caring too much

i care a lot about what other people think about me.  this is a flaw.  when i became a nurse, it took me a long time to accept that not everyone would instantly love me, that some might not even like me at all.  if you would have told me that people would sometimes yell at me, tell me i'm not good at my job, and fire me, i wouldn't have believed it.  because i am likeable, and friendly, and am someone who will bend over backwards for approval.

or i guess i should say i was.

i have become mean.

it makes sense why.  every day i go to work and am essentially told 'do better'.  there's always some issue: entitled patients, arrogant doctors, crap staffing, some new policy that takes yet another resource way from us.  and it sucks.  so bad.  and no coping mechanism that i have seems to be acceptable.

first when i was frustrated i cried.  then everyone thought that i had mental health issues and looked at me like i was scaring them and all my evals would say things like "find ways to cope with stress".  well crying WAS my was of coping, but i got tired of everyone else thinking i was crazy, so i tried to minimize the waterworks and tried to talk out my feelings. vent, so to speak.

ok, so maybe it was ranting.  whatever.

but that is "negative" and "a bad influence on new staff", and if i am frustrated i'm supposed to "take a moment to myself to collect my thoughts and carry on".  yes, because i have so much time for contemplative moments.

so, i shouldn't be crying out my feelings, and it's is forbidden to express my frustrations out loud, so i'll swallow them all instead.  (not literally, although i tried that too.  gaining 20 pounds doesn't make anybody feel any better, for the record.)  so what am i left with?  i'm just supposed to suck it up, all the time.

lets practice:

oh, we're short a nurse and all of our techs have to be sitters today?  great!!

you're sending me a patient who is in 4 point restraints and has been getting ativan regularly?  fun!!  i can't wait!!  and you plan on DCing all the benzos?  i love a challenge!!

ooo, you've come up with another form to fill out to record productivity?  i'll look forward to completing this q shift, as per policy!!


i want to punch everyone in the face.  i'm not allowed to cry, i'm not allowed to express my frustrations to my coworkers, i'm not allowed to say how crappy it is to work here in the staff meetings, i'm not allowed to tell my patients that they can't have 234 juices for all their babies and baby mommas, i'm not allowed to tell the director that i think she's nuts for thinking that people 'have a lot of respect for the healthcare system and don't bring guns to the hospital', i'm not allowed to tell trauma that they're a bunch of idiots this month, and i'm not allowed to tell their chief residents that they're bitches.  i'm not allowed to have any emotions on the outside at all, apparently.  but on the inside i am a big ball of ranty angst, and it stews and it stews until it bubbles up and i can't stop it.

but that makes people think that i actually am evil and awful and mean, and i don't like that either.

i have a nursing student this semester and all i can think about is how i'm poisoning the future.  who on earth would want to become a nurse after seeing how crazy this job has made me?

how do i stop caring too much about the stupid things, like what people think of me?  and how do i start caring about the important things, like how to be nice again?  and i what do i do with the feelings of wrath?

this job has made me different.  it has made me strong, in a lot of ways.  but i don't want it to make me hard.  i obsess about silly things, i easily forget to be compassionate, i'm frustrated almost all of the time, and i care too much about what other people think.

i might care too much, but at least i still care.

i still care.  so maybe the kindness that used to come so easily to me is buried somewhere underneath four years of day-to-day dealings with humanity.  and maybe i can still find it.    




          

your job: you're doing it wrong.

typical ED exchange, and proof for my theory that our ED nurses are actually unlicensed homeless personnel and/or circus monkeys:

me: what's the medical history?

ED RN: elevated PSA, basal cell carcinoma, arthritis... (in snotty voice) you know i'm just reading all this, it's in the computer.

me: okaaaaay.

patient comes up, and we're reviewing the medical history.  which is "in the computer"...until we get to the reason that he's actually here.  a complication from a recent surgery.

a whipple.

not in the computer, for the record.

the whipple: a major surgery in which basically everything gets removed and/or reconnected...stomach, gallbladder, pancreas, duodenum, etc. etc.

huge surgery, kind of a big deal.  definitely worth mentioning and/or charting on, definitely something i would have liked to know about.  

and it would be nice to know that the patient is one of the chief of surgery's privates, as he is very particular and likely to throw things should we violate one of his unwritten rules.

and it would be nice for the patient to be admitted under the correct service, which he isn't.  

and it would be nice for the patient to be admitted to the correct floor, which he also isn't.

circus.  monkeys.  i rest my case.

and they wonder why we're all burnt out.

i like to do things correctly.  i like them to be neat, and finished.  my life at work is barely organized chaos on the best of days, and surviving on a wing and prayer the rest of the time.  i will never be good enough for management, or JCAHO, or CMS, and i have to learn to accept this.

the hospital is never going to be clean enough.  i am tidying patient rooms on "clutter rounds" and wiping down the computers daily and meticulously recording it on a paper log.  because i have to.  or else there will be "corrective action". 

i am now responsible for IM notices and some other government mandated mumbo jumbo about people refusing to be discharged.  if i don't give them out, there will also be "corrective action".  

it's not quiet enough and patients don't feel that they are being listened to enough, and the call lights aren't being answered soon enough and patients aren't receiving help as fast as they would like, and communications with the care team are dismal, and also the HCAPS and the report cards are not at the median line and we are in yellow and red or something like that.  

our aides are dissatisfied because they are not getting lunches and they are complaining.  and instead of getting more aides so they don't each have to care for 16 patients, nurses need to stop delegating so much stuff.  except for last month, in which we were told to delegate because we are punching out too late and it costs money.  

and then there are the cultural competence online modules and the ever-popular "de-escalation training".  this will be mandatory.  well, only if you want a raise next year, that is.  

and also i need to complete the advanced nursing pathway because we need 4 people to do it by next year.  not to worry, this involves only 20 hours of continuing education.  and a poster project to a group.  and a research study.  and that i precept 100 hours this semester.  

which i do, by the way.  

i precept: one on one with a student nurse and then for weeklong stretches with new grads.  i'm charge nurse, which we do while taking a full patient assignment.  i field questions from the new nurses, and am a resource person.  all the nurses on my shift are new, by the way.  with the exception of one other nurse, everyone has been on the floor for less than a year.  

and then there are the nursing students, 4 different groups on 4 different days every week this semester.  we are responsible for teaching them too.  

i head a council, for which i am supposed to attend a monthly house-wide meeting.  then i am to run 3 floor meetings monthly.  then i meet with the heads of the other councils monthly.  there must be typed minutes that are approved a week before for all of this.  and projects.  no one wants to do projects, however, so i do most of them myself.  

and then there is the bedside shift report, which is not getting done and we should all be ashamed of ourselves.  

and the hourly rounding, we have to do that too, or the Studer group says all our patients will fall and die.

and we all must attend the mandatory interdisciplinary rounds.  well mandatory for nursing, i guess, but not for the physician representatives.  they couldn't possibly be bothered to come and discuss their patients, because they're busy.  

and i clearly have all the time in the world.  

it's too much, too much for my brain to even hold and definitely too much to expect from a person.  because those are just the "extras" in my mind.  i also have to assess, medicate, monitor, and nurture 4-5 patents too.  to maintain tubes, to suction trachs, to change dressings and ambulate and bolus and make sure that there is enough urine and that the blood pressure isn't too high and that trauma isn't about to wreck kidneys with IV anti-inflammatories.  and then i need to keep track of all that data by charting the assessments, fall risks, braden scales, IVs, wounds, pain assessments and reassessments, neuro checks, CIWA scales, and sitter scores.  oh and do care plans and patient education too.  

i can't do it all, but it is all "an expectation".  and failing to do any of the above comes with "corrective action" and "negative consequences".  

i don't care about half this stuff, and i care probably twice as much as most people on the floor.  

so what do you do when you can't do it all?  

the best you can, i guess. 

the bizarre story of ringo

ringo* came to me on a crazy august night.  he was completely wasted, belligerent, and 'not cooperative with the plan of care' so to speak.  i first met him when i answered the call for help from several of my coworkers who were trying to keep a very rowdy ringo in bed.  he insisted that he could walk to the bathroom, which he did, bouncing off of the IV pole and several walls as he went.  he was a huge man, tall and solid, and my tiny coworkers were no match for him.  as hard as the three of us tried, we couldn't get him to go back to bed.  it took 5 of our finest security guards to get ringo in bed, and 4 point restraints to keep him there.  as my name badge was the only one he had seen, he screamed my name at the top of his lungs repeatedly, until the haldol finally kicked in and he passed out.  turns out ringo had stolen his "roommate's" moped, gotten ridiculously drunk/high, and crashed it into a bunch of parked cars.  he had a couple of brain bleeds, a couple of broken bones, but was pretty much in one piece.

turns out ringo was actually a decent human being sober, although a little overly friendly.  i took over as his nurse the next day and as long as i avoided his grabby hands, we got along fine.

he had nowhere to go, as is pretty common on the trauma unit.  he had been bouncing around sleeping on friends couches and in his car.  unfortunately, brain injured patients can't be discharged to nowhere, and although ringo was desperate to leave, he had to stay almost two weeks.

word came via social work that ringo's "roommate" with the stolen moped was willing to welcome him back with open arms.  odd indeed, but i packed him up and sent him on his way.

not 24 hours later, guess who's back in the ED?

surprise, surprise.

now we are no strangers to discharges/readmits.  it happens all the time...wound infections, bowel obstructions, etc etc.  so i was shocked to read in the ED notes that ringo was being readmitted for a NEW problem.

namely, he got the beat down.

that's right, he was discharged and readmitted the next day after being found down in an alley with a GCS of 3.  he ended up with a new brain bleed on top of his old ones, and several new fractures.  he was IDed in the trauma bay by the surgical chief resident, who recognized him from his previous stay.

he was admitted to the floor, and we picked up right where we left off, like we were in some sort of bizarre hospital time warp.  he claimed not to remember what had happened, and tried to tell his sister that he "fell".

yeeeeeeah.  ok.

my guess?  those open arms of his now moped-less "roommate" turned out to be closed fists.

so that's the bizarre story of ringo, who managed to rack up two traumas in two weeks.  may his brain cells rest in peace.




* names have been changed to protect patient privacy, as have the details of this little narrative.  so hippa nazis can go 'head and step off

bffs

i don't want to get all emo up in here, but i swear most days nobody gets me.  people think that nursing is 
a. easy
b. a good way to make a lot of money (haha)
or 
c. like working in a doctor's office.  

thank god for my fabulous, amazing, very talented nurse (and real life) bff.  she and i have been through everything together...the first horrid, cry-all-day-everyday years of being a nurse...the first awful PTSD-inducing codes...the first time a doctor gave a stupid order...all of it.  she makes me laugh until i cry, and i recently dug up some fabulous emails that detail our trials.  please excuse me while i go pee my pants.  


dearest friend,

lawdhelpmejesusimabouttolosemyshit. i do not care that you do not have
$24 to pay your copay, but you have enough money to pay for your
cocaine. i hate my patient today, and when they turn {the hospital} into some
holistic + integrative medicine hotel, it's going to be worse. okay.
well, time to go slap some bitches

to which i reply:


my advice on the person who wants you to give him $24?  give it to him, it will make him go away.  this is sad.  tgisunday, and drink up.

she also understands my frustrations on the day to day hassles of nursing.  and she's way more descriptive than i am :)

begin rant.

i hate my job. i hate my job. i hate my job. i hate my job. i hate my
job. i hate my job. i hate my job. I HATE MY JOB. I HATE MY JOB. I
HATE MY JOB!!!!!!!! seriously,  i do.

i hate {new computer system}.
i hate my patients. especially my icu tx. A*HOLE.
totalm*f*a*hole. just told me that i want him to stay sick
because i'm afraid i'm going to lose my job. this is said between
labored respirations at 32/minute, because i said he can't shower.
seriously.
i hate doctors, too. they're lazy.
i hate how pharmacy can't send meds up under {new computer system}.
i hate how the kitchen doesn't send trays.
i hate how blood sugars and vitals dont get charted.
i hate how i get attitude when i ask for things.
i hate when all my meds are missing, so everything is late. and i have
to do twice the work to find them, and then find time to go give them
again.
i hate how icu lied about supplementing potassium before transferring.
i hate how there are now no orders for potassium, and i have to call
the dr. for the billionth time to try and find some.
i hate how i started with 5 patients, sent someone home, and had to
pick up someone else by 1545 so we could send a nurse home because we
were overstaffed.
i hate this s*.
seriously.
i am going to drink all weekend.
and i wish i could start now.
but that's illegal, and i'd lose my job. but right now, that would be
a blessing.


oh, look what time it is. it's f*thiss* o'clock.

i'm going to go eat now. and turn my phone off. if anybody is looking
for me, they can go to hell.end rant.

truth.  every word.  

she also is one of the only people i know who has patients who are equally as/more repulsive than my own.  as is evidenced by:

this evening i had the pleasure of admitting a darling 40 year old woman for weakness, dizziness and syncope from the er. she's schizo, htn, dm2, ckd, asthma, seizures (and not the 'seize the day' kind), smoker, cva with left residual, in contact for hx mrsa and r/o cdiff. oh, and she's just plain weird. lives at a rooming house, her "fiance" is homeless (and thankfully left to head to {the shelter} for dinner, but came back with bloodshot eyes..hmmm....wonder where he detoured for a little something special). when i walked in and introduced myself, and asked her how she was, of course her reply was "i'm hungry. and i'm not going to eat a diabetic diet. i need to eat sour cream." ummm....okay, good to see you, too, ma'am. and sour cream? wtf.  so, she had a seizure at 0400 and has been having diarrhea x a month. yep, a month of daily diarrhea without the need to go to the doctor. she's orthostatic with lying bps 90/50, sitting 70/40...a bit dehydrated. anyways, you get the idea. she's nuts. and she's kinda sick. but mostly just nuts.  so, when i'm doing her admission database, i have to ask her about her meds (in addition to safety, which she says she doesn't feel safe because whenever she goes to the bathroom at her rooming house - so she goes with the door open - her roommates dry to steal her vicodins...anyways). so, when i ask her about her meds, she tells me she doesn't take them. when i ask her why, she says "well. i'm too lazy to walk to walgreens to pick them up." seriously? so, because you can't walk your crazy ass to walgreens to pick.up.your.seizure.meds. i have to admit and pay for your hospital stay? when i offered that she take the bus, she informed me that she "ain't gonna waste $2.25 on a bus ticket". but she can waste her money on a pack of cigs a day? f*. that s* pisses me off.

so, then i have to give her some diflucan. guess why? oh, yah. she's itchy. down in lady town. i just wanted to give her the pills and get out of her room, but she felt the need to tell me...and i quote..."well, yesterday i was itchy down there, so i put my finger in it, and when i took it out it had curds of whey on it". take a moment to barf, please. THESE PEOPLE ARE INSANE. and she says this all with a blank stare. how am i not supposed to 1. barf, 2. laugh or 3. cry with these people.

see?  

so in summary, god bless fabulous, amazing, very talented nurse (and real life) bff.  and may she never have to hear the phrase "curds of whey" ever again.  amen.     

more ridiculousness

i've seen a lot of things, this we know is true.  

but i've never seen a patient flip off an entire team of neurosurgeons while they're trying to explain the C-spine surgery they have planned for him.  and i've never seen a patient sign his name on a consent form, followed by the words "f*** off". 

a bit of advice: if you plan on being an ass to your surgeon, you should start after they perform the delicate procedure that could very well leave you paralyzed and on a vent.  

just a thought.   

ridiculousness.

hard to say what the high point of ridiculousness was today.  perhaps it was the man going through full blown DTs with the rude, condescending resident who thought that he didn't need to go to the ICU even though 10 mg of Ativan and 6 beers hadn't touched his full-body tremors and hallucinations.  or maybe it was the same resident, who said that the constant trickle of blood from the fresh neck dissection was just "skin level", and wasn't concerned that he was saturating gauze at an alarming rate.  oh, i could go on all day about how this particular resident is patronizing and a bit full of herself considering that she's been a doctor for all of two months.  and maybe she'll have a come to jesus moment when she realizes that those trauma nurses were onto something with the DTer (ICU-intubated-ativan drip...duh).  and maybe she'll realize not to bite the hand that feeds her...aka the hand that tells her exactly which orders to write, which patients she needs to see, and when she needs to ask for help.  THAT IS MY HAND.  and she'd better learn to recognize.  

but i digress.  believe it or not, none of these instances were the most ridiculous of the day.  that honor goes to the patient's visitor who came to the nurse's station because "i've missed three doses of my vicodin and i'm really getting uncomfortable".

seriously.

the VISITOR.

he expected us to hand him vicodin. 

and the sad part is, i'm sure the gods of patient satisfaction will smite us for not running out to the nearest pharmacy to pick some up for him.  

and they wonder why we can't keep these people happy.

unreal.     

roll me back in time

today i had a moment -maybe my first- where i felt like i was exactly what my patient needed.  she was getting her epidural and freaking out, so i stood in front of her, held both of her hands, and told her to breathe and that she was doing so good.  just breathe.  i kept her from panicking.  no one else was getting it...the anesthesiologist had a job to do, her mom had to leave the room, and the nurse was monitoring her.  so i stepped in and got her through it.  it was one of the most satisfying things that i've ever done.  i was a nurse today, and it was good.

this happened my junior year of college, during my OB clinical.  i was so young, but my patient was younger.  i still remember her terror, she was on the edge of an epic freak out and i was all that stood between her and blind panic.  i knelt down in front of her until my legs went numb and murmured soothing things as the doctor put the ridiculously long epidural needle in her spine.  after we got through it, i remember the nurse that i was shadowing looked at me, impressed.  that was the first time that i knew that i was really supposed to be a nurse.  and on days like these, when i can't remember the last helpful thing that i did and can't focus on anything except how hard this job is, this is something worth remembering.