Saying No

I told my boss this morning the reasons why I don’t like going to the other unit that they have been floating me to often.    She took notes while I said things like “not nice” and “there is a weird vibe” and “I feel there are landmines waiting to blow up in my face” and “they hate their manager” and “they treat me like I am incompetent”.  Not sure she knew what to do with my it has been a long night fighting fevers and I am tired,  statement that I was sorry I couldn’t more be more technically technical about why I didn’t like it.

Good way to impress your boss, say things like technically technical.

They wanted me to go last night.  At midnight.  Leave my patients, go over to the unit and get all new patients.  I said no, unless they would give me callback pay.   They didn’t send me.

I don’t say no often… I go to meetings, I get up early to take computer classes.  I am the only nurse on nights who hasn’t flat out refused to float to the unit.  I am on committees and a super user.  My boss loves me because as a rule night nurses don’t do things.  They are much less likely to get involved than day shift… we tend to come to work, do our job and go home.  So for me to agree to do it all makes them happy, and makes me feel less bad about saying no.

in a completely random not even connected sort of way, I am having a good morning.  One of the local rehabs brought breakfast in for the nurses, as a recommend us to your patients thing, and they served bacon.  REAL BACON.  My hospital doesn’t do real bacon, it does turkey bacon.  Same with sausage.  So, the real bacon was yummy.  And now I am sitting on my couch eating a Hersey's chocolate bar with almonds.  Healthy breakfast, that.

Bacon and Chocolate.  2 basic food groups.

nite.

For A Moment…

(I am late again with You Capture but it was vital to my sanity that I get my suitcase out of the middle of my living room last night as opposed to play with my pictures… so here we go)

For a moment, the sun reflect perfectly across the reflecting pool at the Nelson Atkins Museum… 

As the building itself, for that moment, also reflected….

For a moment, as I stared at this fence, I could pretend I was back in one my favorite places, the country-side of Ireland …

(and seriously? for a moment a wondered how hard it would be to buy a house with a stone fence.  I do so love them…) 

For a moment… my instructor was there, and then not.  Can you see him?  We are practicing light painting… it has something to do with a  black card and leaving your shutter open for a very long time… I did not quite get the concept, but it looked pretty cool. (if, you know, the person holding the camera did it right, which none of us did…)

For a moment… I could play with my camera, dream about the lens I am going to buy (as soon as I decide which one I want) with the money from the extra shift I worked (crazy corrie working 5 shifts in 6 days…), and forget about all the stresses floating around my brain and the decisions I am scared to make.  It was a good moment…

Grading Myself

In the grand scheme of things, I am a good nurse. 

I know this as surely as I know that the sun is shining and my balcony door is open.  I know this as much as I know that cardizem will lower heart rates but to watch the blood pressure… as surely as I know that I don't want to be the nurse giving ambien to anyone over 65 for the first time… as much as I know that regardless of what their oxygen saturation is putting a patient on oxygen will instantly make them feel better because it is something medical being done…

I had the same patients for 3 nights in a row.  I laughed with them, took them on walks in the hallway.  Called 2 doctors on 2 patients all 3 nights… blood sugar high. hemoglobin low.

Had a dude with a splenic infarct… think a heart attack in the spleen.  It is interesting having to worry about strokes and heart attacks and blood clots all at once… the doctor was convinced he was going to throw a clot from the dead spleen, we just didn't know where that clot would land.

I got floated on my last night.  Night 4, all of my patients were still here and they floated me to my least favorite place.  I think the time has come for me to stop being so nice and agreeing to do things I don’t want to do.  I need to talk to my boss about it…

I filled out the skills checklist for a couple of the traveling companies I am looking into working with, and then yesterday ended up talking to one of them… she said I didn’t do very good.  What?  Apparently I scored myself a 2.6/4.  She said you can usually tell the good nurses because they are honest… it is the people with a perfect 4 she worries about.  I think I took the test as a brutal self assessment of my skills, and now I need to take it again as  a selling myself to potential employers test.  I am a tad worried about the other skills list I filled out, though… haven’t talked to that recruiter yet.

I am a good nurse.  I know this as surely as I know that sometimes you don’t need haldol to calm down the slightly confused/agitated post stroke with expressive aphasia(aka can’t make sense with his words…), you just need to sit with him and hold his hand while he falls asleep.

As much as I know that sometimes a short walk in the hallway can make a patient totally depressed about his health smile again… look, I am getting better!

As truly as I know that sometimes (not always) giving 5 blood pressure medications at once is a stupid idea, as surely as i know that very few doctors care about anything not directly related to imminent death in the middle of the night, as much as I know that as a nurse it is my job to occasionally call doctors about things not related to imminent death because my number 1 job is to be an advocate for my patient.

I still fail fairly often at IVs.  I still ask questions. and more questions.  I still occasionally let my bags of Amiodarone run out, and avoid going into a patient’s room cause they give me the creeps. 

But still, I am a  good nurse.  I just don’t know how you put a grade on that…

 

You want me to do what???

So I stroll into work today and check the assignment sheet and it's blank! The night charge nurse was on the phone and when he got off he said, "The day charge nurse called off, the Manager is talking to the triage nurse, then she wants to talk to you." My heart sunk...I knew what was coming. You see, we can't seem to hold a charge nurse. Nobody wants to do it and so far I have managed to dodge that bullet due to the fact that I am only 9 months out of school. Well, there was no dodging it today. There was only the 3 of us 7a-7p nurses, one was agency so she can't be in charge, and the other has been a nurse a year or so longer than I but she only just transferred to the ED. So I was named Charge by default.

All I had to do was last until noon when some more nurses came in. I was a nervous wreck...a few days ago I had just been telling Nurse Corrie that my biggest fear was having to be charge. Granted, I know the system and flow of the ED as well as most of the nurses including the other charges. But I have such little experience, I am so afraid that I won't be able to recognize a serious problem when I see it or that I won't be able to handle the drips or meds or codes if the situation were to arise.

The first few hours went by very nicely...not busy at all! Then we got 5 ambulances one right after the other...it was ridiculous! Nothing too serious but still, it's rough finding some place to put everyone and not giving too much to a particular nurse. By the time noon came around, we were full and I had 3 patients as well as still being in charge. I decided to stay in charge til three and gave my assignment to one of the noon nurses. Another couple of hours went by and I was relieved to have gotten everyone to lunch and the place wasn't overly packed, we were able to handle it.

The most exciting patient we got was an older woman I had care for before that was in SVT. I love SVT for some reason, I think I love being able to stop a patient's heart with the flush of a syringe! Sadly we didn't need to give her Adenosine, the doc had me start her on Amiodarone instead.

1500 rolls around and the crew talked me into staying in charge because things were going ok. It truly wasn't so bad except I was constantly waiting for the other shoe to drop. There was no relaxing and my stress level was through the roof. But I do a good job staying cool, not letting the situations get to me. Apparently I was hitting the OBS side with too many patients in too quick of succession because one of the nurses came and was basically complaining about the load I had given him, but he didn't even have his facts straight, he just jumped the gun and came and complained about it to me. So I calmly set him straight and he went on his way, I was glad I kept myself in check and stood by my decisions.

An hour before shift change, ICU called a code blue which one ED doc and the ED charge nurse are required to attend. It was a cool code, the patient had just been put in bed after being up in his chair for awhile and he suddenly went unresponsive, apneic, and pulse less. By the time we got up there his pulse was back but it tachy at 150 beats per minute and he still wasn't breathing. He was really tough for Dr. C to intubate and when he finally got it, it appeared that he had aspirated something. I was no longer needed so I moseyed back downstairs...by this time I only had 40 more minutes til shift change!!!

Night charge showed up and I gave him report. I knew the story on every single patient and the place wasn't entirely in shambles so I think I was a success! I am so relieved to have this day behind me. I've always known this day would come so it's nice to have conquered this mountain. The first time is the hardest and now it's behind me. I truly love my job and all the people I work with, and am grateful for the experience I gained today!

Reaching Florida

This week I was able to go to Florida to celebrate my Birthday with nurse RaDonna  and my big sister and brother in law.  I try to go see them twice a year... life is good.

I reach for some of this every time I am at my sister’s house

(want the best bbq recipe around?  Buy a ticket to Florida.  Call your sister and beg for chicken.  Show up and find your brother in law  grilling chicken that has been marinating for hours.  Eat.  Eat some more.  For good measure go back a couple of hours later for another piece.  or two.  then, as an added bonus freeze the leftovers and put them in your suitcase to take home… on the plane.)

His tongue is reaching for a taste, but it shall be denied.  That chicken is mine.  All mine.

Mini golf is my favorite thing to do in Florida.  Nathan usually ends up reaching for my ball when I whack it into the water… Hit it HARD is my motto.  

Me and my big sister.  We like being grown up friends.  I find it very unfair that she tans and has non frizzy hair.

And then I got to reach out for a huge with my bestest friend NurseRaDonna!!! And of course that requires reaching out to take a self-taken portrait!  (or 2. or 3. or an uncountable number…)

All decked out for my birthday!!!

(is there any better day than St. Patrick’s day to have a birthday?)

(Corrie, RaDonna, and Randi) 

I leave you with a picture taken by the very talented Randi Jean (RaDonna’s sister… and the photographer behind the new blog header)

This picture might look like I am reaching out to her.

But no.

I am pushing her.

I am that kind of friend.

The end.

(written at 7am sitting in the Memphis airport.  Being in the Memphis airport at 7am means I got on a plane at the Jacksonville airport at 6am. Oh… and I go to work in approx. 10 hours and work the next 4 nights.  Woe is me.)

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Part of You Capture!

Chapter 23

Today I turn 23. 

23 has been a big deal to me for years.  For some reason I decided when I was like 13 that 23 was going to be the perfect age.  Out of college long enough to have a career, be comfortable in my job, making good money… it was the right age.

For the past several months I have been struggling with some changes to make in my life, to the point where I am pretty sure I am moving in the next couple of months.  (moving=new job=way scary.)

Where? I have no clue.  (well, I have a clue, but no idea what is going to work out, so therefore… no clue)

Several of the things I have planned in the last year have fallen through, and that is hard…  no air force.  no Uganda.  no masters. 

Enough failures makes taking the next step hard.  But I am determined too.  Determined to be proud of the life I am living.  To not sit home in my apartment because I am scared to leave it.

So here is to you, 23.  There are decisions I will be making during your year that will be hard, scary.  I think you and I are going to be good friends.  I am excited to  see what you have in store for me.

And so the next chapter begins…

Quiet.

This past weekend I did one of my favorite things to do… I went to my grandparents.  They live in a tiny town near the Kansas/Nebraska border called Axtell.  I always feel better after being there… refreshed, happy.  It is quiet.  No big city noises, no constant beeps at work.  When I am there I don’t dream of IVs going off in the background and patients yelling my name.  Some of my favorite memories growing up are the weeks in the summer I would stay with Grandma and Grandpa, usually with a cousin or two.  The quiet house I love now was not so quiet back then.

This house has everything I love about old houses.  It has history~it used to be the town hospital.  It has character~there is still a window from a bedroom into the hall in what used to be the  nursery.  It has a huge porch… many times I drive up and see them sitting on the porch swing waiting for me.

This is my grandma.  She is the quiet one of the household, but full of strength.  She raised 6 kids, moving them around the country and holding down the fort while grandpa traveled to various places with the Air Force.  She wrote a column for years, and has written 4 books. Every time I go she talks about some other award she has gotten for various articles she writes.

We went on a walk Saturday, Grandma and I.  I don’t think it gets much quieter than main street.

There wasn’t much work going on at the grain  (silo?  elevator? my small town vocabulary is failing here…)

Come fall and it will be less quiet I am sure.

Grandpa is rarely quiet.  (maybe that is where I get it from, along with my red hair and Gin Rummy skills (at one point in time I was 6 cents ahead!  That is a record!) and love of telling people what to do.)

I go there, and I rest.  I curl on the couch and read some of grandma’s old columns.  I play cards.  I eat food I don’t have to cook, and I help do dishes afterwards without even thinking about it.  I smile… take long walks… talk about the never-ending supply of great aunts and uncles and cousins twice removed and the daughter of the sister of the uncle by marriage who moved in across town… go to pancake breakfasts to support the local fire department… take naps in the sun… and in the end, I get a hug and a “Love you, babe” from grandpa, and life is good.

(part of you capture)

Hope.

Hope is wearing your sunglasses for the first time in 2 months

Being Hopeful that spring is coming

Hoping that March turns into the wonderful month I have been choosing to believe it will be for the last 2  months.

Hope, like the gleaming tapers light,

Adorns and cheers our way;

And still, as darker grows the night,

Emits a brighter Ray

~Oliver Goldsmith

(part of you capture at I should be folding laundry.)  

(Taken while driving to Topeka the other day.  I hope I learned my lesson… don’t tell your mom that you take pictures while driving down the highway.  It makes life less stressful for everyone…)

The day

There is an obituary on the bulletin board in the galley.  For a man who spent over half of the last several years of his life in our hospital.  He was my first rapid response, my first blood sugar of 17.  I took care of him many a time, and even though he was grouchy and noncompliant and tended to make things harder than they needed to be, even though he was a 57yo man living with his mother, I found myself saddened by his death in a way I wasn’t expecting.  And saddened that he died at a different hospital.  Is that weird? After spending so much time with us, he went somewhere else to die.  And as much as I would gripe about getting him again if he were my patient tonight, it is sad. 

Rest in peace, Mr. N.

It has been a hard month at my work, for a million reasons that I will not get into.  Moral is down, and there is this negative energy flowing.

It has been hard to go to work.  Hard to get the motivation.  There is the feeling that as hard as we try, it is never good enough.

A patient of my had a seizure this morning.  Completely unresponsive… three of us did sternal rubs before she finally came out of it… slowly.  Scared me a little bit, I thought we would have to rapid response her.  But she was okay.  Then, as I sat there waiting fro the dr to call me back, my admit showed up.  At 530.  Crazy times… crashing patients and new patients and I was stressed.  And you know what?  I made it out of the hospital at 720.  And that happened for one reason only.

I work with an amazing group of nurses.  Nurses who checked in my admit.   Who did the ekg on my seizure lady and who called monitor techs and who put up my charts and walked my pt to the bathroom.  Who asked what needed to be done and then did it.  Who did some things before I even asked.  We are a  team, which makes my job doable.  I have worked on other floors that have less of the team like atmosphere, and I don’t know how they do it. 

Today I was reminded why I like my job.  Why I am not sure I want to leave it.  Why I will never regret where I chose to get my first few years of experience in this crazy career of mine.

It was a reminder I needed.