The Act of Patience.

I have been struggling with patience lately. Not usually something I have a problem with, in all honesty (can I admit that without sounding stuck up? I have issues, just not that one...) I don't know what is different lately, but my guess is a combo of a crazy schedule (try on 2, off 1, on 1, off 1, on 2 and see how well your body knows what way is up), the fact that the fall is finally winding down, the fact that I desperately want to go home (TOMORROW), the fact that I have been worried about friends and am more stressed than I have been since Junior year when I started researching waitress jobs in Alaska.

There is an IA (IA=information associate=unit secretary) on our floor who is pretty much worthless. As in, half of the orders she puts in are wrong, if she doesn't understand it she tends to skip it, and she asks the same questions over and over. Normally I handle it okay... normally I whine in my head but answer her questions with a smile, double check the double check and put in my own orders whenever possible. The last few nights, however, I have just not been able to handle her. She called me last night to ask a question, and I was abrupt. I told her I didn't know and hung up. I didn't say thanks when got my chart. I didn't tell her it wasn't an issue when I had to take the chart back up twice to get things fixed. I told her what I needed and when she started asking questions I said "I don't know ask someone else" and walked away. This morning I am not proud of myself. That is not the nurse I want to be. The co-worked I want to be. I like helping people learn. And I want to be the person who is nice, not the rude person. I hate that last night I forgot how hard she is trying... how much she works to do her job that supports her and her daughter/granddaughter. How she is (I am sure) really under-educated. I forgot that. and maybe there is reason. After doing a job for as long as her, she should be better. But I should be, too. Cause I ask a lot of questions. And I know what it is like to be over your head. and I have a standard to live up too... the ultimate healer's standard, in fact, and I failed last night.

I was going to blog today how good I am getting at IVs. I have gotten the last several that I have started, easy=peasy. Then, I failed. Twice. and about cried. I hate that I can't start IVs. I hate that I don't want to be a charge nurse because what kind of leader can't do IVs? I hate that out of all the things in this career I cannot conquer, it is something that easy. They tell me to visualize it, to do it by touch and not sight. To go in believing that I can do... negative attitude is the pits. But I didn't even hit blood last night. Not even like I blew the vein, I never found it. But then I started thinking... maybe I need to have more patience with myself. I soared through school... it was my thing. I was on top and I loved it. Then I hit the floor and the bottom dropped... and I am still trying to find my wings. I want to be super nurse. I want to be the one others look at and say, oh she is good. I want to be there now. But honestly? I have done this job for 18 months. It is okay that I don't know everything. I am learning something new every day. It is okay that I don't get all the IVs that I start. I get a lot, and I keep making myself try before I bring someone else in. and whereas I will always struggle to be better, maybe I need to have some more patience with the fact that I am still a baby nurse and it is okay for me to not be perfect. Even if that is what I want with all my being. and you know what? In 20 years I am going to be a force to reckon with... and i am going to rock at IVs. Until then? I need to learn to show myself some grace. and remember to pass that grace along to others. Not always and easy thing to do...

Because I am bored and I was reading my facebook notes...

I posted this on facebook last fall. It made me happy to read it today, so I thought I would share.

1. I have a Wii. With Mario Kart. I am very bad at Mario Kart. I run into the walls. I also have a Wii Fit board. I am considered unbalanced. Probably true. I beat Tiffany at Mario Kart, but not on the fit board. she is more balanced.
2. I read a lot. My mom says I am an emotional reader in ways that people are emotional eaters. Does this make sense to anyone?
3. I am turning into my mother. Which is okay, cause my mom is cool.
4. I have gotten very good at chest compressions in the past two months. Which is not especially a good thing.
5. I love the idea of living in Alaska. Someday I will travel nurse there and stay for a while. Feel free to come visit me.
6. My favorite places in the world: 1. Axtell/Hillcrest (aka grandparents). 2. Paradise Valley Nature Reserve (waterfall beats ocean any day). I wish there was something like it here 3. Florida. Hate the place, but a lot of my favorite people are there.4. My couch with a good book. even better, at home where mom is cooking while I sit on the couch.
7. I just bought a new car. A 2009 Hyundai elantra. I love it like mad, but I still kind of miss my old grandma car. A lot of good memories happened in that car.
8. There are squirrels that live in our ceiling. I listen to them a lot, and am thinking about naming them. The one that keeps running into the duct work I think I shall name crash.
9. I watch a lot of Sci Fi, which is kind of funny. I was very sad when they canceled Starga te:Atlantis.
10. Some people thrift store shop for clothes or furniture. I buy books. I have more books than I have room for, which is sad. Because I totally plan on buying more (such as the one that is in the mail right now that I bought cause I felt sorry for myself cause I was sick and I had to go to work. That is the kind of excuse I use to buy books)
11. I feel guilty when they call and ask me to work extra. Even if I already have plans, and I say no, I still feel guilty. I need to get over this soon, since they tend to call a lot.
12. I have lived/am living with the best group of roommates ever. They were an answer to my mother's prayer that Corrie make good friends at college. They make me happy. Keep me grounded. God is good.
13. I love my job. I complain about it a lot, but I really do love it. I wouldn't want to do anything else, even be a waitress in Alaska, which was my backup plan throughout college.
14. Calling and bugging my brother is high up on my list of favorite things to do. It is a game to see how long I can make him talk to me before he finds an excuse to hang up.
15. I am very proud of the e-mails I write, especially to my grandparents. They make people laugh.
16. I am the only person in my family with red hair. I have been to family reunions, no red hair. It does appear in the beards of various brothers/uncles/cousins. On the same note, my mother has always been very opposed to me dyeing my hair. I did it, and she didn't notice for 4 days. I told her she is no longer allowed to comment.
17. My birthday is my favorite day of the year. My apartment will be turning green sometime in the next couple of weeks. Everyone should celebrate it. ( and no, chelsie, it is not just about beer and greed.)
18. I love Africa. I am planning on going back. Maybe this year, if I can find a good trip. Anyone know of any good medical missions to Africa?
19. I love school. I am planning on starting my master's soon, for no other reason than I want to take advanced pathophysiology.
20. In my opinion no one who graduates from nursing school has any clue whatsoever how to be a nurse. I have been doing this job for 6 months, and I still feel clueless. Slightly less clueless, it is true, but still clueless.
21. My dad thinks I should be able to write a book since I read so many. I tell him it is not quite the same thing. He doesn't believe me. Maybe some day I will give in and write a good mystery involving a nurse who solves the crime and gets the guy.
22. I am a greenbay Packers fan. Thanks to my roomie from WI. It helps that their team color is green.
23. I love being the baby of my family. I am spoiled, I freely admit it, and it is nice. Very nice.
24. When I am bored at work I sit and look at house through www.frontdoor.com I picked out my dream house on Roosevelt road, College Hill, Wichita. I really want a house. With a library. And a dog. Lots of windows. Laundry room where I don't have to use quarters. Ahhh... dream big.
25. Freshman seminar I called myself Chatterbox Corrie. My prof laughed at that, because up until that point I had said, well, nothing. But I do chatter. a lot. My dad tells me, Corrie, your mouth runneth over. I eventually started talking in class too, so my prof believed me. I discovered it was faster to give the right answer and move on than wait for anyone else to talk ( I have not yet decided if that is a good attitude to have, but honestly, 4 hours of HR a day called for that attitude).
26. (cause I like going over) I think I like the person I have become. That makes me happy.

Thoughts a year later: I have been doing this job for 18months and I am starting to feel like I have got it. I desperately want a house, to the extent I am not sure about going to Alaska anymore. They have stopped calling and asking me to work extra, and started calling and asking me to stay home. I am done saying yes. I am now living alone, thanks to people getting married all the time, but I still have the best group of friends. I still enjoy my job.

I do like the person I have become. It is official. And that does make me happy.

Realities.

Today I am in Wisconsin, hanging out with a really good friend from college. Life is good.

3 days ago I was getting ready to work my 6th day in a row when the phone rang. It was my bank telling me of suspicious activity on my debit card. Someone managed to empty out my checking account over the previous 4 days. Life wasn't so good then.

That night I went to work already beyond stressed, only to discover a post-op patient with a trach that wasn't on oxygen, was struggling to breath and desperately needed suction. I did, and pulled out what looked suspiciously like his tube feeding from his lungs. His life isn't going so good either. I spent the night suctioning his lungs every half hour. checking his blood pressure as it came too close to tanking too many times. Calling doctors for fevers, blood sugars, crappy lungs and urine output of less than 200 over 12 hours.

Did I mention the dude didn't speak English? That makes things fun.

I do not understand the medical community sometimes. This man did not become so sick that day. His lungs were pretty bad before they took him to surgery and removed one leg and completely redid his veins in the other. He had so many co-morbidities that I sit here and wonder what the doctor was thinking we would accomplish?

Some nights go better than others. Some nights you swab wounds and culture sputum and check UA's without orders, cause the order will be written first thing in the morning anyway. Some nights you can make the night without calling a doctor, some nights you have to decide which one to call first.

By the time I left, his lungs sounded marginally better, his secretions were thinning out thanks to the mist and the breathing treatments and his blood pressure and urine output were improving thanks to a fluid bolus. I think I improved the situation... his situation. In that shift, I made a positive difference.

But really? In the long run, at what point is it okay to say that someone has no quality of life left, maybe we should stop the invasive procedures and just manage symptoms? at what point is it okay for me as a nurse to start wondering why I have to be doing all the things I do? I firmly believe that there is a good way to die. I just don't think we let people do it often enough.

Thursdays.

Here is the e-mail I sent my dad the other night:

I think maybe I am just cursed in winter.

My patient just coded.

Drats.

It might be a long couple of months.

(in other news... I have no news. i was having a good night. until I walked in the room and my patient wasn't breathing. that kind of killed the good night. )

I hope you have a good day. And that no one stops breathing during it.

At least I didn't have to do compressions, although those are kind of fun.

I would still rather not have to do them... I will take a beating heart over a not beating heart any day. Even without breathing.

Now, give me a patient with both a beating heart and the ability to breathe, and I am a happy camper.

I don't think I ask for much, do you?


Sometimes the way my brain works while I am taking a 5minute lunch break at 5:30am worries me. I don't really think chest compressions are fun. Really. I do like it when my patients are breathing, that much is true. I really cannot tell you how much I liked going back to work last night and having that patient back on our floor... he is okay! Or as okay as someone could be who stopped breathing for a bit. Life is Good. I finally had a code patient live.

3 crazy days

I worked this past weekend and Friday as well, and boy did I have a crazy three shifts! It started with a pretty busy morning, my favorite part was helping the vascular surgeon put in a chest tube! It was awesome!!! It was the first I had assisted as the primary nurse! The patient did it on 0.5 mg Dilaudid and local anesthetic which probably explains why he jumped 6 inches off the stretcher! The surgeon was mad!! He was like "I said don't move!!!" I felt sorry for the guy, it was a spontaneous pneumothorax and he was only 26, he nearly cried.

After that, I got my first review as an RN and I got high marks! I was pleased to discover that my coworkers enjoy working with me and my boss thinks I am doing a good job!

Saturday was a strange day, we saw barely any patients all day long until 1500 when we got a call from EMS saying they were bringing in a 25 year old unrestrained driver involved in an accident on 95, she had been ejected 40 feet from her vehicle. Originally they were brining her to us to be pronounced because no one ever dies in an ambulance but halfway to our hospital she got pulses back so we were gonna have to stabilize her then fly her to Halifax. Right after that trauma call came over the radio we got another saying that a 7 year old in respiratory arrest was coming in. 7! I was ready to freak out because I had the pediatric trauma room so that patient would automatically go to me!

I raced around my room, hooking up the small blood pressure cuff and whipping out the Broslow tape, all the while terrified because I knew half the help would be with the trauma and not in there helping me with the child! Thankfully, we got a correction on the age and it was a 75 year old not 7. I was relieved but still nervous. My respiratory arrest arrived first, intubated, and as they rolled her into the room, they handed me the DNR. I was very confused as to why they had a patient with a valid DNR intubated but we rolled with it. She was in PEA which means the electrical circuit in her heart was still running but her heart wasn't actually beating. As soon as the doctor came in he pronounced her and we ceased all life saving measures. Dr T asked me to go with him to tell the family and after informing them that their mother didn't make it, the son asked what do we do now? Dr T says "RaDonna will tell you" and he walked out of the room.
Keep in mind that this is my fist expired patient and I have never had to deal with grieving family members before so I did my best and was as kind and compassionate as I could be and I called a priest for them and after removing all the tubes and cleaning her face, I let them come be with their mother. It was scary dealing with this new experience and also with preparing the body but you just have to take the hand you are dealt and learn to adapt.

My charge nurse was also very nice and helpful and he showed me how to fill out all the paperwork and told me everything I had to do. The rest of the day went pretty uneventful but we were all a little somber, especially when we found out that the trauma victim didn't make it.
Sunday was a crazy day. I think it was actually a full moon. I had this one nice lady who was only a couple weeks older than my mom who came in for new onset seizures. She was very scared and worried that maybe it was a side effect from the flu medicine she recently started. Unfortunately, after a CT scan, the ED Dr. diagnosed her with a frontal lobe tumor. She had never had cancer of any sort and this came as a complete shock to both her and her husband. The week before they had buried a family member who had died as a result from cancer. I felt completely incapable of caring for this woman emotionally which is part of my job as a nurse. My heart ached for this woman who after sobbing in her husbands arms for more than half an hour, just sat on her bed, staring at the sheet. There was absolutely nothing I could do for her. All I could do was work on transferring her to nearby Hospital for neurosurgical care.

Meanwhile, in room 9, I was given a 15 year old boy who snapped his femur falling off a motor cross bike. He is crying in pain and if that isn't enough to make me feel bad for him, I have to deal with his father in my face at the nurses station asking me why his son hasn't been medicated for pain. I calmly explained the nicest I could that I am realize that his son is in pain and a doctor would see him asap, but until then, aside from an ice pack, there was nothing I could do for him.

(I have had a broken ankle and that hurt like heck so I can't imagine the pain that he was in but seriously, there isn't anything I could do without a doctors order aside from having it x-rayed. Just wanted to make sure ya'll don't think I am heartless shrew. Besides, both docs were busy with a lady who had O2 sats in the 70s and a STEMI)

The father didn't believe me that there was nothing I could do and kept demanding that I do something. Unortunately, my forked tongue betrayed me and I said in not the nicest of tones: "Sir, I do not have a medical license, therefore, I cannot give your son anything for pain! You are going to have to wait until the doctor sees him!" I felt bad afterwards because I can't imagine how hard it is to see your son suffer but he wasn't listening to me! Plus, I was stressed to the max because I had my poor tumor lady in 10, and a SOB guy in 8, AND a pneumonia lady in the hall. I never have four patients and needless to say I was a bit frazzled.

After the doctor finally saw him and I gave him some happy juice, the dad apologized and in my sweetest nurse voice I told him there was no need, because I understood he was stressed.

Everything ended up quieting down and I didn't receive any phone calls today from the Florida Board of Nursing informing me that they would be revoking my license for shoddy patient care so I guess I'm good. I learned so much and had some great experiences this weekend. I wish I could hear how my tumor lady ends up. I don't think the prognosis will be good though because she has developed some abnormality to the roof of her mouth and the CT report said it required further testing. Please keep her in your prayers.

One of the nurses I worked with on Saturday said that one day it will hit me and I will say to myself "I'm an ED nurse". I'm not there yet but I'm getting closer everyday.

The parts that I hate.

There are times I really hate the knowledge that comes with the job.

Times I really hate living in Kansas City.

Times like when I get the phone call from my mom telling me that my grandpa fell and is on the way to the hospital and she doesn't know what is going on yet. When she tells me she is going to tell Grandma in person so grandma doesn't freak out.

When the first thing that goes through my mind is fall= broken hip and people with broken hips have like a 75% likelihood of dying in the next 12 months.

Then she tells me he didn't fall, just was so weak he couldn't stand up by himself and when they went to help him he sank to his knees.

The first thing then was... what is his potassium? weakness=low potassium. Or low hemoglobin. GI bleed? CHF flair= we need to know his BNP now.

The thoughts are endless. He is probably okay... trying to talk mom into taking him home cause "he thinks he can walk now". He's alert, oriented.

But in my brain, I think of the things that it could be. And I want to be there. I want access to the blood work, the doctors notes. I want to make sure his nurse knows what she/he is doing.

So I sit here. I pray. I know that if mom says I need to come home, I will be calling in sick to work and driving home. And I thank God every day that I have been blessed to be loved and to love my grandparents for as long as I have, and pray for just a little bit more.

Monday Blues

I have to go back to work tomorrow and I really, truly don't want to go. I am terrified. I used to feel pretty good about my job and my abilities to function as a nurse but lately I seem to have misplaced my confidence and instead there is nasty dread and fear. I think it has something to do with our census creeping up and the fact that all of the patients have been sicker. I also think I should not be getting the trauma room assignments. I am but a baby nurse and 3 very critical patients is a bit much for me. I still need to perfect my time management skills,something that is difficult to do when I have to give one-to-one care to three patients.
I thought that once I graduated, all my problems would dissipate and I would be a kick butt nurse. But instead, I have a whole new set of problems like being scared of losing my license and causing permanent damage or death to my patients. Another new problem is the loneliness, when I had a "boyfriend" I was never, ever lonely. Now I am lonely all the friggin' time. I also thought that school would no longer be an issue but I am struggling so very hard to keep my head above water in my chemistry class/lab.
I guess problems will never go and they will always come. We just have different problems and we have to conquer each one as it comes along. I would like to think I will be happier next spring but that is too much to hope. Something else will come along and I will have to struggle through it. The point must be that it depends on my reaction to the problems. Do I come home from a hard days work and snap peoples heads off, cry and curl up in a fetal position or do I come home, shake it off and pull out my text book so I can handle the situation better in the future and thank God for the experience?

Yes...that must be it...I must react better so that I can learn this lesson and move on to the next lesson. I must be happy with and in myself. Co-dependency is very unattractive and something I shall never be again. I guess I need to give myself some credit too. I cannot rely on everyone else to stroke my ego and say "RaDonna, you are a good nurse." I need to believe it and do my best. The rest will fall into place eventually if I live and learn.

I wish I could have a pre-name and post name for this blog. My pre-name is "Monday Blues", the post name should be "Live and Learn".

P.S. Sorry for the particularly rambling state of this blog. I can't seem to dust the cobwebs off my mind today.

CNA School

In 2004, Corrie and I went to CNA school together. As we started class in the spring of that year, we were full of optimism and cute as buttons in our beautiful scubs that our moms made for us. Little did we know how completely terrifying it would be! Our first encounter with patients of any kind were an elderly couple, both had to be in there 80's. They shared a room with each other in the nursing home and we were told to help them get up and ready for breakfast. Seems simple enough, right? Well, for starters, the wife had bilateral amputations above the knee and I was supposed to help her put on her prosthetic legs. We hadn't exactly gone over that in Nurses Aide 101! And I had to empty my first bedpan! I nearly puked and spent the next half-hour hiding in the hall. Corrie decided that she never wanted to get old and was pretty sure that she didn't want to be a nurse's aide, much less a nurse.
 We manged to pull ourselves up by our bootstraps and by the end of our 2 month clinical rotation, we were passing trays and dressing the elderly like nobody's business. I would say about 99% of the time, we didn't go anywhere in that nursing home without the other one. We were completely co-dependent! We both got our licences after passing the state board exam the first time around. We relied on each other so much during CNA school and we continued to rely on the other one during nursing school.
Even though Corrie wasn't standing beside me when I put my first foley catheter in or started my first IV, I knew she had done it already and it sucked just as much for her as it was sucking for me right now. And I knew that when I got home I would be able to get on instant messenger and tell her all about it as we played backgammon. I would listen to Corrie in awe as she described watching her first open heart surgery and I laughed at her when she told me about one of the many times she made a fool of herself in front of her patients. I would rejoice for her when she passed another test with a fantastical 99, and dread my NCLEX after hearing her describe the horrendous test.
It's hard to believe we both are licensed professionals when I think back to our humble beginnings but here we are, and I am pretty sure I wouldn't have survived the entire ordeal without Nurse Corrie!

Us

Nurse Corrie
PLUS
Nurse RaDonna



EQUALS:

Us getting into some totally random situations we are not sure how to get out of.

The end.

I am feeling the need to rant. I hereby declare you my audience.

So last week I had a couple of nights where I wasn't done with everything until around 6am... just in time to finish things up and leave relatively close to on time. The week before that I didn't get out of there until 8, because I didn't start charting until another nurse assumed responsibility for my patients. Our patients are getting sicker, and the number of isolation's on the floor have at least doubled.

This morning I went to a staff meeting. It was at 715, so I was not really awake to begin with. Then, in the middle of a bunch of routine business, our nurse educator started pulling out patient protocols. These are the things that tell us what we have to do. We have always worked off the "care of the acutely ill pt" protocol. However, with the opening of the CCU they just developed a new protocol for acutely ill cardiac patients. Apparently someone just realized that our floor gets some of these patients so we now have to follow it as well. To summarize we now have to completely assess each patient twice a shift (normally we do it at the beginning of the shift), 6 hours apart. We have to assess all pulses every 4 hours. Every pulse that is a 1+ or less has to be dopplered (we have old cardiac patients. no one has good pulses). We have to diagnose every strip printed on the teles, not just 1. There is more... but that is the main part of it. Oh, and then after that it was announced that our patient satisfaction scores have gone down on noise at night, and could night shift please be more quiet so our patients can sleep?

I asses at 730-8pm. midnight vitals get done 1130-12. I guess I do pulses then. Second assessment would be 130-2am? then pulses again around 4am, with morning vitals. When do they expect patients to sleep? When do they expect me to chart? They get after us for patients saying we don't respond to their needs fast enough, that we don't make life quiet enough and then they give us things like this that will do nothing but make it worse. I respectfully explained my problems with the subject to the nurse educator, and she thanked me for my input.

Last month they started bedside checks where the oncoming nurse has to go around and meet each nurse with the off-going nurse. It isn't a completely bad system, but it makes me about 20 minutes late in everything I do for the first couple of hours.

They are completely changing the charting system the first week of December. Yup... right in the middle of holiday season. I am a computer super-user, and am taking the class on Thursday. The plan as of right now is to have me and several others go to a 4 hour long class, then take go and in the middle of the night teach the other nurses... have them take turns holding pagers so that nurses can have the class. If it is going to take headquarters 4 hours to teach me how do they expect me to do it in an hour? And with all the extra stuff they are making us do how do they expect anyone to have time to take a class in the middle of a shift? Don't want to pay us to learn new charting? Don't change the charting.

I like my job. I really do. I don't like this part of it. Not at all. It is life, however, life at a hospital facing budget cuts, staff shortage and a whole bunch of new regulations coming down the road.

This is my blog, so I can rant on it if I want. Tomorrow I will go to work, and I will do my job. I will do it to the best of my ability, fulfill their requirements as much as I can, and pray to heaven above that I don't forget to do something and lose my license because it was written on a protocol by someone who hasn't had direct patient care in more years than anyone can remember.
I am a nurse. My responsibility is my patient. As long as I remember that it will all work out in the end.

Thanks for listening to my rant.

Growing Pains

The beginning of the latest schedule at work marked the beginning of my life as an Independent ED RN. I was now officially off orientation and ready to take my very own assignment! My first shift went great and nothing unusual happened and all my patients survived!

The next day was Monday and I got my first Code STEMI all on my own and did pretty well, even had a cardiologist breathing down my neck and still got the heparin hung and the second IV started and the patient shipped out in excellent time! And then I asked the Physicians Assistant to look at the suspicious rash that had been developing on my neck and shoulder and she diagnosed me with shingles! Normally I would have just let it go it's own course and get better over time but there are three prego nurses at work and I would never have been able to forgive myself if my shingles caused harm to their babies. So I told my boss and was promptly sent home from work for a week! I was disappointed because I really wanted to keep up my momentum and get into my own pattern and ways of doing things. But I used the time to relax and tried to find ways of cutting the stress out of my life because that is why I got the shingles at such a young age!

Then I got the flu on Sunday, the day before I was supposed to go back to work, so I had to call out again! I had never been so sick in my life and what's more my mom was out of town so I had to nurse myself back to health! ( I am a very whinny sick girl!) But I finally got better and went back to work. I was behind in school though and my teacher was giving me grief about a doctors note and yadda yadda and through all of this I was doing an excellent job at feeling sorry for myself!

I finally got things back on track and felt like life was going good again until that Sunday I helped work my first pediatric code. It is impossible to describe how it feels to see a 6 year olds' body mangled and broken on the stretcher and seeing all the nurses and doctor working as hard as they can to save him while wiping tears from their eyes. He didn't make it and we didn't have time to grieve for him before two more pediatric patients from the same accident came rolling through the ambulance bay doors. Those were three of the hardest hours I've had so far as a nurse and I'm sure I will have many harder ones to come.

I had been doing pretty well working on my own, all was well and the biggest personal triumph I've had is that I've only needed help twice starting an IV and even was able to get a successful IV start on a 6 year old dehydrated boy on the first shot! That made me happy! For some reason I am fixated on IVs. :)

Like I said, everything was going fine until last Wednesday. I had a 67 year old male patient complaining of blood in his stool. He said he’d been eating raspberries the night before and now his stool looked as pink as my scrub pants. His vital signs looked great, in fact his blood pressure was actually elevated at 152/90. His skin was warm and dry and his color was great: nice and tan. I hooked him up to the monitor and started a line on him and went ahead and ordered some labs tests on him and sent the blood down to the lab since I knew that Doctor wasn’t going to be able to see him anytime soon.

15 minutest later, I walk past the room to find blood all over the floor, the stretcher, my patient, and even the wall. It looked like someone had slaughtered a pig in my patient’s room. He had lost what looked like .25 to .50 of a liter of blood from his GI tract. He was pale, drenched in sweat and complaining of weakness and horrible cramping. I called for help from a tech and another nurse and I started running fluids on him immediately. By this time his blood pressure is now 100/55 and I am downright terrified. The doctor came in, examined him and ordered 2 units of blood stat for him. Meanwhile, a code was coming in so I lost the help of the other nurse and the tech. I got him all cleaned up, the best I could, and after about thirty minutes got him stable enough that I wasn’t certain he was going to keel over any second. About an hour and a half later, I shipped him up the ICU to get his blood transfusion.

I feel like I failed him. I wish I had been able to recognize sooner that he was so sick and was going to go downhill so quickly. I should have gotten a doctor in there sooner to see him or at least observed his stool so I could determine that yeah, this man was having an active GI bleed and not just overreacting about some raspberries. The rest of this shift and day, I felt like a horrible nurse. On Friday, I was grateful I got to work in fast track which meant I had a 99.99% certainty that I wouldn’t kill anyone because all the patient’s were just complaining of minor issues like colds and lacerations.

So now I am terrified of going to work tomorrow. It’s Monday and I know it’s going to be crazy busy and I will be running my butt off and will probably get some very sick patients. I just pray to God that He will be merciful to me and my patients and use my hands and my mind to bring healing and not harm to each and every one of my patients.

I bought some new scrub tops and a nifty new stethoscope hip holder so I am going to walk in to work tomorrow dressed to impress, with apprehension in my stomach and this prayer on my lips: Please God, please don’t let me kill anyone today.

Amen.

Queen of....

Last winter I went through a tough spot in my nursing career. all 6 months of it. Over the course of December-February, I had a either a code blue or a rapid response every week. every-single-week. Not all the codes where my patients, but I worked them all. and to be honest, most were my patients. The first one never should have happened. A healthy 60-somethingish woman post heart cath... no complications, the most routine thing ever. Until she went into sustained VFIB and we had to shock her 3 times to get her out of it. Fortunately, she woke up and talked to us and actually made it out of the hospital alive. That was the only one of my codes that ever did that. There was the lady who blew her fem-pop, spraying blood all over the room. She didn't code, but came super close. There was the guy whose doctor I call 3 times over 2 hours telling him that something bad was going to happen, and it did. The guy's wife had to take him off the vent the next day. One day they floated me to 3north. The charge nurse assured me that I got the easiest group. 6 hours later as I transported my second patient to the ICU for post-op complications I realized there was no such thing as easy. There were more... on and on it went. I was on a first name basis with every ICU nurse there was. People started talking... and somehow I became known as the code queen. I am good at chest compressions... and let me tell you this, compressions on a 400lb man are SIGNIFICANTLY harder than on the little rubber dummy in class. So life was hard and I was about to think I was cursed and then it was march and I love march and people stopped dying and life was good again.


Until this week. In the past week I have had two patients fall. Hit the ground and do enough damage that I had to fix their problems. One dude was peeing blood clots after pulling his foley out... wasn't that fun to fix. My lady this morning slammed her hip into the ground... hopefully it isn't broken. 2 incident reports. 2 calls to doctors telling them I let their patients fall. I don't like falls. I don't like patients getting hurt on my watch. I don't like bad patterns either.


I really don't want to be queen of falls.

the pursuit of knowledge and experiences.

So I don't really like working weekends. On nights weekends consist of Friday Saturday and Sunday. Usually you only work one or two of them. This week I worked all three. Last weekend I work Friday and Saturday. I HATE WEEKENDS. Seriously. I missed church, I missed football, I did nothing.

I did, however, do a whole bunch of things I had never done before. One night I did peritoneal dialysis. I had no clue what I was doing, figured I could fake it and found out soon that it wasn't possible. I ended up having to get a nurse from the renal floor to come help. She treated me like a retard, not knowing how to do it. Of course, later that night I got a transfer from that nurses floor who was like, "I don't really know but I think his heart was regular". Seriously? How hard is it to tell if a heart is beating regularly? Anyway, peritoneal dialysis is an interesting process. You put a bunch of fluid into the stomach cavity, where through the process of osmosis all the toxins in the body float into the fluid, and then we drain it out. How awesome is the human body?

then I got to access a port a cath. Basically that is a port stuck under the skin that you stick a needle into. They are supposed to be changed every week, and this guy had his for over a month. I GOT TO STICK A NEEDLE IN HIS CHEST. How totally cool is that? This isn't some tiny needle, either, it was stinkin huge. and bent. and I shoved it in his chest. Sometimes this job is totally fun.

Not so sure he thought it was fun.

There is always something new to learn, always something I don't know. I like that about my job. In the next month I am going to be taking 5 all day classes to prepare to get my PCCN certification. I am excited for the review, the chance to gain more knowledge. We shall see how it goes.

Carpet.

If there is one thing that should not be in hospitals, at least in the parts that have patients, is carpet. YUCK. Do you know what I get on my shoes on a daily bases? MRSA, CDiff. Blood. Patients leak on the floor on the way to the bathroom. They drop things. Their bandages fall off. NASTINESS gets on floors in hospitals. Up until last year when I first started working, we had carpet in patient rooms,which was gross. Then they got smart and my boss had it all replaced with linoleum. Ugly, but when a patient has a fem pop blow and looses have of her blood in two minutes flat until I can start holding pressure and yelling for help all I have to do is get house-keeping to come mop it up. When the patient starting chasing us in the hallway with a full urinal trying to splash us and then tripped and fell backwards and slammed his head into the floor and started bleeding out of his ear, that blood was still there nine months later thanks to the carpet. There is a limit to now much you can get out of carpet. Especially when it is ten years old and already full of nasty junk.

Nine months being the key word to when the carpet was replaced last week. We were all excited about the new floors, until we figured out that they were putting down more carpet. Yup. My hospital which is perpetually broke spent money to place more carpet down, not something solid that we can mop. want to see what it looks like?
(okay, so apparently I fail at paint and this pic is kind of small but if you click on it it gets bigger)

nice, huh? We are somewhat flabbergasted. The carpet is actually somewhat nice looking. At least it was, until like the second day after it was laid when one of B's patients managed to break his IV tubing, leaving the port open and blood pouring out of his arm. He walked out of his nice, linoleumated floor and onto our brand new carpet to get help. There is now blood all over that section of floor.

Blood that will probably be there for the next 10 years until they get around to replacing it again.

That, my friends, is why I will never like carpet. And why I will never wear work shoes anywhere but work.

(in other news, my dad had an article published in the Wichita Eagle about health care reform. He used some of the info I sent him... exciting. Click here to read it)

My Love For Foamy Soap

I could handle most of it. I was okay with the smell. It had the classic hospital smell of sick people. What it didn't have was the disinfecting smell that covered the sick people smell... you know, the bleach, industrial smell that covers everything else. All I could smell was sick people. I handled the lack of masks for the tb patients. Here, patients with tb go into rooms with reverse air flow and we wear special masks. There, there was big rooms full of sick patients, all in the same ward.

I saw the lack of supplies. They took me into the supply room with the code cart and I wanted to cry. How do you work like this?
We were just there as volunteers, going around and hanging out with patients. Nothing exciting. Lots of bingo. All of the patients that were physically able seemed to be selling items, necklaces bracelets, that sort of thing to send money home. Completely foreign, but we played bingo on home made cards and smiled.

The one think I couldn't handle was the lack of soap. SOAP. There was none. (okay... noto none. One bathroom had one bar of soap.) We were in a 4 story AIDS HOSPITAL where most of the patients had TB and there was no soap. I spent an entire class my first semester of nursing school learning how to properly wash hands, and now I was in a place that had one bar of soap for an entire hospital. (someday I will tell you my opinion of bar soap, but at that point it was all we had.) We went in and out of rooms. We took care of patients. We touched and smelled and played and then we went home and took the longest shower we could. The next week we went to another hospital, where it was more of the same. Big hospital, lots of people, no soap. No gloves, either. Thank goodness for the antibacterial hand wash. But still, sometimes soap is just needed.



the day after we got back from South Africa my friend Rachael got this weird allergic reaction where her face swelled up all the way. I ended up going with her to the hospital a couple of blocks away from our hotel, where mom and dad were going to meet us. (note to self- want to get in to see a doctor fast? tell them you just got back from Africa.) I walked back with her to the ED and it was AMAZING! It was bright! And clean! and it had that disinfectant smell I never before liked! Then I saw it... SOAP!!! I made a very loud noise and went RACHAEL!! THERE IS SOAP!!! Of course, right as I said that the nurse walked in and looked at me like I was nuts, but I didn't really notice... too busy washing my hands. That is the day I fell in love with foamy soap. I never feel as clean as I do if the soap foams. A couple of months ago I discovered foaming soap from bath and body works, and life will never be the same. Not only does if FOAM, but is SMELLS amazing. Heavenly.
*************************************************************************************
Last night at work I was muttering about the new soap dispensers we have. They get stuck all the time and you have to work to make them pump, but then out comes the foamy soap that kills all manner of bad stuff, and life is good. I don't know how the hospitals in that part of the world that I love are doing, but I hope they found a way to buy some soap. Someday I will make it back over there... and when I go I will take some with me.

the perfect kind of night

last night was the perfect kind of night. not entirely perfect,because no night really is, but it was a good night. One of the best I have had the last couple of weeks. For starters, no one needed an IV which instantly makes it good because these days my failures at IV will instantly ruin a good night.

I started with 4, 3 of which I had had the previous 3 nights, and got an admit immediately. ED called before they brought him up, which totally surprised me but I completely appreciated. I was able to get him settled quickly, and do my meds before his admission. I had a patient who was very much dependent on a wide variety of drugs, and I was able to make some decisions about what to give her and when that I don't think I would have made last year. Last year I would have seen scheduled zanax, and I would have given it. This year I didn't mention she had it, she didn't ask for it and I was able to help her system clear out just a little.

Word to the wise... when you take so many meds that you have a perpetual slur, something is probably wrong.

I had a colon ca patient with a bowel resection that threw a fever in the middle of the night. I hate bowel surgeries, they can go wrong so fast, but I was able to sit her up and make her do her incentive spirometry, deep deep breathes, that it came down. The body amazes me. 4 hours of sleeping and not taking deep breaths and it gets a fever. I like fevers. The body is telling you something is wrong, and it is working to correct it. Her fever came down, I actually let her sleep, and all was well.

I got another admit around midnight that I still can't tell you why we bothered admitting, but hey, census is low so why not. I got her pain meds reordered and then she was happy and sleeping.

Note to the wise ED Doctor: if you have a patient that takes oxycodone, oxycontin and morphine at home, and choose to admit them to the floor with a kidney infection, PERCOCET is not going to cut it. Or even pretend to cut it. All it does is make me call someone in the middle of the night to get the right stuff ordered.

I don't know. Nothing major happened, but it was a good steady pace. I was never overwhelmed, I had time to spend with each of my patients, but I wasn't bored out of my mind at 3am.

Another fun thing: all of our CAs have gone back to school now. The one I was working with is going to have to work on priorities, because she pulls out the study books way to early in the night, but she still did a pretty good job so I didn't say anything. Anyway, she is studying rhythms, and not understanding it at all, so I spent around an hour working with her on it, explaining strips, counting them out with her, showing her AFIB and some blocks on the monitor.

I am going to get my Masters at WSU, and then I am going to teach, and it is going to be wonderful. I am excited about that part of my career, because I love doing it. I love explaining things and having people understand it... such a high. I loved tutoring. It just makes me happy.

Long Overdue

Today I went to the movies and watched Julie & Julia and was inspired to once again do my part and contribute to A tale of Two Nurses.

Hi--Longtime no see :D

I feel like a different person since the last time we have spoken. I have been through the ringer so to speak and emerged a little damaged and a lot changed. For the better I hope. Oh where to begin...the last time I blogged I was trying to keep from freaking out over a dirty needle stick.

Clinically I am still a spastic nurse...I recently attempted to bleed a patient out one of her anticubital veins because I started her IV without properly preparing my supplies and when I scored a superb vein, I was unable to staunch the flow and had to call in reinforcements to help me unwrap my supplies and cap the the IV catheter. The patients daughter was on the verge of freaking out. I was mortified. And about a week ago I forgot to take the tourniquet off my patient's arm after drawing blood. The tourniquet was found by the paramedic who wrote on it "No circulation is a great thing!!! RaDonna!! Ha ha ha!!!" I was humiliated!!! But I learned 2 valuable lessons that I won't soon forget.

Educationally I am now Trauma Nurse Core Course Certified and Emergency Nurse Pediatric Course Certified which means I will better be able to care for my patients in crisis situations and I will also be more marketable in the likely event I don't stay at my current hospital for the rest of my life. And as of Tuesday I will be a University student! I am going straight back to school for BSN because knowing me if I lose momentum now I won't ever go back. I will also be taking College Chemistry which is the the only class to ever kick my butt so I am going back for more! Wish me luck because it is making me nervous.

Emotionally I am doing pretty horribly. A week ago today I broke up with boyfriend of nearly two years. Irreconcilable differences I suppose would be the technical reason...we just started sucking at being together and decided to call it quits. We are trying the friend route which I really hope works out well because not only was he my boyfriend he was also my best friend and he knows me better than anyone. So we'll see where this goes. I am filling my newly found time with lots of sleeping, lots of Call of Duty 4, some crying and a bit of self-loathing and pity. But I am doing my best to keep my spirits up and look on the bright side...I can now wear high-heels and will be able to focus more on my school this fall. People say that breaking up is hard to do and I think that is a serious understatement. I actually feel like I am walking around with a gaping hole in my chest and nothing that anyone says or does will make it better. But I will be ok, I will emerge a better and more complete person, it will just take time.

That is all for tonight...I am typed out for the present...

Mental health and all that...

I am off for a week again. I get these long breaks every three weeks. This time is longer than normal because I took Wednesday off. I took call. The beautiful thing of the census being 14 patients less than what we are staffed for, for over a month running now, is that you can put yourself on call and no one cares. Actually they think it is a good thing, because it is one less nurse to call and beg not to work. (side note= I would not like staffing job... getting turned down all the time. people are also talking about mandatory canceling. I wonder if that is allowed.)
Anyway, I called it my mental health day. I needed it. I could have gone to work. I would have given okay care. Not excellent care though, which is why I didn't go. Do you ever feel so tired your brain can't focus? Honestly, my eyes wouldn't focus on the computer screen. My brain was a sludge. I could not think. I wasn't sleeping well, because I had switched back and forth so many times from day to night that my brain couldn't figure out when it was supposed to shut down. I woke up more tired than when I went to bed. Over the last 4 days I have slept probably about the same amount of time I have been awake. That is probably not normal, but it has felt good and my brain is actually functioning again. That has to be a good thing. Going for a month with either work or something major planned every day is not conduicive to my well being. I will remember that in the future.

Today I bought two new books on amazon... books to help me prepare for my PCCN certificiation. RaDonna has motivated me. I don't even know what all she has done since she graduated but it is definetly more than me. Time for catch up.

I went to the wound care meeting this past week. We are getting some new products I am excited about. I really like being involved, one of the first to hear about the new things.

Life is good.

MY HAIR IS GREEN!!!

Well, not really. It is red, rather bright. Sometimes curly. always frizzy.

When I was little I hated my red hair. Probably due to the fact that everyone made a big deal about it, probably because I was the only person in my family to have red hair. All my uncles/brother/dad have dark brown hair, and red beards. That is me, I match their beards. When I was five I had the eye doctor convinced I was color blind because I insisted that my hair was GREEN, not red. My grandpa still comments on my green hair.
Today I read 2 articles about redheads. My grandma sent me one, and I found one in the new york times health blog. Redheads make up only 2% of the population. It is a recessive gene, so both parents have to have it (I have been at family reunions for both sides of the family... tons of people and I am still the only redhead). Our pigment clings to the hair follicle tightly, which is why it is very hard to dye red hair. I should know, I have tried to go brown twice, and not even my mom noticed.


Of course, it is also the most asked for color in hair salons, and it is the hardest to achieve. Normally you can tell the difference between a natural and a not.

What I found interesting about the second article in the New York Times is that there is now evidence that redheads are resistant to anesthesia, which means in procedures if we are given the amount of meds normal patients are given it is less effective. We hurt more at the dentist because Novocain is not as strong in our system. I have also read, not today, that redheads bleed more. Combine with bleeding more and hurting more, Doctors are told to keep an especially close eye on us when we are giving birth, as we are more inclined for complications.

Oh joy.

I find genetics fascinating. I have heard of patients refuse medications because it is a blood pressure med designed specifically for African Americans. There is no difference, I am trying to discriminate, give me the stuff you give everyone else. Yet it is proven to be more effective. The way the body works, and is formed, is amazing. The fact that we have the technology and knowledge to find out how people are wired different and give them different treatments, incredible,

And trust me, I will have no problem using my hair color as an excuse for more pain meds if I ever need too.

(just found another article about how we need more general anesthesia as well.

The one in which I talk what little politics I know.

I get an e-mail every day from the ANA with the most important news articles regarding health care. I like it, because it keeps me updated on things going on without me having to search around for articles. I found an article that was very interesting to me, as it pretty much sums up the job I want to have some day. (not today, mind you. some day.)WSJ article
http://online.wsj.com/article/SB124873545269485081.html

I want to do long term outpatient care. Not in a nursing home setting, but it a HOME setting. I get so many repeat patients, frequent fliers as we call them. People with CHF, COPD, renal problems. I truly believe that if we could do more with them as outpatients we could prevent this. If I could call Mr. W once a weeks and talk to him about his meds and his weight and what his blood pressure was doing, if we could visit and I could check for swelling, if I could do this than he wouldn't know my name because I have taken care of him every couple of months for the last year.

And now I get political. IT ISN'T PAID FOR! Home health won't cover it, because most of our patients don't fall under the guidelines for qualifying. Apparently Medicare is now threatening to cut funding for repeat customers, and yet they aren't setting up programs to help pay to keep people out. The Massachusetts hospital that has a program like this had this to say:
"readmission rates for these patients (in the outpatient program) have fallen. But it isn't reimbursed for much of its efforts. "You do it because it's the right thing to do," says Diane Kelly, the hospital's chief operating officer. "But doing the right thing is getting expensive."
We could control this by helping with blood pressure, weight gain, swelling, etc. We can adjust outpatient meds to keep people OUTPATIENT.

"Attention to these issues can reduce readmission for heart failure by as much as 30% to 40%, according to pilot projects studied by Yale cardiologist Harlan Krumholz. But the services in such projects often don't qualify for reimbursement by private and public health plans. In a 2005 study, Dr. Krumholz and his colleagues reported that 13 of 15 successful projects to reduce readmissions were canceled after special funding for them ran out.
"These hospitals knew they had something that worked," Dr. Krumholz said. "But they couldn't come up with a business model that could afford it."

So here is what I am saying. If medicare and private insurance wants to keep people out of the hospital, they need to stop threatening us with taking away our funding, and instead start offering to fund some new programs. SERIOUSLY, HOW HARD IS THAT TO UNDERSTAND???

I really like this article. Things like this work. It is proven. There are stats. There just aren't enough programs like it. No offense, I understand that you think health care should be cheap, and that we add things just for the sake of it, but if hospitals are businesses and trying to make money we can't expect them to run programs for free. Here is something else. When I first got hired(or maybe when I was in school..) someone told me that patients will only remember like 10% of the education we do in hospitals. That is why we send so much printed paperwork home with people, so they can read it later. So don't get after us for not educating enough, not making sure people have enough and know enough to come back. WE EDUCATE LIKE CRAZY!!! Every time I give meds, talk about procedures, EVERYTHING i do with patients I am trying to educate, trying to do everything I could to keep them from coming back. Honestly, though, trying to teach while someone is sick isn't the most effective. Outpatient is.

Does any of this make sense? I am trying to put my thoughts into words... I might have to revise.


Winslow, Rob and Jacob Goldstein. Cutting repeat hospital trips--simple idea, hard to pull off. WSJ http://online.wsj.com/article/SB124873545269485081.html

My hospital rocks.

I read two e-mails posted to various bulletin boards last night.

The first: CONGRATULATIONS NURSES!!! S*** (my hospital) has been voted as having the best nursing staff giving the best nursing care in J************** county (my county). It was an exciting e-mail to read. Most of the time we are being told how we need to do better on stuff, so it was exciting to see how people already think we are doing a good job.

The Second: a note in a much less obvious place telling us how most of us set up facebook/twitter/youtube/blogs as a personal forum for family and friends, but that we signed a code of conduct and we are reps of our hospital and how they except us to only share positive things. Or something like that.

So for the record, I like my hospital. I would let people I love go there. I would handpick their doctors. and nurses. but I would let them go. These are the positive S*** thoughts I am sending into the universe.

I had my midyear review today. Probably shouldn't have agreed to do it this morning, due to being seriously pe-od at a person in a department I shall not name in honor of being nice to my hospital, for this post anyway (but, RaDonna, was not the ED for once. Just to let you know). We talked about things I am doing, and I came away feeling fairly confident that with a little effort I can get in the exellence category towards raises next year. If, you know, they give us raises. She is going to get me info on becoming a PCU certified nurse, which I would totally love. I also found out that PCU is apparently considered critical care. It seems to be somewhat controversial, our CNO thinks it is, and my manager (who I love, by the way) thinks we are more advanced med-surg than easy CC. Who knows.

and my boss thinks I should take some leadership classes. Who knows why, but I think i will, since she suggested it. Maybe something cool will come of it...

end of post.

And so begins the second chapter.

When I graduated last May, I figured that I would be doing this job, in some form or another, for 40 years. Be a floor nurse for a while, get an advanced degree and do that for a while, get a job teaching and do that for a while.

The first year was hard. Oh so hard. Around April, 9 months in, I woke up one morning. (and by morning I mean afternoon. I don't do mornings.), and realized that it was starting to make sense. That I was comfortable in my skills as a nurse. That I was calling Doctors without first asking advice. That I can handle chest pain without calling the charge nurse. That I can be insanely busy with really sick patients and not panic. That I can prioritize.

Day number one of year number 2/40 started with a phone call at 7pm. "Corrie, It's Nancy from staffing. We were concerned that you were not here yet." Apparently I have lost the ability to remember my schedule, and I thought I was supposed to work Thursday. Not Wednesday. I made it out my door in 6 minutes. I was at the hospital 15 minutes after the phone call. I started getting report at the same time I usually get done getting report. Everyone was teasing me. It is a testament to how excited I was about Colorado that all the nurses, day and night, all were teasing me that I still had Vacation on the mind and asking me how Colorado is.

It was a good week. A good way to start year number two. I talked to RaDonna last week about how her job is going, and all the feelings of the newbie nurse. I remember those days, but am starting to feel like I am past them. Not entirely. There is so much more to learn it is a little overwhelming. But still. I have made it through the first year.

It is a good feeling.

In other news. This day last week I was floating down the San Juan river, at a temp of 54 degrees, give or take, freezing my toes off. It was fun. We have no pics to share, mainly because there is no logical way to take pictures in a river without getting the camera wet. Last night I went camping, and it was pleasant. I mean, as pleasant as sleeping in a tent can be. until like 530 this morning, when the worst thunderstorm of the summer happened. With me in a tent by myself. I pulled on clothes on top of my other clothes, packed my bags, and hi-tailed it over to my parents tent.

I am now done pretending to like it outdoors, and plan on spending the rest of the summer sitting on my couch reading.

an unfourtunate event

Have you ever had one of those moments where time stands still and in that moment you ask yourself "Did I really just do that?". The room closes in around and you realize in shock that yes, yes you did do that terrible thing you dread. You would rather be swallowed up into the floor than face the consequences of your actions.

Obviously I had one of those moments today.

It occurred at 10:50 am and in 3 seconds I was aware of the fact that I had stuck myself with a dirty needle. I was sick with shame and fear. I calmly threw away the offending sharp and ripped my gloves off. Blood pooled on the tip of my thumb as I walked over to the sink and scrubbed my thumb with soap and hot water. It's amazing how what little they taught me about needle sticks in nursing school, somehow floated to the forefront of my mind. I continued to wash my thumb for several minutes and squeezed blood out of the puncture wound. I slapped a 2x2 on it and sought out my charge nurse.

She calmly heard me out then proceeded to check me into room 17, take my vitals and helped me start the huge file of paperwork. I had a few minutes before the ED doc was going to come in and evaluate me so I went outside to get some air and call my mom. That's when the tears came. I wasn't exactly scared for myself (the patient was very low risk as far as possibly having HIV and Hep B or C), I was mostly furiously angry at myself. I could only imagine what everyone was thinking. "Newbie nurse should have been more careful". I felt so inadequate and stupid. My mom told me it would be ok and it was a good learning experience for me. This is true but I would have rather have learned this lesson some other way.

For the rest of my nursing career, I know I am going to be so cautious with sharps of any sort, especially 23 gauge butterfly straight stick needles. Even now I cringe thinking about what happened! How could I have done this! I know better! ARRRRRRGGGGGHHHHH!

My preceptor found me sniffling in the parking lot and assured me that she had been stuck several times with dirty needs and was even put on the anti-viral medications. So many healthcare workers have stuck themselves but it made them all better at their jobs. She said the risk for getting something was slim to none and to not worry, it would all end up ok. So I pulled myself up by my bootstraps and went back inside and down to the lab to have my baseline labs drawn and to get a urine drug screen (workman's comp you see). The patient consented to having his blood drawn for HIV testing, amoung other tests. The results to the rapid HIV test came back negative much to my relief.

I learned a valuable lesson today, one that I won't soon forget.

Colorado: 3 days of awesomeness. plus two days in the car.

We had grand plans to post while in Colorado. However, we were too busy having fun, or recovering from having fun, to do so.

It was fun. We had no schedule, no set plans, no place we had to be at any certain time. It was my mom, dad, cousin Jessy, RaDonna and myself, and we just relaxed. And did more exercise than either of us do in a month.



We walked around town with the craft fair. I got sunburned all over my shoulders and back. It hurt the rest of the week. We went to a great mexican restaurant. We walked around Echo Lake,



and up Treasure Falls.


For the record, mountain runoff waterfalls are cold. As in my toes froze in less than 2 seconds and it hurt like mad cold. BRRRR.

We talked. We hung out. We enjoyed life. We saw beautiful views that girls from Kansas and Florida don't often see.

I don't have to go back for 8 days.

She is on a plane flying to me as we speak. Or type.

Life is good.

what I was going to write. and reality.

I had this post all planned out in my head last night. want to hear it?
Last night, I:
was not done with meds by 9 like I usually am. Or 930. or for that matter 10. I wasn't done with my chart checks by midnight, not to mention my charting. I had a bed alarm go off 3 (maybe 4?) times. A patient refuse to take her meds. I showed up with 2 patients without IVs. a guy who was laying stark naked on the bed and refused to wear any clothes. This night had the basic definition of a bad night.

But now the rest of the story.
Last night I spent 10 minutes with naked guys wife talking about the nursing homes she had visited that day, after realizing that her husband who was driving a month ago was so confused and weak she could never take care of him at home. A hard thing to realize. I also spent almost 30 minutes with the son of bed alarm lady explaining everything going on with her medically, and reinforcing what he had been told all day about why she couldn't go home alone. "she is so independant" he said. She can't tell me where she is, and she is obviously not tracking this conversation at all, I replied. I think I made headway. I moved a pt to a bed by the window so she could see the sunset. I talked on the phone to the significant other of the guy in 1*, who she had signed hte papers to make a DNR that day.
It was a good night. I love talking to pts and families. Doing basic education. That is the one thing I miss about working days.

That was going to be my post today. Until 205 this morning when I got a page that 41*s heart rate had just dropped in half, and ran into the room to find an O2 sat of 41%. I had been checking on him all night long, halfway expecting him to die, but still, not easy to find the man who the night before was talkking to me laying unresponsive and gray. My first patient died this morning. While I was on the phone once again with the significant other explaining, that no, we didn't expect him to get better two other nurses were listening for 2 minutes verifying no heart beat. Even after I got off I stiill wasn't sure she understood.

He was a DNR. A very sick man. who had been struggling to breathe, and in pain. Now he isn't. And that is good. Someday I will expound on why I am such a firm believer in DNRs and Advanced Directives. He didn't die alone, which was something I promised myself the day I saw a nurse sitting at the desk while her pt died and the family members didn't bother coming in. Unless there is just no way to avoid it, my pts won't die alone. There will be family present, and if that is not possible, I will be present. Everyone deserves to have someone with them at the end of life. It always made me feel better that my dad had made it to the hospital before Grandma Ross died. That she was with someone who could tell her how loved she was.

Okay. Just started crying for the first time all day. I expected I would start bawling when I walked in my front door, but I felt horrid so I just climbed into bed and slept for 8 hours.

Some nights, this job is harder than others. Yet sometimes I think it is the hard nights that makes it all worth while. that make me feel like the nurse I want to be.

The things I think about/want to tell people when I am at work.

Dear ED nurse,
Hello! this is Corrie from 4th floor. I would jsut like to say a couple of things to you. Notice I do not say these things during shift change, because I for one acknowledge that you are busy. So maybe next time you send me a pt at 715, you could show just a hint of awareness that 715 is a really bad tiime to get a pt? and that when we ask you to wait until at least 730, we are totally serious? and that calling me and getting mad that I cannot talk to you that exact minute is not going to make me any less busy and unable to talk? Oh, and for the record(and I send this out to admitting concerning direct admits too)it really wouldn't kill you to spend 60seconds finding me to tell me you dropped off the pt. or find my aid. or for that matter, tell the IA you are dropping off the orders. really, tell anyone. Just don't make me walk into a room and find the pt sitting there. it looks bad, and makes me mad enough to last all shift. Just a thought. Feel free to ignore it.

Dear People who design scrubs,
Hello. I was wondering if you are all men? Cause I have been wearing scrubs for quite some time now, and I am pretty sure a man designed them. Why, you ask? Cause most women have butts that are bigger than their waists, and buy clothes accordingly. Seriously, for me to get a scrub top that fits my chest, it is almost always too tight around my bottom, which makes it bunch up annoyingly. MAKE THE SLITS BIGGER! Seriously. I am tall, which means they shorter on me anyway. The things just don't make any logical sense. Oh, and Dickies? Yeah, I hate you. I might own 3 pairs of your pants, but I for the life of me cannot figure out the drawstring, and I always feel trapped cause I can't get it to loosen. Learn about elastic, people. Makes life easier. (in your defense, I love the flair.)

Dear God,
Hi! So I just wanted to thank you for the miracle of the fact that RaDonna and I managed through no planning to have 7 days off at the EXACT SAME TIME, and that she could find cheap tickets on a holiday weekend, and that she is coming and we are going, and I am so excited and it totally had to be a You thing so thanks. You must know how much I could use a week with my friend. Oh, and thank you also that my pt that coded twice this week already didn't code on me. It made my night so much better.

I spent almost an hour the other night sitting with an older woman while others coded her husband. She just looked at me... we have been married 64 years. He is my soul mate. I don't know how to live without him. I hate to see him suffering.

that kind of love? I don't see it all that often, but it was so real. I could feel her fighting for her husband, trying to make him fight. How do you tell a woman who doesn't know how to live without her man that maybe the best thing she could do is let him go? I didn't... just sat there, made sure she wasn't alone. That was probably the most important 45 minutes of my last 3 nights.

Someday I would like a love like that.

A week of 1sts

I am now a Registered Nurse :)

Thank you to everyone for believing in me and supporting me through this long and hard journey. It isn't cliche' when I say I couldn't have done it without my wonderful family and friends. You truly are amazing and I thank God for you all daily.

I am now settling a little better into my new role at work. It's taking some adjusting not to jump for the phone every time it rings and when the ED doc tells me to call the hospitalist, I politely remind him that I am no longer a secretary. Now I have to retrain my ears to be alert to the sounds of cardiac monitors and call bells, and when the patient in room 12 is calling "Nurse", he means me.

I don't feel stuck in the middle anymore. Going from graduate nurse to rn has made me feel much more purposeful, like I actually belong in ED instead of just looking on from the outside.

All the nurses and doctors and my bosses have been so kind to me at work. They seem almost as excited as I am with my new position. So encouraging and always looking for opportunities to teach me.

I have had many new experiences this week, some good...some bad. I had my first amputation, that was fun! Now I know you wrap the loose appendage (in this case it was a finger tip--painted nail and all!) in moistened gauze then put it on ice. Unfortunately, it didn't look like the orthopedic surgeon was going to be able to save the tip but she would still have most of her finger.

I had a gnarly old man patient that was trying to get me to come home with him and an anxious woman who yelled at me for not being able to read her mind. I am getting better at my IV starts, I can do them on feeling alone now without being able to visualize the vein at all.

There was also a little boy who got hit by a car that was brought into our ED who was in asystole and I was able to watch from a distance as my fellow nurses and the doctors tried their hardest to keep him alive. They brought him back, ct scanned him, and had him packed on a chopper in under an hour. Sadly the 8 year old boy's injuries were too extensive and he died approximately 24 hours later.

Although the outcome was a tradgedy, I was amazed to see how well the nurses and doctors worked together and knew exactly what to do. I can't wait til I am at that skill level and can help save lives.

So I am doing what I can to prepare myself. Under the advice of my daddy, I am taking a Trauma Nurse Core Course next month and tonight, I bought a book called "Emergency Nursing made Incredibly Easy". I don't see how anything in nursing can be termed easy but we will see if it can whip me into shape!

My goal is to be the best possible ED nurse I can and my dear sister Randi Jean says that's the first step in greatness, wanting it to be so and doing everything in my power to achieve it. I'll have to let God do the rest.

Dearest RaDonna...

My dearest RaDonna.

In a few short hours you are going to take the most horrible test of your life. (At least I hope it is, because if we ever have to take a worse one I will be very unhappy.) Anyway, it is going to be hard. Bad. You are going to leave it and be convinced you failed.

You won't.

I have so much faith in you. Faith in your ability to read the questions, narrow the answers and choose the right one. I have watched you, friend, the past years. I have talked with you about nursing things, and heard the wisdom and understanding in your voice.

I always judge the people I work with by who I would let take care of my family. I know what doctors I would choose, what nurses I would ask for. More importantly, I know who I would not let anywhere near someone I love. You, I would trust. I would trust you to take good, competent care of the people I love. Even though you are young (which can be a surprisingly big drawback for old people... get me someone with experience is something I have heard several times).

So today, NCLEX becomes the last great hurdle. When it is done, when you pass (not if, just when. cause you will. cause you are brilliant. and beautiful. not that beauty matters on test taking, but it can't hurt...), you will be a nurse. not a student nurse. or a graduate nurse. just a nurse. you will have the two vital initials behind your name to be able to walk into a room and say "Hi, I am RaDonna and I am going to be your nurse today."

And life will be wonderful.

There will be days when you want to quit. days when this job is so bad you want to go home and cry. days when you WILL go home and cry. But that is okay. Because for every one of those days there will be the days when you walk out the doors feeling like you did some good today. Like you made a difference, saved a life, or just sat and talked with a patient and made them feel better about everything going on in their life. It is the small things that count. When those days happen, you will know. Know that this job, it is great. It is hard and messy and stressful, true, but still. I wouldn't trade it for any other job.

You won't read this before the big test. That is okay, because I know you are ready to go rock the NCLEX world. You can read it later, during those horrible I think I failed why won't they just post the stupid results already hours. Just know you didn't fail, and it will soon just be a nightmare that will fade in memory.

I look forward to getting your text on Tuesday.
Corrie

NCLEX Blues

in exactly 12 hours, I will be 45 minutes into the dreaded NCLEX exam. I am not ready for this.

Heaven help me

my month is over.

not the literal month. The literal month just began. My month of madness, however, ended at 6 tonight. My friends graduated here the first weekend of may, parties and ceremonies all weekend long. Two days later I flew to Florida for a week. 3 days after I got home I went to a wedding 3 hours away. I took the bride and groom to the airport. I watched as my living room filled with the new roommates stuff moving in and the old roommates stuff on the way out. MASS CHAOS is what my apartment has been. I stopped trying to pick up because, quite frankly, why bother. This past week I went to the old roommate, Tiffany's, wedding. Went on Wednesday to a tiny kansas town 7 hours away. Spent all week running like a madwoman.

I really don't like the part where they file your nails in pedicures...



I am tired. I am home. I really don't want to see anyone for like the next month.

My attitude has been increasingly bad. For the most part I have been able to hide it, but today it exploded. My friend Chelsie was in the car with me, and she just grabbed the ipod and put on happy music. It worked for a while, but now that I am home I am just *blah*




There comes a time when I need to not be around people. When I need to just be by myself and breathe. I haven't had time to do that in a month. Maybe this week I can. I had a grand total of 9 days off of work... three more nights to go! I am excited. On my last night my boss asked when I was going to start building the wound care box on our floor. I think she expects me to do it during work, and yet, I have barely had time to sit down the past couple of weeks. She is either going to have to pay me to do it on a day off, or accept that it might not happen anytime soon. That is my opinion, and I am sticking to it.


I was so excited to see a new RaDonna post! I haven't gotten to talk to her in forever, but I am so excited things are going well. I still hate putting in IV's. She does them all the time in the ED, I am sure, but I don't do them all that often, so I still don't feel 100% comfortable. Then the hospital changed the brand we use... so didn't help.


I so remember the feelings of the first couple of days. weeks. months. Believe it or not, it gets better.


Oh! I forgot to add that last weekend my dad and mom came up and we did the american.heart.walk. It was fun, but one more thing to add to a crazy month...

my hospital made us wear green wigs because they didn't think we got enough press coverage last year considering the fact that we are corporate sponsors. Green wigs were supposed to get attention from the press... no word yet on if it worked. I like green, so I was okay with it.

Wow. this post was random. I think I am going to go to IHOP now and get butterscotch pancakes and a splashberry.

fake it til you make it

I have completed 4 shifts in the emergency department as a nurse so far and I feel like I have absolutely no idea what I am doing. I make the silliest mistakes like taking a blood pressure in the arm of a man whose finger was so infected and swollen that his skin split. Something is strangely a muck with my IV's--I got them all today but they just didn't seem quite right. I somehow manage to blood-let every one of patients! :)

I feel adrift in the nursing world. Being a graduate nurse is kind of crippling. I am in limbo between Registered Nurse and Secretary and I can't really find my niche. Soon though! 8 days and counting!

I did have my first "trauma" today. An 80 year old man who took a spill on his scooter going thirty miles per hour. Wouldn't have been so bad except he was on a blood thinner so it took a bit of work to get all his bumps and abrasions to quit oozing. He was so nice and sweet but his wife called me Rhianna...haven't heard that one before!

I love being a nurse though. I enjoy being the hands that bring God's healing touch. My people skills are improving so much. Dealing with all kinds of people in all different kinds of situations has a way of launching a crash course in diplomacy and patience. I have been so protected these past 3 years, deep in the nurses station only interacting with the doctors and nurses. Now I am one of them (almost) and I couldn't be happier!

My plan is to take it one day at a time. Do the best I can with each and every patient I see. And continue to fake it til I make it :)