Sharing some sweet

It has been a crazy week at work. I had a patient that REFUSED to leave.  Seriously, they were supposed to be out of the hospital at 5, and I didn’t convince them to leave until 9.  There were patients with extreme dementia who would try to kick you every time you got close.  Patients who had made complaints against staff and required 2 of us in the room at all times.  3 out of the past 5 nights I didn’t even start passing meds until 930, much less be done by then.  It has been like a 2 week long full moon.

Last week in the midst of the confusion one of my coworkers brought in dark chocolate cookies with toffee chips.  They were awesome… and much needed on a bad night.  So when Hy-Vee put their strawberries on sale for 4lbs for $4, I decided it was my turn to return the favor.

You start with a not-sweet biscuit.  if you are me, you start with a not sweet biscuit that has 2 different kinds of sugar in it because when you run to the store to buy more flour you don’t realize you are out of white sugar as well..

Add a pile of strawberries that were sprinkled with powder sugar and left in the fridge to create their own sweet juice…

And cover with whip cream for the final touch of sweetness.

(and if you are me, you go back halfway through for more whip cream because you ate the whip cream faster than the strawberries…)

Then you take it to work where some amazing nurses who all look a little ragged by 1am all get excited when you plop it on the counter in the galley, and tell you how fast they inhale it in between delivering pain meds and charting.  And what started out as a  fairly bad night turned into a pretty good one.

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And just for grins… I think this picture is pretty sweet because it is the first one I figured out how to run an action on.  I still don’t have it all down, but just figuring out the basics made me happy.

(vintage action from Rita’s Coffeeshop)

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Part of You Capture

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.

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…

 

Green is Good.

It is the day after valentines day, and the blog is now green.

Except the header, because I forgot how to change it and my brain is dead.

so we have a green blog and a red header. But not Christmas colors, so it is good.

I love st. patricks day.

probably because it is my day.

Last night I had an OD pt with a 1:1 sitter. Who fell asleep. So hard that I was shaking her shoulder calling her name before she woke up. A couple of minutes later the patient started vomiting... almost aspirated. I don't think the lady would have woken up with the vomiting if I hadn't woke her up first. So I told my charge nurse, who told the house supervisor, who went and talked to the sitter. Who proceeded to ignore me the rest of the night. I don't feel bad, but I would have rather they talk to her after I was done working with her.

I woke up to go to a meeting early yesterday.

Going to bed early does not make getting up early easier. Just saying

The meeting was supposed to last for an hour. I finally left after an hour and 45 minutes because I had to get ready for work. I need to stop agreeing to go to so many meetings.

I am getting the feeling I should stop typing and start sleeping now.

Good night.

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.

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.