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.