A nurse in the family

I handle my patients pretty well, I’m patient, compassionate and empathetic. But you’d never know that when I’m the nurse in the family.

All of the patience and compassion seems to leave me abruptly when it’s my family in need of it. My grandfather is quite the chronic disease train wreck. There really isn’t a system that isn’t affected in some way. Currently his main issue is fluid balance, with ESRD and heart failure, he is rather brittle. And so, as I am standing in triage room #3, I find myself aggravated. Honestly, I can’t imagine what he was thinking by blowing off the fact that he had weighed himself to be over 8 lbs his normal range (weigh gain is a tell tale sign of fluid retention). Or why he would continue to drink more than he should if he knew that his kidneys were only functioning at 10% capacity. It seems all of the discussion I’ve had with him went in one ear and out the other. It just doesn’t seem to make sense.

But I have to remember to pull myself back a few steps and know that I have know idea what it’s like to live in his shoes.

Are you sure I’m qualified for this?

So I just had a mini-vaca from work, a mid week three days off in a row kind of vacation. One filled with lots of errands, driving long distances, and school work. I felt so accomplished and ready to take on the world. Just to prepare myself, I checked my work email. Apparently I’m registered for an ACLS course NEXT week. ADVANCED CARDIAC LIFE SUPPORT. I’m not qualified to do this. I’ve seen chest compressions once. Scratch that, I’ve seen them quite a few times, on the TV shows House and Grey’s Anatomy. And we all know how realistic those shows are, but don’t even get me started on that. I’ve never seen a code performed, never done compressions of my own. I panic every time my patient’s SBP (systolic blood-pressure) either drops below 100 or is above 145. Never mind what happens when their heart rate falls out of normal parameters. How in the hell am I supposed to get my shit together for ACLS. Let’s just hope my patient’s don’t almost die on me. For their sake, not mine.

What a weekend

I had every hope of getting called out of work on Saturday. I really wish I got the call saying that they didn’t need me to come in… But that isn’t how it’s been working at my hospital lately. Census has been through the roof. When I got into work, things were okay. I had four patients, one of which would be discharged. The discharge was simple, here’s your paper work, there’s the door. And my other three patients I had cared for the night before, and they were pleasant. I had time to provide some solid nursing care.

And then, I got a post-op admission.

This patient was young, and admitted for compartment syndrome. I was intrigued. As unfortunate as it was for the patient, I thought that it’d be so interesting. Needless to say, my interest faded fast.

A little background about our post-op routine. The PACU (post-anesthesia care unit) nurse brings the patient to the floor, together, we assess the patients vitals, any surgical dressings and drains, the patient’s level of consciousness, and any other pertinent information. If the patient is stable enough, a signature here, and a signature there, and the PACU nurse scurries off the floor and the patient becomes my responsibility. For the first hour, vitals are taken every fifteen minutes, then every half hour x4, and hourly x4, and then every four hours. Generally speaking, patients come to the floor very somnolent from their cocktails of fentanyl, hydromorphone, versed, and whatever else. This makes for a very cooperative patient.

Well this patient, came out of anesthesia rather quickly. I couldn’t get the first two sets of vital signs done before the patient was ripping off his gown, jumping up out of bed, and trying to run outside. Hospital policy doesn’t go for that so well. We like to keep our patients on the floors so the can be monitored, which is why they’re in the hospital in the first place. Anyways, there’s a little catch for the patient who just wants fresh air (or a cigarette), they can sign a form saying they’re going out against advice, have their IV taken out, and be on their way. This patient agreed to this.

No sooner do I return with appropriate documentation and supplies, is my patient down the hall, then down the elevator and gone. Perfect.

Security was called, as is protocol for when a patient leaves with an IV. Before the patient was brought back upstairs, he had ripped out his IV and got himself covered in blood (good thing he had decided to wear a white t shirt. Then again, somebody should have told him Halloween had passed). For the rest of the night, the patient was less than agreeable.

Writing it all out now, it seems like no big deal. But the amount of stress these events added to my day, and to my body, is unreal. At more than one point, I was seriously wondering if this patient was going to fly off the handle, I questioned my safety, I questioned the safety of this patient’s roommate (who was moved ASAP), the safety of my coworkers and the other residents. It’s hard to not be in control, and to not know what to do.

At the very least, I can say that I learned something from that day: the number for security.

I came across an interesting quote today.

“When we make a change, it’s so easy to interpret our unsettledness as unhappiness, and our unhappiness as the result of having made the wrong decision. Our mental and emotional states fluctuate madly when we make big changes in our lives, and some days we could tight-rope across Manhattan, and other days we are too weary to clean our teeth. This is normal. This is natural. This is change.” – Jeanette Winterson.

 

This quote is so very reassuring. Makes me feel just that much less crazy. (And for when my bf reads this and says ‘that’s what I’ve been telling you all along,’ I know, I know…)

 

I came across this quote on Pinterest, while waiting to go to work. Yes, work at this time for those non-nurses, and yes on Halloween I’m working nights. And the worst part is I volunteered. I’m a sucker who can’t say no. But more on that later.

 

Evidently, Jeanette Winterson is a British writer/journalist. She’s got quite a few good quotes. But I have to go to work, so do your own research!

 

 

Conversations with Patients

For all those out there… You know who you are

Libertarian RN

“You know, it used to be a lot bigger. People always used to say it was really big. Now it’s so tiny, I can barely find it. I haven’t even used it for six years.”

This would fall under conversations your nurse does NOT want to have while he’s helping you use a urinal.

In other news, drinking a fifth of vodka a day is not good for you.

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Having the day off is for…

Living life outside of work. And of course, wondering what the next day at work could possibly bring you. Who doesn’t love a good surprise? If work has been continuing it’s normal flow, I’d say I’d have at least one patient with a SBO, an NG tube that isn’t draining to save the patient any comfort, and of course uncontrolled nausea as a result. Another patient with so many IVP medications that you might as well be attached to them all night. Then there’s the guarantee of having a patient who’s waiting for surgery. I’ll hope that I won’t get a post-op patient, considering that my last post-op had a SBP running in the 70s. No big deal, you don’t need blood flow for anything important, and it’s not like a little ischemia could hurt anybody, right?
Don’t get me wrong, I generally think my patients are great, and I feel pretty special being able to help them when their at their worst (this is what nursing is all about, or so I’ve been told). But sometimes, I wish I could close the flood gates of overwhelming information about diagnoses, surgical procedures, IV medication policies, and then there’s always remembering the smells that just never sit right in either nostril. There’s nothing like remembering certain smells when you’re trying to eat (you know, like the smell of fecal emesis. They don’t prepare you for that in nursing school, unless you were that lucky student).

Today is one of those days. Especially because I was looking forward to a solid dinner. And now my stomach is turning.

Admitting it isn’t easy

I’ll admit to this: I can be a little arrogant, I have a strong urge to be good, great, okay, I really just want to be the best. And I don’t particularly want anybody’s help. The problem with that? I’m a new nurse. New as in, I haven’t be registered for six months yet, just finished orientation a few weeks ago, oh, and I gave my very first soap-suds enema today. And I’ll admit that when I’m scrambling on the floors, overwhelmed, I have a hard time saying that I need help.

I’m doing well, but I’m not handling it well, if that makes any sense. I haven’t caused any of my patients harm, I haven’t had to stay late after a shift catching up on documentation, but the stress of being a new nurse is getting to me. And I have a hard time admitting to myself that I’m having a rough time. The road to recovery always begins with admitting you have a problem, right? I sleep, a lot. Fourteen hours of sleep and still not feeling well rested. But that’s just how my body handles the stress. It’s only taken me a few weeks to realize what’s going on, with my subconscious, but also grossly large amount of stress, my body is taking a toll. But you know what, I know I’m not alone in this so it’s okay. I knew ahead of time that the first year as a nurse isn’t for the faint of heart, and I know that I have been prepared very well for this incredible role. And I know that if I survived the four years of nursing school, I can handle one more crazy year. But I swear I don’t have a problem.

Thankfully, I have a great pool of supportive nurses around me at work. They understand that I’m going to have questions (how do I give a patient an enema through their colostomy?), and that maybe I’ll miss an important thing or two (don’t forget to bring extra towels to mop up the mess). They know that I’m learning, and this first year I will learn more than I probably did in nursing school. Or so I’ve been told.

And so that’s what this blog is about, the crazy things I’m going to encounter through my first year as a nurse on a surgical floor. I’ll also share some stories as my role as a student, and teaching assistant too, because education never ends!

And for those of you wondering, yes today I administered my very first soap-suds enema, by way of a colostomy. What an experience that was.

Here’s a little something from the NSNA, the National Student Nurse’s Association, which to me is essentially a warning beacon for the nursing students out their…. http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_SeptOct07_Feat_Guide.pdf