do it now, and I'll be more comfortable next time.....but talk about being thrown to wolves.

And the AC was fixed by 10am....which was nice.

******
Ari's having some real anxiety with first grade. Once this week while dropping her off, she refused to get out of the car. I had to park and coax her out, walk her to class. The next few days she was sick, with one day she was actually....really sick (A sinus infection with psuedo-pinkeye...the eye I think was irritation from the sinuses). The other days I think she was milking it.

I asked her what was wrong with school, she says that it's boring and not as much fun. That they are working too hard.

I kind of expected this shock with 1st grade, it's not Kindergarten fun anymore. I just didn't think she'd be so stubborn about it.

She's trying to convince me to be a stay at home mom and home school her. Not gonna happen.

Mike

2007-09-03T14:00:00.000-05:00

I've decided since I won't be writing about anonymous patients anymore that it would be generally safe to post pictures of me here.

This pic is from a happy time...we were young, healthy (way thinner), and happy. 1995... Just about to get married so that the Air Force would ship me where ever he was stationed. Which turned out to be right next door in icky, yucky, smelly Shreveport,LA.

It'll be 6 years since he died...tomorrow. I still think about him everyday.

Be My Friend

2007-09-02T18:06:00.000-05:00

I'm networking, I'm lonely, I want more friends!

click on it to add me to your Netflix!

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On Pogo?

I'm Jojodow there...add me!

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On MySpace? (who isn't??)

Here's My Space

Clinic Nursing

2007-08-27T19:40:00.000-05:00

I'm back! At least for an update. I'm not sure if I'll continue posting so I'm sorry to all of you who keep checking in on me....i see you....from my web counter...I do appreciate it.

I quit the Hospital the beginning of August. The hours although not long were just not accommodating for a single mom. I hated getting someone to take Ari to school for me. I hated panicking every time there was a holiday where I was expected to work. I hated the long commute...45 mins to an hour in the am and then the hour to hour 1/2 home.

I left because I accepted the most excellent position working for an Endocrinologist. At first I thought it might be too boring for me but It's sooo busy. It's just me and another Nurse working for this one Doctor. The Doctor is awesome with her patients and is really nice and encouraging so far. But she's very particular with her charting and how things are done. It's almost like learning the routines of an Obsessive compulsive. I know she has her reasons for doing things this way or that but it's sooo overwhelming to learn.

Here's my Hospital vs Clinic comparison for all you new RNs looking for a job.

Hospital:

Longer Hours/ fewer days a week

Holidays...most you have to work or at least rotate

Weekends...typically at least 1 weekend/month but you usually get paid extra

Far better pay, when you consider differentials and bonuses

Using most traditional Nursing skills...the ones we all checked off in RN school

Dealing with patients not in their right mind who may throw something at you

Not having to deal with referrals, financial stuff, and insurance companies

Working at a pace you manage with probably nobody to check to see you are doing what you are supposed to be doing. (it's all honor code at the hospital)

Treating Doctors more like equals and even teaching the baby Docs a thing or two

Patients can have life threatening situations at any time

You can't leave unless you have a nurse to take your patients. It would be illegally abandoning them.

Clinic

Shorter, more human hours but 5 days/week

Most if not all holidays off and usually paid for

All weekends off!

Less pay...unless you stick around awhile and maybe get certified to do fancier things, however... it's easy to work through lunch if you have too much to do and that = overtime

Not using a lot of "Traditional" Nursing skills...injections and a few IVs is basically the best chance

Dealing with patients who may not be in their right mind who might just yell at you over the phone.....or threaten to "take their money and insurance elsewhere"

Having to deal with referrals, financial stuff, and insurance companies...the most annoying part of my new job...hate it.

Working at your doctor's pace and schedule....all else you have to fit in between phone calls.

The Doctor is boss...what they say...goes. Whether it makes sense or not.

Life threatening situations RARELY happen in a clinic....especially mine.

You can leave....for appointments, to pick your kid up, etc. My fellow co-worker brought hers in today just to color at her desk while she worked.

It's still chaos...just a different kind of chaos.

So....... with Ari starting 1st grade (waaa...she's getting too big!) this week, it's been really great to drop her at school and know....if anything happened to her, it wouldn't be illegal or a threat to my license to drop everything at work and go get her.

So, with me being in a clinic setting I won't be able to post much about patients...too easy to figure out with a close nit setting like that. But I'll try to pop in and post every once in awhile with updates.

AWOL

2007-05-09T17:53:00.000-05:00

I know I haven't blogged in awhile and I don't think I'll be blogging much in the future. I just don't have much in me lately....in general...and to blog about.

Nothing's changed, still working hard at the same place, same hours.

I'm just chronically tired. So in my free time, work...is the last thing I want to think about.

I'm not saying I won't be back, I might. I'll leave the Blog up regardless.

I wish you all well.

Take care.

A huntin' I will go

2007-03-23T17:35:00.000-05:00

I've been hinting around now for awhile about looking for a new job. I am getting serious about it and I plan to revamp my resume and actually start putting it out there in the next few months. The reason I haven't yet is because I am a woman of my word....I signed up for one year in my current position and I owe my fabulous boss at least that much.

It all just boils down to the hours. When I'm working even until 3, I still have to "work" when I get home taking care of a kindergartner. I want to be able to take her to school in the mornings, spend holidays, and weekends with her. Basically, I just want to work when the rest of the country does.

There's this fantastic site....www.nursingjobs.org that's going to help me plant my resume, look at job postings, and possibly help my new employer find me.

Not only does it do that but it's also a great resource for nurses with links to Nurse-y shopping, state boards,Nursing schools, and nurse blogging.

Shane, the founder also founded Nursing voices (see the very top of this page).

Shane's also kicking up some new ideas for the site as well so I know we'll be seeing even more to come.

It's all the Internet savvy nurse needs for Internet nurse stuff!

Potential students, Nursing students, and Nurses everywhere could benefit from at least one thing on this site. Nursingjobs.org is NOT just about nursing jobs.

Slackers

2007-03-06T11:06:00.000-06:00

Wow. I'm such a slacker. One month since my last post. I'm truly sorry to those who have checked by in the past month unrewarded.

It's been busy. Working, Girl Scouts with Ari, Gymnastics with Ari. Ari was pretty sick there for a week with a nasty case of Strep that had even caused a rash. She happens to be home with tummy troubles today too.

I've gotten lucky the last 2 weeks at work. I haven't had the worst patients on the floor. (by worst, I mean crazy and hostile)

Now this week I did have some heavy patients on the floor but I had students with me. Thank God for students! I don't understand why some nurses don't like students. I love teaching and it's fun to show them the tips I've picked up. And how can you not love having an extra set of hands, especially in nursing?

Recently at shift change I called another CRT on my patient. Physical Therapy had been moving my CVA (Stroke) patient and when they got him back to bed he became unresponsive and started breathing in the style of "Cheyne-Stokes". (It's always when they're moved) Since he was still breathing I called the CRT.

I was very pleased the student I had with him stayed late for the whole process to help me answer questions to the CRT team and the MD. With both of us answering their questions we had him in the ICU within the hour. Not a slacker.

The most frustrating thing about that CRT was that the MD I had been communicating with all day passed the buck off to another MD when he heard his patient was crashing. The new MD (who is one of our own...we all love him) walked in knowing nothing about the patient. The original MD.....Slacker.

I'm not sure why my unit has been slammed with all these heavy patients lately. We used to be the lightest floor in the hospital. The problem is we staff for a "light" load. 5-6 heavy patients on a day shift is not cool. People are quitting.

This summer, when my contract is up, I may be searching for a different position myself.

COS

2007-02-08T08:26:00.000-06:00

Change of Shift is up again at Nurse Rached's Place!

I have a lot of reading to do.

Judgements and ASSumptions

2007-02-04T13:02:00.000-06:00

Today is my younger brother's 16Th birthday! Happy Birthday Walker! (I'm 15 yrs older then him and 20 yrs older then my youngest bro, Zak....I feel old.)

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I was thinking the other day about writing a post about the judgements nurses and doctors make with patients. I wasn't sure how to lay it all out and coincidentally came across Third Degree Nurse's post about a similar subject.

I've heard a lot of comments in the past about what patients do to put themselves in the hospital.

"Why do these people drink themselves to death"

"He has COPD but thinks it's OK to keep smoking"

"A 40 yr smoker...what did she think would happen?"

"He has Diabetes but he won't follow the diet"

"She weighs 500 lbs, maybe she should've exercised"

"He's been hospitalized 4 times this year detoxing, he doesn't learn"

Even as I watched a liver patient lay there unresponsive and dying I heard an experienced 20 yr nurse say "If he had only stopped drinking..." in front of him.

Maybe it's my personal and family background in addictions that keeps me from even thinking these things. I just don't. When I hear patient diagnoses it doesn't occur to me to think what caused them....just how to care for them.

It's natural for anyone to look for blame....it's human. If we look for a reason it prevents us from doing the same to ourselves. We can tell ourselves that it won't happen to us. Prevention is important.

However, it doesn't always apply.
When I tell people that Mike died of Oral Cancer, the first question asked is always "did he dip?" (use chewing tobacco). He didn't. Diagnosed at the age of 21....there's not much one could do to cause it....it just happened.

I've met widows of victims of lung cancer who didn't smoke.
I know people who are overweight because of their thyroid gland and not because of their eating habits.
I've met a few Liver disease patients who never drank.
Sometimes it just happens.

On the other hand, there's those who drink because they've had a really hard life. They smoke because it's the only way they know how to cope. They eat too much because they are really sad and depressed.

In Nursing you have to check your assumptions and judgements at the door. A nurse is there to take care of the patients needs now and hopefully teach and encourage the patient to not damage their bodies further....if that is the case.

The trick is to remain compassionate, empathetic, and caring despite what caused the patient to walk in your door. Don't avoid the patient because "he deserves what he caused". And bite your tongue.....I guarantee the patient knows why they are there.

It helps me to remember to never judge a person unless you've walked a mile in their shoes.

CRT

2007-01-27T12:49:00.000-06:00

CRT-critical response team. At our hospital it's a Seasoned nurse (the charge from ICU or ER) a Resp. Therapist and a house supervisor. They are called when a patient hasn't coded yet but has had some downward turn or when something just doesn't seem right. That way the nurse is not alone.

I've called 2 CRTs in the past month, my first 2. The first one was when I had floated. The patient's BP dropped suddenly into the 70s over 30s.

The other was last week. My patient with Liver Disease had an Ammonia level in the 200s (Outrageously high) and became unresponsive and had periods of Apnea. The night nurse had done nothing about this but I was not comfy handling this situation on my own and I thought he needed a higher level of care (ie. a monitored bed and a floor where the nurses had less then 6 patients each)

The first CRT made me feel foolish, all we did for the man was get a reliable IV in him ( a PICC) and started pushing fluids into him. The fact that this man looked like a hospice patient seemed to escape the team. The second one was different. Good things happened. The team agreed with me and had him transferred to one of our Critical care floors. I like that we have this Pre-code system.

In the old days a nurse was left alone to deal with a gradually crashing patient and couldn't "call a code" until the pt stopped breathing.

Texas Ice storm

2007-01-26T12:21:00.000-06:00

I have absolutely no excuse for not blogging for awhile. I was snowed (Iced really) in last week and only worked one day. I should've blogged. I guess me and Ari were too busy playing in the ice and keeping warm.

Here in Texas we have roads not built for ice and drivers who shouldn't drive on ice. I think there were like 300-400 accidents last week.

The hospital went into "Code Ice, level II" That means everybody goes into 12 hour shifts and they need to stay the night. I didn't get there before the roads got bad so I was stuck at home. If they had gone to level 3 they would've sent police officers out to come get us. They did have child care set up but by the time they had a guaranteed set plan, the roads were too nasty. The day before my boss had only been "pretty sure they'll have something set up" and they were going to allow me and Ari to sleep on a stretcher in Daysurgery. Sounded too scary for Ari for me to risk our lives on the roads.

They need to have a better plan for these ice days.

As for this past week It was really good. We were well staffed and I had sweet patients. Everything ran smoothly. I only wish everyday went as smoothly. I'm getting my resume prepared to apply at the new hospital they are building like 5 mins from my home. It's the same company running it so I feel like I'm not really leaving my peeps. It doesn't open until early 2008 anyway. The commute will be nice.

Here's some pics of our ice storm:

Ice off my car

Same shot with a weird reflection cloud

My car doors were frozen shut

Ice on my car, about an inch and a half

The fun part, Ari and the neighbor kid
catching snowflakes in their mouths

Icicles on my house

Stressing the body

2007-01-13T01:04:00.000-06:00

I'm making myself post at least once a week.

It's hard to come up with a topic because I either lack an interesting experience or I'm too overwhelmed with experiences to pick just one to write about. (and remember clearly)

I worked only 3 days this week because Ari is suffering big time from a nasty sinus infection and Pharyngitis thanks to the ugly Cedar monster that has enveloped this area of Texas. My friend, Student Nurse Jack has eloquently written a funny post about that.

My paychecks suffer when Ari's sick or when I get cancelled. Cancelled is what we call it when we are overstaffed with nurses and someone gets called at 0430 in the morning to be told to stay home for the day. We take turns and it's been happening to everyone at least twice a month. I'm annoyed by it later but at 0430 I'm always happy to hear I can fall back asleep under the covers all snugly.

++++++++

I'm stressed out.
Stress does funny things to me. I feel it in my bones and joints. I don't sleep well at all and I get headaches. I get heartburn at night. I have a skin thing called Pompholyx a.k.a. Dyshidrotic Dermatitis on my hands. That flares up pretty bad when I'm stressed. (Yes I realize the dangers of having this at work...especially on my unit....I wash my hands a lot...keep them dry....and cover any of the blisters with Tegaderm when I need to)

Am I stressed right now? I don't know. Mentally I feel fine but all these little body alerts are telling me I am.

So I take benadryl to sleep and for the itchy hands.
Tums for the heartburn, Aleve for the headaches and joint aches. I medicate.
medicate. medicate.

What am I stressed about you ask?
Beats me. I would say every thing's going OK. Sure the job is tough right now but getting easier for me to handle...I'm adapting. And I still love it.
My daughter is healthy and happy.
I have a roof over my head and the rent is paid and the bills are slowly but surely getting paid. I have great friends and people who love me.
Still....Yet..... here I am at 1 am blogging with itchy hands, heartburn, and my hips and ankles are killing me right now.
And I can't really think of anything else to write about.

The Med Room

2007-01-05T13:39:00.000-06:00

I've had a rough week in nursing. It actually seems like I have a lot of rough weeks in Nursing. The bad outweigh the good anyway.
Is it possible to burn out after just 7 months?

Maybe it's just the time of year, the holidays and such. I'll hang in there because I still like the job....I still love the career.

I just know some of my co-workers feel the same way.

It seems the Med room on my unit is the the dumping ground for frustrations. We nurses don't get too much time to chat with one another if we are really working our tails off.

Although there are some units who have Nurse's stations for that. Ours is pretty open with lots of people hanging out there. Interns, Residents, Physical therapists, patients even. Some one can overhear the venting and take offense.

We Nurses, We run into each other in the Med room getting our Narcotics, Insulin, Saline bags, IV supplies, and etc.

While we are in that tiny, hot, and somehow soundproof room it seems we have the perfect opportunity to vent to each other about our frustrations of the day or vent about the one or two nurses or aides who aren't pulling their weight.

The door has a code lock and a thick window....you can see and hear people coming in.

I have on many occasions heard and uttered the phrases "Is your patient load as bad as mine?"; "What is WITH these people today?" and "Why are all these sick people here?!"
That last phrase is my favorite sarcastic one.

The Med room is a safe place to utter and hear these phrases. It won't be overheard by someone who will take offense....the only people who hear are the other nurses who understand.

I like our med room, it's quiet there. You can hide in there if only for a few moments and collect yourself.

I need that in a particularly crazy shift.

EMU

2006-12-28T18:15:00.000-06:00

Windfall woman asked in the comments if I had floated away. I haven't, but sometimes wish I had. Ha Ha.

Actually it's been a really good week. I had the Seizure unit. Called EMU, Epileptic Monitoring Unit. It's a unit within my unit, 2 monitored beds set up for EEG to monitor Brain waves for seizures in patients who have been having them for some unexplained reason or their seizures have changed, etc. etc.

When we have the seizure patients we are only allowed to have 3 patients. 1 Seizure patient and 2 regular medicine patients. The reason for that is the EEG they are hooked up to will alarm if it detects seizure activity (unfortunately it also detects head scratching, chewing, coughing, talking on the phone, etc.)

When the alarm buzzes, we have to run in to make sure it's not a seizure every time. When my unit has got a good team working this is a great gig.
When I'm in one of my other 2 patients rooms, or the med room, or the supply room, and the alarm sounds, any of my good co-workers will poke their head in for me and check on the patient. That's how it went for the last 2 days.
Those were great days.And that's how it goes ANY day for ANY one who has that assignment.

Today was an exception. I had a charge nurse with a bad attitude who admittedly didn't feel well yell at me for not staying at the monitor. She yelled at me 3 times.
Each time I was with my other 2 patients. My seizure patient never had a seizure, it was always just a false alarm.
But instead of poking her head in for me she yells at me.

That 3rd time I yelled back. (For me, yelling isn't yelling.....Really) I sarcastically (as is my fashion) asked her what I was supposed to do with my other 2 patients and stated that it was impossible for me to do my job if I had to sit outside this room all day.
She told me I needed to tell someone when I left that spot.

So I did just that.....(I can be passive aggressive at times) Everytime I walked away to the bathroom, the med room, the supply room, into another patient's room, I yelled out loud to her at the nurse's station.
Example " I'm going to the bathroom...Somebody please listen for the alarm!"

I did that soooooo many times that I think she and everyone else was tired of hearing my updates. Although some of my fellow nurses thought it was comical and that she deserved it. Could have saved her that headache if she had only been willing to poke her head in on my patient for me occasionally.

Onto other news...Change of Shift is up today. Go check it out!

COS V.1 # 13

2006-12-14T09:33:00.000-06:00

Another Change of Shift is up. For good reading go here.

Floating

2006-12-12T08:21:00.000-06:00

I was floated yesterday. For those of you who don't know, "Floating" is when a member of the nursing staff gets sent to another short-staffed unit of the hospital. We were overstaffed, they were understaffed.

When I signed my residency contract I was promised 6 months of no floating. I was one day short...my 6 month's mark was today. They couldn't just give me one more day of float-freeness.

I now know why all my fellow nurse's HATE floating and bitch and moan when they do.

It was horrible.

We have one unit in the hospital where we always float. Why? Because they have terrible management, they are extremely disorganized, there is no teamwork so it's every man for himself, the staff is rude and lazy, and because of all these things they can't keep staffed for very long so we have to go fill in.

I got to the floor and the charge nurse, who kept her butt at the nursing station all day, gave me my assignments and begrudgingly gave me as little info as she could about where things were, codes for supply rooms, etc.
I noticed that out of my 5 patients I had FOUR who were not ambulatory (One was a with assist). I noticed throughout the day that my patients seemed to be the only ones who were not ambulatory.

Sure....that's smart management....let's give the visiting RN, who doesn't know where anything is, the hardest patients on the floor.......the ones nobody wants.

That way the rest of the nurses can sit at the station and flip through magazines all day.

If I asked for help I got attitude.

I did find 2 people helpful. An RN who was there just to do IVs. (Yes, they floated me up there even though they did have one of they're own on staff just to do IVs........we don't have IV nurses at our hospital)
However, She was helpful and nice. The other was a brand new assistant who was still in orientation who volunteered to help me do a bed bath.

I appreciate my unit so much more now. We maybe sometimes dysfunctional but for the majority of the time, we function, as a unit, like a well oiled machine.

When we hire someone new, they stay...for possibly years because we have the kind of staff that would never pile a heavy load onto a visiting nurse. (In fact our charge tends to give the easier patients to visiting nurses)

With a few exceptions, you would almost never find magazine reading at our nurse's station when there's a nurse running like a chicken with it's head cut off.

Not on my unit.

Total Care

2006-12-09T12:43:00.000-06:00

My unit Christmas party is tonight. We always have great Christmas parties. Everybody, including the boss, gets a little tipsy. I don't drink, but it sure will be fun watching the others get that way.

Frankly, After the week we had...we all deserve to do a few shots. Yesterday I had gotten to work to find that 3 out of my 5 patients were total care. When I whined about it, I found out the whole floor was practically total care.

How can that happen? What are the odds? What happened to all our ambulatory homeless guys coming in from the cold?

You'd think they would increase the staffing with accuities being so high. It just makes sense. I was running around without lunch breaks or potty breaks all week.

It really bothers me when I simply don't have time to give the best care to all of my patients. If it's just one patient taking up my time, I can usually manage to break away to get to my other patients. But when I'm in 3 rooms all day, changing briefs, giving bed baths, removing or starting Foleys.....I have no time for the not-so-heavy patients who still need my care.

Not even the best Delegation and Prioritization skills in the world will help if there is simply no one to help.

One patient looked pretty bad, admitted with pneumonia and UTI from a certain government run mental facility. Their temp was elevated, BP started crashing, HR increasing (Yeah...you know what this sounds like) going from unresponsive to screaming incoherently (I was told that was their baseline). I asked the Resident to consider moving the patient to a critical care floor. She said they'd discuss it in rounds. It didn't happen.
So with my heavy load, I did frequent assessments, charted everything in detail (Including the "Dr X notified of this, no orders received")
That patient had no business being on my unit.

Another patient with whom I had developed a rapport called me a "Dirty Rat". He had Necrotizing Fascitis in his arm muscles, a result of several failed attempts to shoot up some sort of illegal drug. (He didn't elaborate)
He was upset with me because the wound care nurse had taken off his bandages from a Post-op incision and drainage and I hadn't warned him about what his arm looked like. It was a big filet. Sliced open from wrist to underarm in several places.
You could get a pretty good anatomy lesson by checking out his ligaments, muscles and bone. I told him I had no idea his arm looked like that...the MD had ordered the bandages to stay on for 24 hours. He forgave me.
He'll probably lose that arm though.

I still love my job, but days like that make it very hard to continue loving my job.

COS v.1 #12

2006-11-30T21:08:00.000-06:00

Change of Shift is up again over at Fat Doctor. She did a good one....check it out!

Patient advocated

2006-11-28T17:52:00.000-06:00

Patient X:
A middle aged man comes with back pain. "Back Pain?" I thought "What middle aged person doesn't have Back pain?"
As it turns out this one broke his back a couple of years ago at work. Fixed by surgery, rods were put in. He became addicted to pain killers... and then other things.
Now he's in the hospital with an abscess in the soft tissues of his lumbar spine that won't heal. Because of his past and present addictions (he came in positive for 2 different types of drugs, nonRx) The doctors are serving up the pain relievers very sparingly.
So every 2 hours...on the dot...I went in with his meager 1/2 mg pain shot.
Every 2 hours, I called the MD and reminded him about how much pain our patient was in.How he yelled out for help, writhed in bed, had a constant sqinty eyed look, never watched TV, ate, or slept. (If my patient and I were going to suffer so was he)
The really sucky thing is his drug use became known to his family (By him) just recently. He won't be getting the emotional support he needs from them.

Patient Y:
I stopped a seizure dead in it's tracks today.(I used a vagal stimulator magnet thingy, which was so cool.) A seizure that causes a Post-Ictal Violent phase. So Violent that the seizures this patient has had since admission usually takes 6 staff members to restrain him after he throws several punches, kicks, bites. He'd been in restraints off and on since admission. He was as nice as the Pope himself when not seizing.

But no restraints from me. After this 4 minute Tonic Clonic seizure, I gave him the PRN Zyprexa. It worked! No violence, a bit lethargic but nobody got hurt. He was cooperative even. I passed the word on to his MDs and the night RN. Zyprexa, Zyprexa, Zyprexa. Miracle drug for this one. For some reason the nurses before me hadn't thought to give it. I was the first, even though it was ordered. He awaits placement in a home soon...his family can't handle his violence.

Change of Shift v.1 #11

2006-11-15T18:53:00.000-06:00

Change of Shift is up again!
Julie over across the pond at Life in the NHS did a fantastic job.
Yeah, I'm in it again.

a Special kind of hell

2006-11-14T18:12:00.000-06:00

I'm assigned 5 patients in one shift.....here they are.

1 Elderly gentlemen showing new neurological deficits....weakness on the right side, pupils dilating sluggishly, Nystagmus, sometimes he could answer you sometimes he couldn't. Total care. Doctors think it was all side effects from a med he WAS on. Doctors were notified of changes...I was worried all day.

1 middle aged women who happened to be a prostitute who was also thrown from a moving car with a broken patella and road rash...You'd think she would be on the trauma floor but God Forbid should they take anyone who might be in withdrawal from CRACK. The whole morning she cussed and yelled at us, refused everything (except pain meds) until finally I talked the doctor into some Ativan. (took me three calls and stopping the MD in the hallway but I did it). She was a new person after the Ativan.

1 middle aged man with severe asthma exacerbation. Enough so that he would De-Sat into the 70s with the oxygen off. He was my only compliant and somewhat pleasant patient.

1 middle aged man with End stage renal disease....seemed nice enough until I wheeled him to dialysis and THEN he decided to refuse it. It took me, the dialysis RN and the Nephrologist to talk him back into it. The Doctor got tough....Literally said "OK...then go home and die then" when suddenly the patient had a change of heart. This patient was incarcerated....had 2 deputies at the bedside.

Last but not least....1 middle aged man ALSO with end stage renal disease ....this one confused (Kept calling to ask for the "OhnoPogo Man" After trying to reorient him several times I finally told him the Ohnopogo man had the day off....and he stopped asking) ,
incontinent (the world's largest code Brown on record....I guarantee),
forgetful (he would call to be turned.....every 5-10 minutes, forgetting that we just did it) Never mind that there was absolutely nothing wrong with his arms and legs and on admission he could walk fine.
The man had a history of "faking paralysis" according to his doc. He drove me the most insane.

I've never had to be so assertive, stern, and patient ever in one shift since my career started in Nursing. It was a special kinda hell....seriously.

Creature of Habit

2006-11-05T12:28:00.000-06:00

I thought it would be interesting to see how my Med/surg unit routine would compare with nurses who work on other type units. Feel free to comment on the differences.

I work 8 hour shifts...from 0700-1500. I know most RNs work 7-7 12 hour shifts. I'm fortunate to have a boss who can be open minded and family friendly and allow some of us slackers to work ONLY 8 hours.

My Routine:

0430-0550~ Wake up, get coffee, shower. Pack lunch and Ari's things and leave carrying a sleeping 5 yr old to the car.

0550-0600~ Drop Ari at best friend's house (she's so awesome for making sure Ari gets on the bus in the AMs)

0600-0645~ Commute to work while drinking my breakfast, coffee and a slimfast shake

0645-0715~ Clock in, put my stuff in my locker, grab a phone (a cordless type that's run within the hospital only) and listen to the voicemail report on my patients. I pull them up on my computer. The computers are on rolling stands and you have to snag one quick and put your name on it.

0715-0800~ If the nightshift nurse is a decent one, he/she waits to see if you have any questions before leaving. Start assessing my five patients beginning with the most critical sounding ones. (Granted....most of the patients on my unit should all be stable and not critical or they have no business being there. I go by the "what's the worst that can happen " when determining which patients I see first) For example, those on telemetry monitoring with cardiac history come before those with diabetic foot wounds.

0800-0830~ Our unit should change it's name from Internal medicine to the Diabetic floor. Usually 3 to 4 out of my 5 patients have diabetes and need to have blood sugar checks and insulin coverage before breakfast comes up at 0830. I don't head for the med room to get the insulin until I see the trays coming down the hall.....you never know when the trays will be late and diabetic patient's glucose can crash if they don't get something to eat with their insulin. Blood draws NOT done on the night shift and any frequents (Like cardiac enzymes and Vancomycin levels) are done about this time.

0830-1000~ Morning meds. Everyone's got them. We only pray you weren't assigned with more then 1 or 2 elderly or dialysis patients. They tend to have at least 10 daily meds a piece. Also, any ER admissions you might be getting we hope and pray wait until 1000 to come up or your whole routine and schedule is totally blown. Happens all the time, though. Also, help aides give out lunch trays, call Dietary dept. about any missing or wrong trays. Order missing meds....everyday the pharmacy has forgotten at least 1-5 meds.....everyday.

1000-1130~ Help aides give bed baths, daily care, get my walkie-talkies in the shower. If things run smoothly with meds and baths I might have started charting my assessments at this point. Any meds that were not where they were supposed to be have been ordered by me and brought up by now...Administer those. Chart , chart, chart

11:30- 1200~ Eat my lunch while my aides are checking blood glucoses. Lunch comes between 1200 and 1230. Insulin will need to be administered.

1200-1300~ Insulin, help aides give out lunch trays, call Dietary dept. about any missing or wrong trays. Chart

1300-1415~ This is the time to finish any charting undone, do any non-routine things like dressing changes, IV tubing changes, new IV starts (they expire in 96 hours) and start any discharge paperwork for those patients going home.

1415-1430~ Leave voicemail report for new shift coming on at 1500. Finish last minute charting

1430- 1530~ Send any ambulatory discharging patients on their way after any appropriate teaching, applying dressings, and discontinuing any IVs they may have. Walk down or get the aide to walk down via wheelchair any patients who aren't so ambulatory. Ask replacing nurse if they have any questions and clock out.

1530-1630~ One hour (usually) commute home in rush hour traffic. Rush hour starts at 3 pm in this city. The price I pay for a safe community.

1630-2100~ After getting out of the parking garage, fighting traffic, & picking up Ari from her afterschool program I'm finally home by 1700. Time to make Ari dinner while checking my email. Eat dinner, get Ari in the Bath, story time and a little TV then bed by 2100....if I'm lucky.

Holidays can suck

2006-11-03T10:37:00.000-06:00

Daphne from Scooby doo

Ari designed this Jack o' Lantern

With Halloween and everything I've been busy. I had a visit from Daphne from Scooby doo. I was Velma. It was fun.

Work has had me busier then ever. I'm running from the moment I get my patient assignments to the moment I report off and then some.

In the past 2 weeks I discharged 7 patients total. We have a new protocol that requires us to give Flu and Pneumococcal vaccines before D/C to any patient with a chronic disease or over a certain age. (That's all of them)

I gave about 14 vaccinations in 2 weeks. I say "about" because I gave some of them to my nursing students. Before these past 2 weeks I had only given one intramuscular injection...morphine...in school.

Talk about breaking in a new skill.

I'm an expert at Deltoid (Arm) and vastus lateralis (thigh) injection sites now.

Prevention, Prevention, Prevention

What would be really nice is if my hospital with get off it's derriere and get it's employees the flu shot.

"There's not enough right now" they say. And I'm feeling a little flu-ish today.

I'm loyal to my charity hospital system because I think it's better then the other money grubbing hospital system here. However, their health benefits really suck.....and they get suckier every year.

Their holiday pay sucks. I will have to work Thanksgiving this year and I won't even get time and a half for it. (Only Christmas day, Easter Sunday, New Year's Day and Labor Day (!) ) are holidays.

It's bad enough I have to find sitters for the school holidays surrounding the holidays but I won't even get to offset that cost with time and 1/2. I'm still looking at possible clinic jobs.....for when my residency is over.

Change of Shift v1/10

2006-11-02T11:18:00.000-06:00

Change of Shift v1, number 10 is up again at Disappearing John RN.

He's done a really great job. Not only good reading but great links.

When does a patient become "incapable"

2006-10-22T13:31:00.000-05:00

More on the same patient I mentioned in the last post (with the crazy family).

She needs a Mitral Valve replacement. Hers isn't working sufficiently to move blood through the heart. Clotting has already developed on it and had caused a Stroke/CVA already.

The problem is....she doesn't want to be treated. Sick all her life, she's says she's done. Now diagnosed in the past as Bipolar and Schizoaffective, the family and the doctors have deemed her "mildly retarded" and incapable of making her own medical decisions. It took 3 ethics committee meetings to determine this.

Personally, I disagree. She's been my patient for an entire week and I think she is completely of sound mind. (Albeit an emotional and sometimes kind of hostile mind) But they determined that this patient will get the open heart surgery she doesn't want.

This patient with a history of pulling out tubes, thrashing against restraints until undone, and throwing things across the room at the staff with be tied up in ICU for a week and then probably sent back to us with a healing open chest.

Yeah, If anything goes wrong....Who does the crazy family sue? Is it right to make a patient go through that kind of recovery without their permission?

I just find it odd that the "mildly retarded" diagnosis wasn't spoken until after she needed heart surgery.

Danger in the hospital

2006-10-10T18:11:00.000-05:00

Hospital Shooting last year

Ironic, I just read When a patient threatens to shoot you from Emergiblog yesterday.
Then Today, we had a similar incident.
An Agressive, non-compliant, and very ill patient with agressive, non-compliant, and very mentally ill family member.
We ask disruptive family member to leave, they leave saying, I quote, "I will come back and GET you all"
This wasn't my patient, but the whole floor knew of the disruptions and trouble with this patient.
We called security immediately, they posted a guy on the door.

It's sad when we live in a day in age where we have to be scared of people when they say things like that. The nurse actually told me she was scared that person was going to come back with a gun. I can attest to that nurse being nothing but patient with this patient and family.
There's only so much abuse the staff was willing to put up with.
We are in the business of caring, yet some people still don't see it that way.

C.O.S. Vol. 1 # 8

2006-10-05T11:40:00.000-05:00

Change of Shift Volume 1, number 8 is up! For those of you who don't know it's a Blog "Carnival" an interesting entry of links to Nursing posts! Yours truly has contributed in the past but didn't this time.
Please check it out!

NY and back to work

2006-10-01T12:22:00.000-05:00

Well, I put off blogging for a week because I wanted to get some good pics. My friends haven't gotten them to me yet so I'll just show you these.

Central Park

The American Museum of Natural History

Polar Bear in the Bronx Zoo

I had a good time on my trip. NY is not a relaxing city. It was stressful combating crowds, figuring out directions. I yearned for the friendly atmosphere and slower pace of Texas. Above all, I missed my baby girl.

It surprised me how many New Yorkers mentioned Ground Zero and asked if we'd seen the "WTC site" yet. 3 NYers told us their stories.

I met Rupert Jee from David Letterman. Nice Guy. I went in to buy a Tshirt for a friend of mine who's a fan. He was working the register.

Rupert Jee at Hello Deli

The highlight of my trip was seeing a Broadway show, Phantom of the Opera. It gave me goosebumps and made me cry.

******

Back to work this week it seems so much more chaotic and busy. Sicker then usual patients. Every bed full. We also seemed more understaffed.

I sat with and held the hand of a Bipolar patient with Kidney issues who didn't want to be discharged last week.
She allegedly had left an abusive husband just previous to her admission and according to her, had no place to go. I talked with the MDs and the social worker. They had been unable to get her into a women's shelter and it seemed to me that they didn't quite believe her abuse story. I, too had my doubts about her story but I did believe she had no place to go.
I was the one who told her she was being discharged, her mood did a 360 degree turn. I sat and tried to convince her that staying at the Salvation Army would be better then going back to her spouse. When I left, she was still going back.....I hope she'll be Ok.
******

Listening to: "I want to want you" by Juliana Hatfield

Tagged!

2006-10-01T08:33:00.000-05:00

Tagged!

While I was out of town I was tagged by Janet at Chocolate and Raspberries.
Tricky Woman!

I'm supposed to list 7 favorite songs.

1. "Silent all these years" by Tori Amos ~ Will always remind me of Jenni asking me to sing it acapella at lunch in High School.

2. "Love Song" by the Cure~ Reminds me of Mike

3. "Down so long" by Jewel ~ My favorite song to sing

4. "Movin out" by Billy Joel ~ Reminds me of being silly with my sister

5. "Turn me on" by Norah Jones~ speaks for itself

6. "Pump it up" by Elvis Costello ~Makes me tap my feet

7. "I alone" by Live- That man's voice is so sexy

I tag the first 7 peeps on my blog link list, unless you've already done it.

I heart NY!

2006-09-19T21:42:00.000-05:00

Just a quick note to say I'm surviving up here in NYC. It was hot and muggy today but that didn't keep us from trekking across the Brooklyn Bridge, visiting Pier 17, Seaport, Ground Zero, Chinatown, Little Italy, Wash. Square park, Greenwich Village, and Chelsea.

The blisters on my feet have blisters....and I even wore my good Nurse shoes!

Will blog more later!

"Start Spreading the news...."

2006-09-17T16:34:00.000-05:00

"......I'm leaving today
I want to be a part of it,
New York, New York"

Well actually I'm leaving tomorrow. I can't be more excited....and nervous. It's been a couple of years since I've flown. It's been...never.... Since I've been apart from Ari for more then 2 days. I'll blog about my adventures and post pics after I get back on the 24th.

********
My sister, Jamie and her love Marcus (I call them Jamicus) got married yesterday. Congrats to them! Aren't they cute?

Do we look alike?

(Yeah...she's way cuter then me in this picture!)

********
I also want you bloggers out there to have this link:

Bluebird Blogs

A contest to get a new design for your blog!

Happy Trails!

******
Listening to: "Elsewhere" by Sarah McLachlan

Patriot Day

2006-09-11T00:16:00.000-05:00

When I volunteered to write with 2996 on Sept 11, I had no idea how difficult it would be. I researched my assigned person, Gregory T. Spagnoletti for weeks. I found out a little bit about this man who suffered a terrible fate when the World Trade Center was attacked and collapsed in NY city.

I think the best way to pay tribute to him is to share with you what I found out.

He had a great smile.

His friends called him "Greg" or "Spags".

He worked for Keefe, Bruyette, and Woods as a Bond Salesman.

He was the 3rd Brother of Four.

They were all big hockey Fans.

He organized hockey games at Chelsea Piers.

Out of the 4 Brothers, he was called the "responsible" one.

He was known for dropping in to have coffee with his tailor.

He was engaged to be married to Gretchen Zurn.

They had just fixed up their new Apartment on West 72nd st, and he was very proud of it. His family said it would take him 45 minutes to give you the tour of all 1200 sq. feet.

His parents started the Gregory T. Spagnoletti Memorial Foundation. You can donate to it by sending to:
Gregory T. Spagnoletti Memorial Foundation
62 Wolff Street
Waterbury, CT 06708

But the biggest thing I found out about Greg was that this man was definitely loved. He is definitely missed.

He like all Americans had no idea as he got up and went to work 5 years ago that America was going to change that day. He had no idea that those 2 towers, which have represented the NYC skyline for 30 years, could ever possibly be brought down by terrorists. Those Towers would become his tomb. He was on the 89th floor of the South Tower when it went down. It took officials almost 2 years to identify some remains and return them to his family for burial.

Greg,
Five years ago I can say I was thinking about you as I watch the towers collapse on TV. But mostly I was thinking about Gretchen and the future she had lost with you. I was thinking about the children she would never have with you. I knew you were in a better place but I knew all too well the horrible place your loved ones were in. I prayed that God be with them on that day. I want you to know that America won't forget what happened what happened to you and 2995 other innocent people.

To my readers,

Please visit 2996 to find links to 2996 bloggers who have paid tributes to the victims of 9/11.

The Art of Grieving

2006-09-04T00:01:00.000-05:00

Mike and Tristan-cat 1997

"There are no mistakes, no coincidences. All events are blessings given to us to learn from. "

"It's only when we truly know and understand that we have a limited time on earth - and that we have no way of knowing when our time is up, we will then begin to live each day to the fullest, as if it was the only one we had. "

~Elisabeth Kubler-Ross

My late husband Mike died five years ago today.

Of all the anniversaries,this one's the hardest.
There's something about the smell of the September air, the Back to school/Labor day advertising, the weather changing... that will bring me right back to that horrible day I woke up and found him gone.

Five years ago he wasn't supposed to go that quickly....The doctors had said it would take about a year for those little metastatic tumors in his lungs to kill him. What the doctors didn't count on was the palliative Chemo killing him early. I think he had had enough too.

I believe your spirit and will to live can keep you going....Mike was tired of the pain. He had a bad reaction to the chemo and when it made it hard for him to swallow, eat, and drink....he just didn't try. I don't blame him for not.

It was almost like a gift from him...not to have to watch him suffer any longer.

Five Years has made me stronger, more resilient. Things slide off my back now that wouldn't have then.

In Five Years I went from unemployed to a college graduate and a member of a respected profession. I still wonder if I would have gone back to school if his loss hadn't of given me the opportunity, confidence, and the initiative.

Five years has actually made it harder for Ari. She understands more now, the older she gets. She understands how she stands out among her peers...having a Daddy in Heaven.

Elisabeth Kubler-Ross lists the 5 stages of grieving as:
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

I went through all of these....several times in various orders. I did finely come to rest on acceptance.

I accept that he is gone. It doesn't make me miss him less. It doesn't make me less lonely. It doesn't make it easier....it just make the pain of his loss softer.

Time doesn't heal all wounds...just makes them more tolerable.

Med Error....Or not

2006-08-28T18:09:00.000-05:00

I'm very sorry I haven't been frequent with my entries lately. I've just had little interesting to say.

My latest development is that I sorta kinda made a med error yesterday.

I worked yesterday and today and had the same patients both days. Today I was confronted by a not-so-friendly resident about an order he wrote on Saturday. (I was off Saturday) He had increased the patient's dose of Insulin (Lantus) from 10 units a day to 20 units a day. Well on Sat. that order was signed off by the nurse and sent to Pharmacy. When I had the patient yesterday, the med order on the computer said 10 units. Pharmacy screwed up and hadn't changed it.

I gave the patient 10 units because that's what the MAR (med record) said. This morning....I was looking in the past doctor's orders (Those are still written and not on computer yet)...I was looking to clarify another matter and came across Saturday's increase order.
I caught it...called the pharmacy to inform them to fix it and gave the patient 20 units. After that...Cocky not-so-friendly resident gets huffy with me about the 10 units yesterday. I told him I caught it after the fact and that it was corrected this morning.

He actually WROTE an order to file an incident report. That's like basically the doc saying "Nanny Nanny boo boo....I'm telling on you"

Well I was happy to file the report. I explained to my charge the situation, he showed me how, and I described in it....in depth...what happened.

Now yes...I could have checked the PREVIOUS DAY"S orders but no nurse with 5 or 6 patients has time to do that. If I had dug into the comments of the MAR on the computer I could've found the increase but that was not where it was supposed to have been. It was not listed correctly on the MAR by the pharmacy. The nurse on Saturday should have caught that when she or he should have given the patient an additional 10 units that day as well.

The whole damn hospital shuts down and nobody wants to work on the weekends. The Lab, the pharmacy, the doctors, even the damn nursing staff get lazy and use the fact that "It's a Sunday" as an excuse.

I really hate working weekends.

*****************
Listening to: "Save me" by Aimee Mann

Et Tu Brute?

2006-08-14T20:18:00.000-05:00

Still going well at the hospital...no major screw ups yet. ;)

I had one of those days today.
Ya know...the ones where everything goes down at once?

I will preface this with reminding you that I worked as an Nurse Aide aka Clinical Asst. aka Patient Care Technician for 2 years. I worked as a Unit Clerk for 1. I liked being an aide. I took pride in my job....enjoyed helping the nurses.

Most meds at our hospital are given at 0900 or sometimes 0800 if needed before a meal.
I started the day with only 4 patients which means I get the first admit of the day. The first admit from the ER came up to the floor at 0830. We have a one hour window to give meds on time or they are flagged (In the computer) as overdue. Which means my 0900 meds are due by 1000 or they turn bright red in on our MAR (Medicine assignment record).

At that same time, I had a Cardiac enzyme blood draw on a 98 yr old women at exactly 0800. and another set due by 1000 on another patient.

I also had one of my cardiac monitored patients (I had 3) go into SVT while the other 2 went on the fritz and needed new batteries, leads, etc.

I also had insulin coverage to give before breakfast at 0830.

All I needed from my aide (one I've worked with the whole 3 years I've worked there) was to weigh my new admit, get a set of vital signs, and orient him to the call light, TV, etc.

She was" too busy". Et tu, Brute?

My Lazy LVN "partner" decided to not do anything today so I was also getting flagged down by her patients as I passed their rooms for pain meds.

The charge....whom I love and was indeed helpful to me when my 98 yr old lady's IV blew for the 5th time...he started a new one on her....which she pulled out later. He was busy also helping Lazy LVN with her patients.

Is it too late to consider clinic work?

******
Listening to: "Ohh La La" by the Ditty Bops

Feeling snuffy and the 5th vital sign

2006-08-10T02:01:00.000-05:00

Sorry, I've been MIA lately. These past two weeks have found either me or my daughter with coughing, aching, stuffy head, fever so we could NOT rest and needed medicine. (Little Nyquil commercial joke)

Ari has just today become fever free so I think things are back to normal. I really hope I don't catch any flack for missing 4 days of work though. (2 last week for me, 2 this week for Ari) It sucks really, I need to be working to get that extra dough for my NY trip which is in just 5 weeks.

Work has been good though. Since going off orientation last week, I think I have been handling things ok. I haven't gotten more then 5 patients yet (we can get up to 7 on my unit). I'm hoping they'll hold off on assigning me more then 5 until I'm a little less green.

The last shift I worked I had an unusual patient. He was in for a recently diagnosed stomach ulcer....my age....middle class.....had a job....and a supportive family at the bedside. Really weird. He was my most pleasant patient for the day and pain control was the only issue at hand.

I'm big about that....Pain meds. It's always high on my priorities to get patients pain meds when needed and asap. The older nurses I work with don't see it that way. From what I understand..RN schools have only recently begun teaching the importance of "Believing the patient subjective complaints about pain" over "seeing objective proof of pain". It IS the 5th Vital sign....not only taught in my RN school but also incorporated MULTIPLE times in our assessment charting.

For me, I think a hospital stay and a doctor's order for pain meds is enough proof. It's not my place to get all judgmental over whether someone could be in pain or not.

HOWEVER...I did have another patient on another shift almost put herself in a coma because she was asking for and getting pain meds from us ON TOP of taking from a stash of vicodin she kept hidden in an Motrin bottle in her room. One of our nurses discovered that and promptly tagged it and sent it to our pharmacy to be held for her until discharge. This particular patient didn't really have any diagnosis supporting her pain either....other then COPD...which might cause some breathing discomfort. It's patients like this that disillusion nurses like me, I think....over time.

It's still not up to me though...I would have a chat with the patient and the MD if I thought the pain was not being addressed or being OVERLY addressed.
********
By the way, check out my new banner to the right.... a link to Change of Shift. This week's edition is out and worth checking out.

Listening to: "It don't mean a thing if it ain't got that swing" By Duke Ellington, Swing Kids Soundtrack

Hey Bloggers

2006-08-04T20:28:00.000-05:00

Hey Bloggers,
I found this through Kim at Emergiblog.
Join in the tribute.
I'm number 1284.

Roller Coaster

2006-07-27T19:52:00.000-05:00

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

2006-07-27T19:45:00.000-05:00

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

2006-07-25T19:46:00.000-05:00

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

2006-07-16T12:16:00.000-05:00

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

2006-07-06T19:48:00.000-05:00

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

2006-07-02T16:48:00.000-05:00

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.

The results are in!!

2006-06-28T20:41:00.000-05:00

I passed!!!!

I can't even express how relieved I am.

I'm gonna go have a NCLEX guide bonfire now.

Thanks Ya'll for your support and good wishes.
********

More good news today...My little niece was born this afternoon.

Welcome Briana Ashlynn!

Take the NCLEX....Check

2006-06-27T02:04:00.000-05:00

Well it's done.

It shut off at 75 questions. For ya'll already educated in how the NCLEX works, that could mean I did really good or really bad. I either proved my competency by the minimum 75th question or proved my incompetency.

I feel awful...There were drugs I never heard of.....4 right answers.....more educated guessing then I would have liked. Too many Cardiac questions....I hate Cardiac!

To celebrate it being over (I hope) me and Ari grabbed some pizza at our favorite dine-in Pizza joint that has little flat screen TVs at every booth. She loves that place. Got me some Gelato afterward as well.

Nothing like drowning your worries in Gelato. Or maybe your triumphs. (Fingers crossed)

I'll post on Wednesday and let you know whether or not I passed or failed. I know at this point I can't honestly say I feel confident either way.

That test was soooooo HARD!
**********
Listening to: Jamaica Inn by Tori Amos

Success or Failure

2006-06-24T13:14:00.000-05:00

(I'm Artistically disabled)

I'm posting this for all the students I know occasionally read this blog.
I've been studying my big tail off this past week for the NCLEX.
I'm using 2 methods. The Kaplan, for which I paid $350 for the online quizzers, the 4 day course and book.
Also I'm using the Saunders, which cost me $50 at Barnes and noble and came with a CD with a study guide and quizzer.

Now According tothe Kaplan, I'm doing TERRIBLE. I'm passing the quizzes at 60-70%. (Still passing in the NCLEX world)
According to the Saunders, I'm doing FABULOUS, passing the quizzes at about 85-90% rate.

So how do I judge how prepared I am for the boards?

Not that it actually matters, I will not re-schedule again. I am taking this thing come hell and high water and no entity on earth will keep me from getting this thing over with.

Now going by websites and hearsay, I have heard that the Saunders was a better way to study for the boards. I regret giving my money to Kaplan. (see previous post)

The Saunders quizzes make more sense, the ones I get wrong make sense after reading the explanation.

The Kaplan ones I get wrong, I could argue and win and I don't think their methods of "testing strategy" alone is gonna get me to pass. You still have to have that knowledge.

So anyhoo, that's my vent. I'm sure I'll be fine. I'm not panicking .....Yet.

After all, No one from my graduating class has failed yet, even the handful I thought might fail has already sent out the announcement that they have passed. I had better grades then them.
The odds are in my favor, right?

Listening to: KT Tungstall "Black Horse and a Cherry Tree"

Craziness

2006-06-14T22:54:00.000-05:00

It's been crazy!
I've moved in...Almost done unpacking.
I'm studying for the boards, I have hours and hours of online-unit-specific-competency exams to complete.
I start making the big bucks this week.
That's good because...I owe I owe.... So it's off to work I go.

My A/C's not working too well. I leave it on 75 during the day and night and it won't get down past 80 during the day. I HATE 80!
It's been in the high 90s all week and I just can't stand it.
I get REALLY irritable and mean when I'm hot.
Stupid A/C guy came and left without doing any work today!
He came early when I was in the shower. Ari let him in (EEK, I know...I lectured her about that afterward) and came and told me he was here. I came out and he was gone.
I got ahold of him 5 hours later and he said "it felt cool so he left thinking he had the wrong place"
What?! Idiot

My mom's freaking me out and acting really weird. She's drinking a lot with some pills.....now there's some drama with a local man...I'm not gonna get into that one here.
Suffice it to say....I won't be trusting her to watch my daughter for me on the weekends I work next month. Which leaves me in quite a pickle as there aren't too many options for me on a weekend.

I'll be sure to post more about my orientation and the big test soon. Please check back.

Chicken Jo

2006-06-06T23:56:00.000-05:00

I rescheduled the test last night out of panic.
I didn't feel ready.....I'm moving, Jerry's passing, Mom's Drinking. Just couldn't be good right now.
I'm taking it on June 26th. In the mean time, I must move by Friday and study my butt off while attending those boring orientation sessions the hospital makes you take.
I'll post later about the family drama that ensued at the all so fitting Redneck Wake this past weekend.
I'm exhausted from moving today.

Still here

2006-05-31T01:37:00.000-05:00

I'm Still here. I'm just really busy as I pushed my move in date up to the 9th not so conveniently two days after I take the NCLEX (The 7th). Pressures from the landlords. That and I really like the idea of being completely moved in before I start working. My first day of orientation is on the 12th. I imagine it will be around then you'll be hearing more from me again. I will post an entry on the 9th or 10th and tell you my exam results.
Please check back......I won't be gone long.

As for my stepdad....It's truly weird he has lived this long. I thought for sure he'd pass away over Easter. Last week he showed signs of going soon. He was becoming unresponsive, incontinent, cold hands and feet. I spent 4 days up there last week helping my mom give him meds through the G tube, changing his sheets, pads, and dressings. He's developed 2 fistulas out the side of his neck where the tumor is deep underneath. It's draining fluids of all consistencies and colors and the smell would rival most dumpsters. Mom was actually having a hard time keeping those little fruit gnats away from it.
I noted his vital signs slowing over the 4 days and he went from somewhat responsive to completely unresponsive, GCS 4, BP 70s over 50s, RR 6 with apnea,Pulse tachy to 70s. He was like that the last 3 days I was there.
It's awful, slow, painful dying.
Tonight Mom called and his eyelids popped open and stayed that way....Mom tried to close them but they just pop open again, his eyes fixed straight ahead. The Hospice Nurse told her his BP today was 50 something over 20 something.
Maybe tonight? I don't know, I've said it before so I'm not gonna assume it this time.
He's always been a very stubborn guy.

Listening to: Meltdown by Live

*************
*Update* He passed away at 2:00 am, Just after I wrote this entry.
13:04 May 31,2006

The Boards and My new place

2006-05-19T23:13:00.000-05:00

I take the NCLEX on June 7th!
Please be sending good "Passing" vibes on that day. I keep telling myself the last 2 hellish years can't have been for nothing.

The other big news is that for Graduation, Cathy and Michael are taking me to New York, NY!
I'm way excited. I have always wanted to visit there and I've never been. We are going to go see Phantom and visit all the landmarks. We go in September.

My new place.

Slowly moving in. I actually took the place Michael is selling because it was much nicer and he's letting me split up the deposits.
Movers come on June 23rd....I'm hoping to have all the non-furniture moved beforehand.
I'm excited and a little scared. This is the first time I've ever attempted a move by myself and I've been at my current homestead for 7 years. I'm one of those people that likes for change and routine to be evenly balanced but I'm very much a home body and don't like my stuff in chaos.
I just want it there.

Why can't we have been intelligent enough beings to have discovered molecular transport by now? Like in Star Trek? (Geek moment here)

Beam my stuff over Scotty.
**********
Listening to: "Jumping someone else's train" by The Cure

In Burrito

2006-05-16T23:13:00.000-05:00

I'm in Burrito....I mean...In cognito.
I'm referring to the name change...I'm Jo now.
Saves me time. :)

inevitable

2006-05-15T22:14:00.000-05:00

Well this week isn't going as planned.
I had planned to take the Kaplan review course through the week (For the NCLEX). I went today and it was a Complete....Total....Waste of my time. I'll give them this....They have excellent testing strategies and a cool online test taker. Everything you need to know is online. My advice to students.....Take the online program!
I will not waste 8 hours for 4 days listening to an OB NURSE go over possible test questions that I can get online.
Yes...an OB nurse taught the course and couldn't explain half the questions and even disagreed with some of them.
(I have nothing against OB nurses, they are still RNs...but if that's your only specialty...Then maybe teaching NCLEX review is not a perfect fit....I want someone a little more rounded.)
*******
It's OK that I decided to self study for the boards, as it turns out, I am going to head to Mom's again tomorrow. I'm hesitant to say it looks like the end for my stepdad.....I've said it before. But the last 24 hours he's been agitated, disoriented, hallucinating, and now has a "rattle" when he breathes (says my Mom).

I have a line here and I'm crossing both ways. On the RN (GN) side I've been trying to hand over tips and advice on how to care for him. On this side I'm trying to stay objective and respect my mom's wishes. On the other side, the family side....I want my mom to stop the tube feedings and allow my stepdad to go. The tube feedings is the reason he's remained in this subconscious state for months. He's down to about 80 lbs...Mom's only giving him a can of formula a day. Just enough to keep him suffering. She doesn't see this as suffering because they have his pain under control. But the Good Ole boy/Redneck/Biker man my stepfather was would have HATED his wife bathing him, wiping his nose and butt.......HATED living in this state.
Since he had a laryngectomy and is too weak and sometimes too confused to communicate, it's hard for him to stop her.
I'm afraid his GI system is going to completely shut down (It's obviously slowed now...9 days before the last BM) Then he'll be even more miserable when she runs a feeding.
I'm going up there to help Mom with his care, and intervene with Hospice (They haven't been coming out because Mom tells them he's just fine when they call). I want to get them out there and tell them that he's fallen twice getting to the bathroom, that they need a urinal or a foley, that my mom needs someone to relieve her so she can go to the grocery store.

Mom hardly sleeps, hardly eats. She's squeemish about body fluids....and she says "She's not ready to let him go."

That leaves me with little to do but help.

Here's my living will right now....If I am ever diagnosed as terminal, Don't ever allow my family to leave me in that state. Don't prolong the inevitable.

Listening to: "I go to Extremes" by Billy Joel

Graduate Nurse

2006-05-08T23:40:00.000-05:00

Did well on my Final. 88 Made a B in the course.
I am now officially......a Graduate Nurse....GN.
It's still not real to me. I can't believe that school is over.
My pinning is on Thursday.....after that... NCLEX and moving.
My parents can't come to my pinning. My dad lives several states away and works two jobs. My mom is still holding vigil over my dying stepfather. (Yes...he is still alive...I don't know how)
But a few of my best friends will be there,my daughter, my boss, and my sister.
Today was a good day.

Two Biggies

2006-05-02T01:21:00.000-05:00

Two BIG things today.

1.I made a 96 on my last unit exam over Renal...Acute and chronic failure, Liver, Burns, and Musculoskelatal diseases. This means I have to make a 50 on my final to graduate!
Not to be cocky but um...I think I could do that blind, standin on my head, with both hands tied behind my back, while taking candy from a baby.....eating pie.
So what I'm saying is....I am sooo graduating next week.

2. I'm moving in June! I found a cute little place locally today and I want it! I'm paying the deposit for it tomorrow. I didn't want to move this soon but I don't want to loose the place so I'm gonna take it. I'm moving out of this Ghetto, Yay!

Listening to: Orange Crush by REM

2006-04-28T20:43:00.000-05:00

Just found out about a worthy cause over at Kims' website.
Just like there's a Surgeon General in DC.....How cool would it be to have a Nurse Rep in DC?
There's so many issues in Healthcare, he/she could address specifically........the Nursing shortage.
Check it out and sign the petition, will ya?

All Good things......

2006-04-25T16:58:00.000-05:00

My actual invite, sans pesonal info. The color is the same as our scrubs

In the past I had mentioned how easy and boring our "Management in Nursing" course was. I wasn't kidding....I made a 94 on my final today!
Add that to my 96 on my midterm, and 2 projects with 100s and it equals a 96 in the class!
It's about time I get an A, I'm tired of those darn Bs.

Speaking of Bs....I have my last unit exam next Monday over Renal, Endo, Burns, and musculoskeletal diseases AND
My Final is in 13 days.

Rumor is going around that it may have "NCLEX" questions on it and may cover topics from ANY POINT in our program.
That could mean that those kidney stones we covered in the freshman semester could ALSO be on this final.
I REALLY hope that's not true. It's hard enough to study the material we've crammed into our brains this semester....but to add diseases we haven't discussed in over 18 months would just be appalling. I'm all for being quizzed on NCLEX questions but not if it means Graduating or not. My review course isn't until after graduation.....and our instructors aren't known for their fair judgment in selecting test questions.
But like I said...It was rumor.

Things are really getting close now......as of today:

Pictures are in for the graduation slideshow
Invites are out
The class photo was taken and presented to the school (thanks to me)
Clinicals are over
My thank-you in the program is written & turned in
The applications are in
The fees paid AND
The job is secured

So what's left to do.....hmmm.....Oh yeah!
Study & Pass!

Easter Weekend........

2006-04-21T13:00:00.000-05:00

"A scary Monster with Fangs!"

Thanks ya'll for all the support on the loss of "Roger" last week. I really do have a wonderful group of readers.

I buried him next to Tristan and Edie at my Mom's last weekend. The Texas ground was rock hard and it took a water hose, several hours of digging, and some hauled really big rocks to do it.

It was in the 90s all week here....getting up to 101 on Tuesday or Wednesday. Today it's supposed to get up to 85...much better.

I would like to say that my visit to Mom's was supportive, nurturing, and special but it wasn't. Last Easter weekend was a special kind of hell. My stepdad is still actively dying....getting worse little by little everyday. But he's still breathing. I'm giving credit to the feeding tube (G tube) which my Mom keeps hooking up to feedings and water, regardless of whether or not he wants it. I did a little education to her about the dying process and how the GI system is usually the first to shut down but she wasn't listening. By yesterday's report, he's now hallucinating and becoming less responsive.

I also had some family drama (unrelated to the dying) while I was there. I'm not gonna get into the grimy details....let's just say, I know now how my mom....really....feels about me. My aunt didn't have to come to my place at all, and after last weekend, I didn't really want her to.

On a lighter note, Ari's birthday was a blast once we came home. My baby is 5 now! We made cupcakes together and brought them to her class. I also made little party favor bags for them and she seemed to feel really special for the day. She has another party this weekend with all her non-classmate friends.

Clinicals are over! FOR EVER! Last night I completed my last clinical day at the hospital. Ironically it was my busiest all semester. We did this "Team Nursing" thing, where we worked in groups of 5.
We had a team leader (Like a charge nurse) , 3 "patient care" nurses, and a medication nurse.We rotated positions for 4 days. Each PC nurse took 4 patients assigned by the leader, that means the med nurse gives meds for 12 patients. I was the med nurse last night. When I was Team Leader last week I was so bored, as med nurse, I barely had time to go to the bathroom, much less, eat.
It was a pretty dumb project since nurses don't work that way anymore (except maybe in psych, but during my psych rotation, the patients went to the med nurse for meds) 11 out of my 12 patients had 2100 (9 pm) meds. You legally have an hour (early or late) to give them.

But it was my last day....Yay!
3 lectures, 3 tests to go before graduation. :)

Threes

2006-04-14T04:17:00.000-05:00

I just got back from the emergency animal hospital. My newest and oldest cat, Roger died about an hour ago.
For those of you keeping count...That's 3....yes 3 cats I have lost in the span of one year. What's that they say about 3?
I was about to go to bed about 1 am and was just putting food in the cat's bowls. Roger is usually waiting for the food and wasn't as usual. Thinking maybe he got locked up somewhere or escaped out the door, I checked the closets, under beds, the dryer, the cabinets and outside.
After about an hour of searching I found him lying next to my bathtub in the corner, laying "funny" and in respiratory distress. I scooped him up and ran next door to Cathy's (My vet tech best friend) She said his color was bad (How can they tell with all that fur?!) and I should take him to the critter ER.
The diagnosis......Congestive heart failure with an associated pleural effusion.
He was about 12 years old.....My Great Grandmother-in-law's cat that I took in last August. I couldn't see spending thousands on what the Vet said would probably be a futile fight. So I said yes to putting him down and he will be laid to rest next to Tristan and Edie this weekend at my mom's. Which, by the way, I have to leave for her house in 5 hours.....I've had no sleep.
I have one Cat left, 4 Year old Easter. Who's going on a weight management diet as soon as we are out of our current brand. I'll be damned if I'll let her die anytime soon. All this as we go take a trip to see my stepdad for the last time.

creepy babies

2006-04-10T17:20:00.000-05:00

Cute, Funny, and Creepy all at once!

Family

2006-04-09T23:24:00.000-05:00

Soooo My stepdad will be passing away sometime soon. This is by my mother's guess and from her descriptions of his daily activities (sleeping, not eating, not drinking) I must agree with her. It's what my first semester Nursing instructor and Death expert would have called "actively dying". Which kinda sounds like an oxymoron but perfectly describes it.

So for support for my mom, my Aunt V, my mom's sister is flying down from VA on Thursday. She's flying into my "BIG CITY" because it's cheaper then flying into my mom's little city. She'll stay the night with me and she, Ari and I will drive to mom's on Good Friday. Too bad it won't be for good reasons.

My house looks like tornados hit it, and my Aunt is super OCD about cleanliness. That and she's super allergic to cats and dogs....which is why I haven't cleaned yet. I'm gonna have to lock the cats in the bedroom so I'm gonna clean closer to the time.

Her flight comes in an hour before my clinicals start, not sure how I'm gonna get her back to my house and then to the hospital in BIG CITY traffic in time.

Listening to: "Cry me a river" by Harry Connick Jr.

*********************

Monday Update!

Aunt V has decided to get a rental car and drive...Yay! I can take my time cleaning and I won't be late for clinicals.

My stepdad's still hanging in there.

Moronic nurses

2006-04-06T17:08:00.000-05:00

Sentinel Event Alert - Issue 36, April 3, 2006
Tubing Misconnections—a persistent and potentially deadly occurrence

Tubing and catheter misconnection errors are an important and under-reported problem in health care organizations. In addition, these errors are often caught and corrected before any injury to the patient occurs. Given the reality of and potential for life threatening consequences, increased awareness and analysis of these errors—including averted errors—can lead to dramatic improvement in patient safety.

To date, nine cases involving tubing misconnections have been reported to the Joint Commission’s Sentinel Event Database. These resulted in eight deaths and one instance of permanent loss of function, and affected seven adults and two infants. Reports in the media and to organizations such as ECRI, the Food and Drug Administration (FDA), the Institute for Safe Medication Practices (ISMP), and United States Pharmacopeia (USP) indicate that misconnection errors occur with significant frequency and, in a number of instances, lead to deadly consequences. Types of misconnectionsThe types of tubes and catheters involved in the cases reported to the Joint Commission included central intravenous catheters, peripheral intravenous catheters, nasogastric feeding tubes, percutaneous enteric feeding tubes, peritoneal dialysis catheters, tracheostomy cuff inflation tubes, and automatic blood pressure cuff insufflation tubes.

The specific misconnections involved an enteric tube feeding into an intravenous catheter (4 cases); injection of barium sulfate (GI contrast medium) into a central venous catheter (1 case); an enteric tube feeding into a peritoneal dialysis catheter (1 case); a blood pressure insufflator tube connected to an intravenous catheter (2 cases); and injection of intravenous fluid into a tracheostomy cuff inflation tube (1 case).

A review by USP of more than 300 cases reported to its databases found misconnection errors involving the following:·

Intravenous infusions connected to epidural lines, and epidural solutions (intended for epidural administration) connected to peripheral or central IV catheters. ·
Bladder irrigation solutions using primary intravenous tubing connected as secondary infusions to peripheral or central IV catheters. ·
Infusions intended for IV administration connected to an indwelling bladder (foley) catheter. ·
Infusions intended for IV administration connected to nasogastric (NG) tubes. · Intravenous solutions administered with blood administration sets, and blood products transfused with primary intravenous tubing. ·
Primary intravenous solutions administered through various other functionally dissimilar catheters, such as external dialysis catheters, a ventriculostomy drain, an amnio-infusion catheter, and the distal port of a pulmonary artery catheter.

What?! What kind of moronic neanderthal nurse connects an IV to an NG tube, Foley, or epidural?! The connection ports aren't even compatable! I guess this should teach a lesson about labeling your IV tubings but something tells me if the nurse found a way to do this she/he would probably miss the label. I really thought when my professor sent us this link that this was an April Fools joke.

88888888888888888888888888

Frustrating day in clinicals. Patient with severe edema to penis and scrotum, severe pain and tenderness, also incontinent of stool with severe diarrhea....you do the math.
Patient had a urethral stent placed and had a circumcision-like incision on his penis yesterday. Edges were approximated yesterday. Today his penis looked like a cauliflower. Incision had split open.
I told nurse (who didn't see him yesterday) who called doctor. Doctor said "It actually looks better today" The only time he saw him was at 4 am, he either didn't look or it happened afterward.
I also asked nurse for something better then vicodin for pain. She refused to ask the MD for that saying it would make him too altered. (Did I mention the pt had alzheimer's?)
Bottom line....No one is gonna listen to the student, my patient is suffering and being tortured, and I'm not allowed to call doctors or family to do anything about it. My instructor caved to the majority too. (His family is only available by phone....they live locally....he's had no visitors)

Tagless MeMe...Where was I?

2006-04-04T01:09:00.000-05:00

I wasn't tagged. But I have to prove to Dr. Flea that he didn't alienate me by answering another "meme".
Well, that, and I really like these things. :)

Where was I one year ago?
I was finishing my 2nd semester of Nursing school (Level 2). I was finally feeling more Nurse-y with the greater responsibilities I was given. Planning my daughter's 4th birthday party, swearing I was going to lose weight and quit smoking over the summer during my Psych rotation. I was also thinking that this time, this month (Now) could not possibly come any sooner.

Where was I 5 years ago?
Was just about to give birth to my first child, my daughter Ari. I was just about to start maternity leave at the hospital and attending my baby showers and finishing up the final touches on the Moon and Star themed nursery. Mike was still alive and in remission having just completed radiation therapy. All residual side effects had faded and he was feeling pretty good. The plan was for me to have baby, stay home with hubby and baby until June and then go back to work part-time. That worked until Mike got really sick again in August.

Where was I 10 years ago?
Still in Newlywed status, Mike and I were just growing accustomed to living in the armpit of the US; Shreveport, LA. The smelliest,rudest, most crime infested city I've ever lived in. Mike was in the Air Force doing his police thing. I had just begun working at a discount drycleaners, where I would stay for 2 years. I worked about 55 hours a week there for minimum wage and managed the store by myself for a year of that. I dealt with it because it was an easy job....take in clothes, tag them, bag them,wait for boss/owner to pick them up, give clean clothes back, count register, deal with complaints. It was a job.(and it was me and Mike against the whole world....sigh)

Listening to: "With Imagination" by Harry Connick Jr (on Blue light, red light)

Beastie Yeasties

2006-04-01T10:37:00.000-06:00

Budding Yeast cells

I feel so Blah this week. I keep telling myself I only have 3 weeks of clinicals left. That thought is what is getting me through.

I'm on Advair for my asthma. It's a combination drug with Fluticasone, a corticosteroid and Salmeterol, a bronchodilator. For the most part it works, I actually get wheezy when it's wearing off. As long as the pollens aren't too high, I rarely have to use my albuterol rescue inhaler.

Here's my problem.

Advair is actually a powder inhaler and so when you take a "puff" some of the medicine sticks to the back of my soft palate. Since 1/2 of it is a steroid, it creates a very happy environment for yeast (which is naturally a part of the environment or flora). Thus creating the condition of Mucosal Candidiasis aka "Thrush". I have it again this week for about the 7th time this year.
Originally, I started out being half-assed about rinsing my mouth after. After the second time I was religious about it. After the 3rd or 4th time I started using Listerine to rinse after.

Every occurrence I took all my medication to get rid of it. My doctor isn't worried and says it's a common side effect of Advair and she says maybe I'm just more suscepible to it. My doctor's colleague, a PA, tested me for Diabetes and HIV, just to rule those out. (Thrush is common in both those conditions)
Thankfully (I wasn't worried) those tests were negative.
It's just really annoying and the only medicine that works for my thrush is Clotrimazole FIVE times a day for TWO WEEKS.

That means I have to take medicine with me to school and work. It's a lozenge type "Troche" and I have to hide the fact that it's in my mouth at clinicals. It's just kind of embarrassing ya know?

Any other asthmatics have this problem? Is there an equivalent med on the market that works just as well?
I was just diagnosed 2 years ago and Advair and Singulair is all I've ever used.

Listening to: "Only the good die young" Billy Joel

Beentaggeditis

2006-03-28T15:28:00.000-06:00

There's this new thing going around. It's highly contagious. It's called Beentaggeditis. I just "caught" it from my friend and fellow RN student over at Third Degree Nurse.
The only treatment for it is to follow the regime and answer these questions, so here ya go:

Four Jobs I've Had in My Life
1. Cashier at a grocery store (in high school)
2. Manager of a dry cleaners (Never dryclean white cotton!)
3. Server and Bartender at a Casino in Louisiana
4. Coffeemaker at a Seattle's Best turned Starbucks Kiosk (I can't drink regular old Folger's anymore)

Four Movies I Could Watch Over and Over
1. Singin in the Rain (it makes me happy)
2. Moulin Rouge (Ewan + Singing = heaven, Nicole + dying = happiness) lol
3. Reality Bites (to relive my post-HS days)
4. Any of the Alien movies (creepy Aliens and Sigourney kickin butt...woohoo!)

Four Places I Have Lived
1. Northern Ohio (where I was born)
2. Hampton, Virginia (as a kid when Dad was stationed in the Navy)
3. Shreveport, LA (The armpit of LA...HATED IT)
4. A big TX city, where I reside today

Four TV Shows I Love to Watch
1. ER (I don't care what anyone says, I love the drama and it's constantly making me look stuff up)
2. 24 - (Can this show be anymore intense?! Go Jack Go!)
3. American Idol - (where was this show when I was young enough to audition?)
4. Scrubs - (Not medically accurate at all, but who cares? It freaking funny!)

Four Places I've Been on Vacation
1. Hampton, VA (Yeah, it sucks that all my vacations revolve around seeing family)
2. Melbourne, Florida (Again....family)
3. Galveston, TX (Went to Moody Gardens WITH family)
4. Northern Ohio (That darn Family)

Four Websites I Visit Daily
1. My blog
2. Pogo (what can I say, I love the mindless games, excellent relaxation for the noggin)
3. My "blackboard" school website
4. Various other blogs I have listed to the right

Four of My Favorite Foods
1. Fettucine Alfredo
2. Cheeseburgers
3. Cheesecake (Can ya tell I like cheese?)
4. Coffee (Yes, in my world, it counts as food!)

Four Places I'd Rather Be Right Now
1. England
2. Ireland
3. Scotland
4. New York, NY

Four Most Wonderful Places I've Ever Been
1. Here, the city I live in, is an awesome place to be (Biased, I know)
2. Virginia Beach, VA (Really nice beach)
3. Williamsburg, VA (in the fall, it's gorgeous!)
4. DisneyWorld, Florida (For lack of anywhere better, I need to go again as an adult and experience the things my cheapskate parents jipped me of)

Four Books I Read Over and Over
1. All the Harry Potter books (silly huh?)
2. Medical-Surgical Nursing by Lamone (because I have to)
3. Sorry that's all I got right now, it's been awhile since I've done any recreational reading

Four Songs I listen to Over and Over Again
1. Anything by Tori Amos
2. Anything by Sarah McLauchlan
3. "Down so long" by Jewel (I can sing this one perfectly, she's in my octave)
4. "Just like Heaven" by The Cure (reminds me of you-know-who)

Four Reasons Why I Blog
1. I've kept a diary since 6th grade (might as well make it public?)
2. I'm hoping others can learn from me. (and from my mistakes)
3. I need more outlets to vent (I can't put ALL that burden on my friends)
4. People keep stopping by and reading this darn thing (I'm obligated. lol)

Four people I tag to do this
1. GlacierMeow
2. Student Nurse Jack
3. Sublimely Mundane
4. Windfall Woman

Listening to: "I Alone" by Live, Throwing Copper

Worst test in history

2006-03-27T18:57:00.000-06:00

Today I took the worst test in the history of Nursing school tests. It was SUPPOSED to be mostly Neuro; CVA, aneurysms, Intracranial pressure, shock, Brain herniations, and it also had some cardio valvular disorders on it. MOST of the class....at least 50%....failed it. Even our A students made Cs or failed it. The one girl I know who made a 90 (which counts as a B), said she got it by "lucky guessing". I made a 78.
One example of the questions (Not a real one) went like this:
Patient X is A and O x 1, P 60, RR20, BP 95/60 has no complaints of pain, Urine output is 35 ml/hr. Which of the following can be assessed:
a. Glascow coma scale 12
b. GCS 13
c. GCS 14
d. GCS 15

With poorly worded and vague questions like that how could anyone have passed?!

There wasn't one question over CVAs despite the 4 hour lecture over it, yet there were like 5 or 6 craniotomy questions of which we never covered in class and there's a brief blurb about it in our text.

In the test review after we all tried to argue these questions to no avail.....It was like talking to a bunch of stubborn brick walls. Today 4 instructors with Master's degrees in Nursing let a class of 46 down....big time.

Listening To: Puedo Escribir by Sixpence none the richer

Locked out & a patient died

2006-03-24T13:24:00.000-06:00

Short audio post today about being locked out and having a patient die on my watch.

Listening to: "Sweet Sangria" Tori Amos, Scarlet's Walk

HESI

2006-03-21T15:38:00.000-06:00

HESI : Health Education Systems, Inc:
"Health Education Systems, Inc. (HESI) provides critical thinking, computerized exams for nurses. The model described in Critical Thinking and Test Item Writing by Morrison, Smith, and Britt is used to develop test items for all HESI Exams."

My Exit exam was today, testing my knowledge from school and giving me a good idea of how I'll do on the NCLEX

Out of 1158 possible points, I made an 1120.... 97%
A passing score is 850

Which means I have a 97.58% chance of passing the NCLEX today.

So...Yay Me!
********
Listening to: Tori Amos "Sweet the Sting" The Beekeeper album

Spring break is gone :( & Cave pictures

2006-03-19T19:48:00.000-06:00

I was going to do another audio today, but it's too loud in here right now. The "Fairly odd parents" are being way too noisy. Soooo.... Spring Break is over and that sucks. I did, however, get everything done that I said I would get done. I did clean my house and my fridge. I finished my Lymphoma case study, research paper, and my resume. I did all those things in the last 48 hours but Hey, I did it. Back to the grind tomorrow....Yet another Neuro lecture. I'm about to become NEUROlogically impaired if I sit through any more Neuro lectures. Me and my monster visited some local caverns today. (Yes! On top of everything else...we visited Caverns!) Enjoy some pics, with the high humidity, I'm surprised at how good they turned out.

The blue lights indicate the cave goes at least 50 feet more

The "Moon" pool and my daughter's head.

We are 70 feet underground here

The ceiling at one point, carved by an underground river

A Flow rock, water was gently flowing on it.

I love this pic, Stalagtites, Stalagmites, &

Limestone, Oh my!

I took this of a really deep hole...not sure what

the reflection is but could be Bat eyes...One buzzed me.

"Soda Straws"

The call that center formation "Draperies"

Grand Rounds 2:25

2006-03-14T11:27:00.000-06:00

What can raise your site counter drastically?

What can bring people from all over the world to your blog?

What can bring a smile to the face of medical professional bloggers everywhere?

Grand Rounds 2:25, That's what!

Over at the previously mentioned Geek Nurse.

(Yes I have a submission in this one too, I wrote one on theme. Shameless, huh?)

Groundbreaking

2006-03-14T00:00:00.000-06:00

Drumroll please........Jodi's voice starring in it's very first audio blog.

I got the idea from Geek nurse. He's a clever guy.

Tell me what ya think.

Sound like me?

2006-03-13T23:38:00.000-06:00

Ok, You tell me....does it sound like me?

Advanced Global Personality Test Results

Extraversion		56%
Stability		56%
Orderliness		40%
Accommodation		70%
Interdependence		56%
Intellectual		43%
Mystical		10%
Artistic		10%
Religious		43%
Hedonism		56%
Materialism		63%
Narcissism		36%
Adventurousness		10%
Work ethic		50%
Self absorbed		50%
Conflict seeking		10%
Need to dominate		16%

Romantic		76%
Avoidant		16%
Anti-authority		16%
Wealth		30%
Dependency		30%
Change averse		30%
Cautiousness		50%
Individuality		30%
Sexuality		70%
Peter pan complex		36%
Physical security		70%
Physical Fitness		10%
Histrionic		16%
Paranoia		23%
Vanity		10%
Hypersensitivity		70%
Female cliche		70%

Take Free Advanced Global Personality Test
personality tests by similarminds.com

Stability results were moderately high which suggests you are relaxed, calm, secure, and optimistic.
Orderliness results were moderately low which suggests you are, at times, overly flexible, improvised, and fun seeking at the expense of reliability, work ethic, and long term accomplishment.
Extraversion results were moderately high which suggests you are, at times, overly talkative, outgoing, sociable and interacting at the expense of developing your own individual interests and internally based identity.

trait snapshot:
messy, disorganized, not rule conscious, rebellious, rash, weird, ambivalent about chaos, likes bizarre things, anti-authority, not good at saving money, not a perfectionist, leaves many things unfinished, low self control, strange, desires more attention, romantic daydreamer, abstract, impractical, unproductive, leisurely, likes the unknown

The Good and the Ugly

2006-03-07T14:30:00.000-06:00

I have had good days and bad days in Nursing school and as well in my work as an nursing asst. My good days were really those days when I left there feeling like I really made an impact and helped someone.

One good day was when I did my pediatric rotation. I got an 18 month old born with a Cytomegalovirus infection, Hepatitis C, and he was definitely cognitively delayed. But that's not why he was there. He was there because his guardian broke his leg, a spiral fracture. Those of you in the Med field and social work field know there aren't too many accidental causes for a spiral fracture in an 18 month old. He was such a joy though. He made you smile when you walked into a room. He was constantly smiling. He loved playing PeekaBoo. Sadly, Since his birth he'd gone from family member to family member. This last "Guardian" would be his last. He was discharged to foster parents, whom I met and they seemed very attentive and loving people. He was finally going to be loved and I got to love him for 2 shifts. That's why it was a good day.

OH but the bad days can be BAD. Not unlike the bad day I had in second semester. I made the mistake of telling this patient I was holding his blood pressure med. I shouldn't say mistake, It's only right to inform patients on their meds, but in hindsight, I should have maybe phrased it differently or something.
The drug was Cardizem, an Anti-hypertensive, and I was holding it because the Patient's BP was something like 90/50 and his heart rate was borderline at around 58. This is what I'm supposed to do, if I had given the drug, his BP could've dropped even lower, and would've been very dangerous. So I walk in with his other meds and explain the situation and I explained why and everything. He suddenly started cussing at me! This was a middle aged, middle income seemingly pleasant man until I told him I was going to do something that could keep him from dying. The other nurses could hear him out in the hall. (Now I'm OK with the mentally unstable cussing at me, I see that often at work. It really gets me when the mentally stable get verbally violent)
I paged my instructor as the patient was demanding I bring him his medicine. She went in with me to explain again and although, not cussing this time, he was still rude. I was brought to tears by the situation, frustration, and the demeaning way he treated me.
His demeanor had changed with me as soon as he found out I was a student. This is not something we hide from patients and it is usually added to our introduction (Not to mention the big ole patch on my arm that says STUDENT). He was nicer to the staff, he just thought I had no idea what I was talking about.

We students have no problem with patients denying our services. Not everyone wants to be a guinea pig for us. We understand. So, I make this plea to you, my readers. If you ever find yourself hospitalized and a student walks into your room, please tell them right away if you have a problem with them caring for you and please don't keep quiet and then treat them with disrespect.

Personally, as a patient, I would love to have a student. We students only have a couple of patients (2 or 3) at most versus our staff nurses who have 5, 6, or 7 patients. Sometimes, We have to do extensive research on your diagnosis, lab results, and medications. We also have to do EVERYTHING by the book and depending on our level, with our instructor (With their Master's degrees) watching. It can be like having your own private nurse for a shift.

Grand rounds

2006-03-07T14:16:00.000-06:00

Kim over at Emergiblog is hosting Grand Rounds 2:24 (Redux) this week. Yours truly has made my very first submission.
For those of you who are not into medical blogging and don't know, Grand Rounds is a weekly post of links to a variety of blogs in the Medicoblogosphere. In other words, Medical professionals blogging about their jobs and lives.
I'm honored to have my first at Emergiblog, Kim truly is a gifted writer and from what it seems, a talented Nurse.

ICU and photo op

2006-03-06T22:12:00.000-06:00

I've been busy. That's the only excuse I can come up with for not posting in more then a few days. Clinicals went well last week and I get to go to the ICU this Wednesday. I'm a little apprehensive about it as there is SO MUCH more going on in the ICU. Since my experience has been predominantly Med/Surg floors, the mere thought of ventilators, arterial lines, and rotating beds really scares the socks off me. Hopefully it will be an educational experience though, unlike my ER experience.

I have an interesting "thing" I'm doing tomorrow. When I worked a shift last week at my hospital, our staff educator approached me about doing a Photo shoot for a promotional thing. She already had a few nurses onboard but need a few CAs as well. I don't know why she picked me as we have quite a few much cuter and younger CAs on my floor but maybe it's the whole RN school thing. Ya know, they can say "This is Jodi, CA II who works on the blah blah floor, she's about to graduate RN school." I think it probably looks pretty good for a hospital to show off someone like me who moved up from Clerk to RN.....and still want to work for them when they could go anywhere else.
I met a CA the other day, a really good one I should add, that started as a Housekeeper. She was telling me she wanted to go to Nursing school. She was apprehensive saying she shouldn't in her 40s but I tried to talk her into it. There are quite a few 40 somethings and 30 somethings in my class, I would say the majority. Anyhoo, I'll let you know how that goes.
I've also been busy having taken on the task of planning our class photos. I remember when I started this journey I went to an information seminar on the program. I must have spent 30 minutes in the main hall looking at all the graduates photos. I was mainly looking for people at the hospital I knew but I also couldn't wait until my picture was in that hall.
Well this year, without any announcement, the school decided to stop organizing the photos. So I took matters into my own hands and have scheduled a photographer to come out and take our pics and put them into a compilation we can buy and give to the school. This guy actually does youth sports league photos but he's gonna come out and do a photo shoot at our school after class. We, students went through 4 semesters of near hell, so if it kills me, we are gonna be on that wall, DagNabbit!

Oncology

2006-03-01T16:17:00.000-06:00

My oncology experience today:

He wasn't young but he wasn't old either. It started with "sinus" pain and pressure off and on for a couple of weeks. Then he started having confusion symptoms, for example, he would see a supermarket and recognize it as a building but not a supermarket. That's when he saw his doctor. The doctor wanted to run a CT scan but his insurance denied it. A few weeks later the pain became unbearable and he went straight to the Emergency room. They did a CT and low and behold found a brain tumor in the Occipital area of his brain. Surgeons decided to operate and removed parts of the tumor (but not all) via Craniotomy. Radiation was planned. Just 11 days later, he was rushed again to the ER, The fast growing tumor grew back and was larger then it was when it was partially resected. It was causing spinal fluid to build up and he developed intercranial pressure. His Doctors decided this time to go in and put in a shunt to relieve the pressure. During surgery he hemorrhaged too quickly and hasn't woken up since.
This tumor was related to B Cell Lymphoma, a nasty Cancer that works fast.
I spent a lot of time with his family today as they just recently decided that Hospice was the best route. He is unresponsive, paralyzed completely on one side, and the other side is posturing. His Urine output is decreasing, he has copious mucus secretions, his breathing is shallow and irregular. I'm not sure he'll be there when I get back tomorrow. I think my main focus will be to keep him comfortable and focus a little more on the family, His wife and his small children.

Boy, this hit close to home. But I have an understanding that maybe some of the other nurses don't. I enjoyed helping this patient and his family today. This disease process fascinates me. Enough so that I plan to do my Case study over B Cell Lymphoma. If I wasn't staying on at my current med/surg unit, I would say Oncology would be my second specialty of choice.

Scut

2006-02-23T09:36:00.000-06:00

12 Lead Ekg Readout

The ER was boring. It was busy but boring.

We (my classmate and I) come in as the nurses were giving report. We stand about 2 feet back and listen (like we should). At the end of report, the nurses start arguing in front of us about who "gets stuck with us." They even joked about putting us with the aide.
One nurse volunteers to take both of us and this spares one of us from being stuck in Triage all day. (Triage means vital signs, no procedures... all day)
The bad part about that is there were only so many procedures to go around, so all in all I did one IV and one I &O Cath(A urine cath designed to get urine for testing, In and out...doesn't stay in) and that was it. Basically we were stuck "setting patients up" in rooms for the rest of the day. We hooked up monitors, changed patients into gowns, and emptied urinals. Scut work.
We made it clear to the nurses that we were about to graduate and was given permission to do anything but they still treated us like aides.
I can say one good thing though, I learned how to do a 12 lead EKG. I did about 4 of them yesterday.

************************************
Update on 3/1/2006:
Ironically enough, this week my classmates who rotated in the ER today had a fantastic experience. They shadowed 1 to 1 nurse and had ample learning experiences including receiving a Med Flight in from the helicopter, an MI who was rushed to the cath lab and a woman going into anaphylatic shock in the waiting room.
So I guess we just went on a boring day.

2006-02-21T15:44:00.000-06:00

"Sam Taggart" from the show ER. Did you know she's the same actress who plays "Velma" in the Scooby Doo movies? It kinda bothers me that they felt it necessary to show belly in this picture. Bad, Velma, Bad!!

Good- ER rotation tomorrow.
Bad- There's only one day in ER
Good- I'm very Excited
Bad- I still have to get up at 5 am
Good- I have free reign to do anything needed of me in the ER
Bad-I have free reign to do anything needed of me in the ER
Good- This particular ER doesn't take level 1 or 2 Traumas
Bad- This particular ER doesn't take level 1 or 2 Traumas
Good-No paperwork to do this weekend
Bad-I will spend too much time playing on internet without homework
Good- No clinical on Thursday.
Bad-Will post about the ER on Thursday.(See! Playing around!)

Blue hand

2006-02-18T14:39:00.000-06:00

I think I knew when I woke up on Thursday that it was going to be a bad day. I woke up AGAIN with a sinus headache and I was very hot. It was really warm Thursday morning and it got up into the mid 80s that day. I hate waking up hot. (It is now in the 30s.....crazy freakin Texas weather)

I took Ari to school and her teacher informed me that the check I wrote for Ari's yearbook a few months ago came back because I addressed it wrong. I was supposed to have addressed it to the publisher instead of the PTA. I distinctly remember the lady saying PTA when I asked for whom to address it. The deadline has passed now for order. Oh well, it's only Pre-K.

I needed to drop off my application package(fingerprints for FBI, photos, etc) to the school before clinicals started at 1:30. I had attempted this already 4 TIMES this week but the secretary who needs to notarize it was NEVER in her office. The deadline was Fri, 10 am. I drive out of my way to the school, find parking and march my butt all the way to the office only to find she was gone in yet another long meeting. So I had to drive up there again, on my day off, yesterday.

So I head to the hospital early to wait for clinicals. I put my 20 ounce coke in my bag so I wouldn't have to carry it the few blocks from parking to the hospital. By the time I got to the cafeteria, my backpack started to feel wet on my back. Upon inspection my coke decided to explode inside and my backpack was now a bucket. My syllabus and patient paperwork was destroyed, my stethoscope sticky, and by the grace of God, the plastic in my folder sleeve had protected my fingerprints and photo.

On the floor, I discovered that one of my patients who just had a new dialysis fistula placed the day before had a blue hand, very hard to find pulse, and it felt significantly cooler then the other hand. My co-nurse with her patronizing style shrugged it off. (Patronizing in a way like saying "She's on Lovenox, which is a blood thinner to prevent clots" DUH! What med-surg patient isn't on Lovenox and I think I know that by now) So anyway, she shrugged it off, so I called my instructor. When co-nurse saw me telling the instructor she decided to go in and investigate with us.
Co-nurse is seeing good capillary refill where I don't and feeling a good pulse when I don't. My instructor got the Doppler and we found a weak pulse only after searching for awhile for it. She tells me I've done all I can do and to make sure I document it thoroughly.

I know the patient was in End Stage Renal Failure but I thought maybe the patient would like to die with both arms.

Graduate Nursitis

2006-02-13T14:13:00.000-06:00

There's a new ailment going around....It's called Graduate Nursitis. It's kind of like Senoritis only with less partying, but it carries a lot of similarities. I thought I would take this opportunity to educate. Symptoms include:

*Procrastination-Hallmark sign
*Being easily distracted from studies for long periods of time
*Pounding headaches at the sight of a nursing textbook
*Doodling pictures (non medical ones) instead of making notecards
*Deciding the day before a test that it would be a great time to catch up on all the phone calls you need to make
*Intermixing studying with games of Mahjong (and others) at www.pogo.com
*Designating stuff like laundry and dish washing at a higher priority then studying
*Tachycardia/ anxiety about graduation followed by the later signs of
indifference and a general feeling of hopelessness and loss of control

Diagnostic tests:
Based on symptoms
Labs: Possible decreased Iron, Protein, and Albumin from forgetting to eat
Upon examination:
*Hair may look "frazzled"
*Marked increase in "worry" lines on forehead
*Fingernails may look chewed down to the quicks
*Suborbital edema may be present

Treatment:
* Graduation and passing the NCLEX
*At least 2 week therapeutic vacation to a tropical island or other location of patient's choosing.
*More then 5 hours of sleep a night
* Sex (controversial)

Yes, I am a Graduate Nursitis sufferer, this past weekend my symptoms had exacerbated.

I made an 86 on my test today....not too bad but could've done better.

Is it May yet?

**********************************
My Word Cloud. I gotta get the t-shirt.

Even better shout out

2006-02-11T02:08:00.000-06:00

My 15 year old brother, Walker is the next Ron Howard. My 10 year old brother Zak is the next Tom Hanks.

This is really funny and quite talented for kids their age.

Godzilla vs Tuck

View more video clips at Yashi

Shout out

2006-02-08T22:17:00.000-06:00

This is a shout out to an old high school chum. We called him Danny back then but now he's called Charles Daniel Sandoval.
He plays a terrorist in a little indie film that is getting some great reviews.
He's in The War Within and it's available for rent or to buy at your favorite movie retailer.
I shared a scene with Danny back in HS, he was awesome, I sucked...but he didn't hold it against me. (I still appreciate him working extra with me after school to get that scene somewhat decent.)
So go see it, Way to go Danny!

"LIKEYOU" lost soul

2006-02-07T01:09:00.000-06:00

Worked a shift tonight at the hospital. We got out of lecture early, so I headed over there 3 hours before my shift started. Much easier then trekking through traffic home and not wanting to leave my house again. Besides, my school is not very far from where I work. I came in and grabbed some lunch at the cafeteria. Ran into my charge nurse there..(he is my Idol, voted Nurse of the year last year) Anyway, he asked if I could come on early after I ate and sit with a suicide (attempt) patient. I agree as my only alternative was studying alone in the lounge, might as well study with a suicide patient and get paid for it. The patient was actually being discharged and was low maintenance. We had a nice chat, watched some good TV, and I got a little studying done. At the start of my shift I went on the floor. We were short one CA, so no one at the desk tonight. (Why does that always happen on my one or two shifts a month?!)
I had an unusual patient. A man found altered with no ID by EMTs. Broken bones in his face and generally doing pretty bad. When they brought him in they found he had bleeding in the brain(subarachnoid and subdural), enough so that it probably has caused some major brain damage. After a couple days, he's in the clear physically but mentally, still very altered. He was in restraints because he became very agitated and combative and wouldn't stay in bed. He had a sitter too, just a much bigger MALE sitter. Male sitter asked me at one point to relieve him for a break, so I got to sit with this poor man. I talked to him, even though he barely responded with anything intelligible. I told him about his view from the window, how the weather was. He didn't say much to me that made any sense, sounded like gibberish really. The sitter came back and I went back to my other patients. Later as I was walking past the door, the patient started shouting "LIKE YOU LIKEYOULIKEYOULIKEYOU" at me. I went in and said "Mr. X there's no need to shout, I'm right here. " So he starts whispering "likeyoulikeyoulikeyou."
So I guess I got through to him a little.
Social worker figured out his ID and his address. It appears he lived alone, no family or friends found yet.

Big Whopper with cheese

2006-02-03T01:08:00.000-06:00

I know I post about a variety of things on this blog. I try to keep it predominantly about Nursing as it is what has enveloped my life for the past 2-3 years. I have also written about being a single mom, my nutty family, and widowhood. Tonight I need to post about the latter.

I knew it was coming, I just didn't expect it so soon and so early. Ari had her first emotional break down just a few hours ago. We were sitting on the couch talking about the day and Ari mentions something about her Nana and Poppa being old. She asked me if they were going to die and go to Heaven like her Daddy. I told her, "Yes they will one day get sick and die and they will meet her Daddy in Heaven". I felt compelled at this point to explain more about Heaven. I told her it was a wonderful place where you are always happy, and people never get sick or hurt themselves. I told her that I also believe that they can watch us from Heaven and that Daddy is watching us every once in awhile but we just can't see him.
It was then she said and started crying "I miss my Daddy in Heaven, I want to see him." She cried for quite a bit while I just hugged her. It's still breaking my heart.
I told her how happy her Daddy was that he got to live long enough to see her when she was a baby. And I told her that when he was sick, he was hurting a lot from the cancer, but once he went to heaven, he didn't hurt anymore. I told her we still have each other and the two of us are a team. Then, I offered up some photos for awhile and we watched an old video of Mike. She fell asleep watching it.
I thought I was prepared for it but it took me by surprise, coming home, late from clinicals and I felt a little knocked over. I guess I expected her to be older before she felt the loss. She grieves more for losing a Daddy, not particularly her Daddy. She can't remember him fully, she was 4 months old when he died. But then, maybe she does in a way, as she has seen so many pictures of him, and heard so many stories. Her memories might be false, but they have to be good at least.

Mike and Ari 2001

I still miss him too

"Sim Man"

2006-01-31T16:02:00.000-06:00

We had an excrutiating long 90 minute lecture on blood transfusions today. It was OK to bear however because the other 90 minutes (3 hours instead of 4 this semester, Yay!) we got to run a real time simulation on "Sim Man" ,the simulation dummy. It was fun. Our instructor picked 4 people to run two simulations. I got to do one. The 4 people acted as the one Nurse. One to do the charting, one to lead, one to do meds, one to draw blood/put in the IV. I did the IV. It was an emergency scenario, Patient coding. I go to start the IV with an older cath. I thought I had it the first time but I didn't see the flash of blood (red food coloring in water). They kept asking for IV access and for some reason...no flash. I finally think screw it and leave the cath in and withdraw the needle. Sure enough I get return but it's just water. The group before us pushed a bunch of "medicine" (water) into the "veins". UG! My instructor mentioned like 3 times during the review that we needed a line in him. I had the line in and didn't see red! So unfair!

Calling for malpractice...on mechanics

2006-01-30T16:30:00.000-06:00

I can think of a handful of occupations in our culture that have a majority of sleazeballs carrying the title.

Mechanics, Lawyers (some...Kelly..... Some) , Evangelists,Clowns, and Dentists. Yeah...... That's right I said Dentists. I have been lied to by a dentist before and have witnessed same to a few friends. I mean, how do you KNOW you really have a cavity unless they actually show the x-ray (which most don't). When I was in LA, I went to the dentist and was told I had 4 cavities. I had to go on a payment plan with them to pay for the fillings and the whole time I'm there they are trying to sell me some fancy toothpaste and fluoride treatments that they sell only there. Later, a friend of mine goes into same dentist and is told she had 6 cavities and needed a root canal. She knew about the root canal (pain was the reason she was there). The quote was so expensive she decided to hold off and go to the AF Base where dependents CAN be treated on a last priority basis (you could literally wait all day to be seen and never get to). The base dentist saw her and told her, yes she needed a root canal (it had even abscessed) but she only had 2 cavities.
She asked why would the other one lie. The base dentist asked almost joking "Did they have a new office building?" Sure enough the practice was brand new and fully staffed. Dentists are Doctors for pete's sake!

A little ADD today so bear with me. Anyhoo, My car had been doing this HORRIBLE screeching for a few months, ever since my oil change place changed my belts out. (2 belts, my A/C belt and my alternator belt.) I took it back and the mechanic said there's nothing wrong with it, he said they were new belts and sometimes they need breaking in. He put some oil on them and sent me on my merry way. I took it back the next day after the oiling didn't work, still screeching, and seemed to be worse when I ran my A/C. He had the car all day. Calls me and says, it's not the belt, it some fancy schmancy A/C part that's gone bad and the belt is making the noise because of it. I actually say "Well that's odd because, my belts made no noise whatsoever before you replaced them, What incredible timing that is." He agrees. Well I told him, I'll just have to do without A/C because $800 was way too steep for me, even for the TX heat, and I'll just have to deal with the screeching.
That brings me to Saturday night, driving home from hanging out with Jen. I'm driving hearing the usual screeching and then suddenly the screeching stops and simutaneously I feel something fall out of my car and I run over it. At the same time, my battery light comes on. I have an instant revelation, It wasn't my A/C belt, it was my alternator belt. (My past experiences with piece of crap cars gave me the knowledge that Batteries and alternators are best friends)
By the time I got home, coolant and steam was spurting out from my hood. Yeah, I know I should have stopped but I was on a not so busy highway at 1 am, there was no way!
It actually started again the next day so I took it to Firestone (about 1/4 mile away) the closest place that happens to be open on Sundays. My alternator belt was missing alright and it damaged my alternator and power steering belt in the process of snapping off at 65 mph. Grand total $460 dollars.
I know I should've pressed the issue with the initial mechanic. I'm just so passive and hate confrontations. I thought my sarcastic remarks would do it.
Thank-you Jenni, Cathy, and Jon for being my ride the last 2 days. Finally have a vehicle again and I feel less vulnerable. I'm gonna have to put a rush on my tax refund though. I used my school money to fix the damn car.

Clinical day 2

2006-01-27T09:00:00.000-06:00

Yesterday was awesome! When I first came on to the unit, initially I felt overwhelmed though. What we do is we get assigned to a nurse and then we pick or the Nurse recommends our patients. I introduced myself to her and she told me right away she had 2 good ones for me.

A post-op spinal fusion and a post-op I & D (Incision and Drainage). They were good, IV starts, IV piggy back meds, and a couple JP drains to play with. However I listen to both reports and realize the OR nurse is the only one reporting. I thought, "Well that's weird, maybe the previous shift hadn't had time to record yet." So I get to both charts and realize they were Post-op.....RECENT Post-op, they had both just gotten to the floor within the hour. So I was just a tad bit concerned about my abilities, not to mention there were frequent vitals to monitor, orders to check and making sure the pharmacy has and was processing their post-op meds.

After the first few hours though, things calmed down, both patients were stable and doing fine. They were also both really nice and one was a jokester who made me laugh every time I went in. He even sang my praises when my instructor assisted me with the IV antibiotic.

The IV start didn't happen until there was 15 minutes left for me on the floor. There was another IV start for my classmate at the same time (she had less experience, had only tried one in the past) so my instructor asked me if I was comfortable doing it with my co-nurse. Of course I was! (More comfortable, actually) She said I did great. It went perfectly, first stick, no digging, patent IV. I hope my co-nurse reported this back to my instructor.

I felt more like a nurse yesterday, then I have in any clinical day so far. It was great!

Semester 4, Day 1

2006-01-25T16:05:00.000-06:00

I spent my first day of my last semester on the Ortho/Neuro floor. We were told we would be assigned to a nurse and that we should pick one from her assignments that would have "the most going on." What she meant by that was to find one to practice our skills such as picking the patient with a central line and a foley versus the guy who can walk, talk, and will probably be going home soon.

So I did, I had a hard time listening to report (we use a voice mail system) and it kept cutting out and the night nurse had a very thick accent which made her hard to understand. I had to listen to same report 3 times to sort of get the gist. Well turns out despite my patient's issues with not eating, being cachetic, and having a gastric tube, today's patient was pretty easy. On the floor at 7, assessment completed by 7:30, Meds done by 8:30 (all morning meds) and Bath and linen change done by 9:30. From then on I think I was harassing my patient with my frequent visits and my constant "Are you doing OK, need anything?" questions.

I went to my classmates down the hall, asked if they needed any help, I think they were afraid to ask but they looked busier then I. I went to my primary Nurse asked her if she needed any help. She let me follow for a bit and help with some small tasks with her other patients. Overall, too laid back of a day. It made me feel guilty in our post conference meeting when I heard how busy everyone else was. Why was I so bored?

Luckily we increase to 2 patients tomorrow and then on to 3 next week. I think I may start my patient profile homework now, so I don't have to worry about it over the weekend.

Da Dum Da Dum dadumdadumdadum DaDaDaDA!

2006-01-23T14:39:00.000-06:00

I just applied to the Texas Nursing board for State Licensure!

If that doesn't hit home, I don't know what does,

Holy cow, I'm going to be a Nurse in 4 months!

Excuse me, While I freak out.

Blog Wars

2006-01-22T13:40:00.000-06:00

Wow!

I never would have thought writing this in response to Dr. Charles story about a Trisomy 21/Down Syndrome patient would have started a blogging war:

"I've always believed that Down's syndrome patients are "God's golden children". I can't remember where I got that title but I can tell you, I've never met a sufferer who was unlikable or mean-spirited. They just emit happiness.I love this story."

I'm not the bad guy here, am I? I'm about to be a medical professional and I'd like to think that I would treat all my future patients wth the utmost respect and dignity, chromosomal differences or not.

Is this really about being Politically Correct?

I'm guilty for not being politically correct, behind closed doors. But in public, If I'm not sure about a "correct" term, usually I'll say nothing at all. But frankly, since I'm being honest, Political correctness as a whole irritates me to no end. Changing the name of something or a term that has been used for decades maybe centuries doesn't change what it is.

I can't keep them straight. I joked in my comment box in my last entry about having a PC handbook. I kind of wish I really did own one.

However, some things can be offensive to some and not to others even when they are in the same boat. You can't please everybody.

I'm truly sorry if my above statement offended, I really am.

However, I still truly can't understand why saying someone or someone's are not unlikable, meanspirited, and happy is a BAD thing.

But I'm the kind a person who doesn't nitpick and tends to look at the big picture in every situation.