no good deed...

"room 28's wife says her water just broke.  what do i do?".

our newest nurse looked nervous as she grabbed me out of the hallway.  i went down to the room and talked to the wife.  sure enough, she was 37+ weeks pregnant and was leaking fluid out onto the floor.  i called the ED, who told me to call L&D.  i talked to the charge nurse up there and told her to expect the patient and her s/p motorcycle crash husband with his chest tube in tow.

apparently this is where everyone started freaking out.

first my assistant manager says that we can't go to L&D, we have to go to the ED "because of EMTALA".  seriously.  there is a law about that?  ridiculous.

then transport freaks out because the chest tube is to portable suction.  mmmkay...not like you take people with chest tubes on suction to tests EVERY SINGLE DAY or anything...

so the wheelchair caravan of terrified first time parents/trauma patients and spouses heads off to the ED...where they are immediately sent up to L&D (um, told you so.  ok).  the nurse settles her patient in and reminds him that L&D can't give him meds or any cares, and gives him all of our numbers to call when he needs anything.  she comes back to the floor to update the trauma team

...which is where everyone resumes freaking out.

the intern apparently asks "did you get permission for that", which is where i will begin side rant.  permission...seriously.  this from the service that acts like any nursing request is inconvenient to them.  the service that will let patients get as sick as humanly possible before intervening just to 'make sure' or something like that.  the service that has been in the ED with traumas for the past 4 hours and has made it clear a million times before that floor priorities are NOT priorities.  you wanted us to ask PERMISSION for the STABLE patient to go WITHIN THE HOSPITAL with his very pregnant and terrified wife to help her give birth to their baby.  mmm.

i'm still not understanding why everyone is so riled up, but i feel responsible because the nurse asked me what to do and this is what i came up with.  so when i saw the attending come to the floor, i excused myself from my patient's room and went to see what was up.

"WHERE IS ROOM 28!?!?"

 i haven't really seen this attending raise his voice before, and i am about to pee my pants in the nurses station because i'm the one who did this.

new nurse (bless her) stood her ground and replied simply "L&D bed 12".

"WHY IS HE THERE?!?!"

i couldn't take it anymore "this whole thing is my fault..." and i explained that i had done this before with another patient several years ago.  that the patient can come back to the floor for assessments and whenever he's needed by the doctors.  that the L&D nurses are not responsible for him and that we need to provide all his meds and cares.

the attending relaxed.  "oh, that's reasonable.  we had been told that he had a bed on L&D".

they seriously thought that we transferred the patient to L&D.  

after we all finished laughing hysterically, i was a little offended.

so the nurse went over to L&D to give the patient his night meds, and who was there but the attending. telling the patient that he should come back to the floor.

I.  GIVE.  UP.

you ask those people things, and they act like you're the biggest inconvenience in the world.  you try to be autonomous and make reasonable decisions for yourself and this is what comes of it.  NOW they care, when every other thing that you bring up gets you an eye roll.  NOW they want to be involved, when they were previously very busy in the ED and not to be disturbed.  NOTHING that we do is right, EVER, and i'm over it.

i tried to help a couple have a decent birth experience, and all that i got out of it was a headache and the knowledge that the trauma team thinks that its nurses are stupid enough to transfer one of their patients to L&D.

so it's true.  no good deed goes unpunished.

year five.

five years.  five years.  five years.

what have i done with the past five years?

what have i done with the past one year?

i guess that's a little easier.  2012 was a blur of worry and stress, so for the last 6 months of it, i did exactly nothing.  and i needed that.  the beginning of this year started out pretty rocky.  i finally cracked under the pressure of trying to do too much, and i took a step back from all of the 'extras'.  i've been trying to get ahold of my emotions and facing the fact that i'm old enough to have to act professionally, whether i like it or not.  thus i've been trying to express my feelings and my job concerns constructively, through carefully written emails and well placed, fully thought out comments.  as someone who enjoys saying outloud the first inappropriately direct thing that comes to her head, this has been difficult.  but when you start to wonder if you are becoming enough of a troublemaker to be fired, it's time to shut your mouth.

the phrase "it is what it is" is an unofficial floor motto, and i kind of hate that.  but for the first time, i actually understand why people feel that way.  there are things that i would have dug my heels in and fought over three years ago that i've just given up on these days.  i just don't have enough energy to get worked up over every injustice like i used to.  does that make me bitter and washed up?  i hope not.  i can still work up some passion over the big stuff.  i guess i'm just trying to let the smaller things roll off my back...finally learning to accept that there are a whole lot of things with management and new policies that i'll just have to deal with.

i don't think that i'll be on the floor too much longer, to be honest.  i'm tired of being constantly running and feeling like none of my patients are getting as much care as they deserve.  i think that my personality is better suited to someplace like the ICU, where i could focus my energy on taking really good care of a few people.  i'm ready for new challenges.  i'm ready to do crazy things.  i'm ready to save lives, and not just heat up people's dinners and bring their family members extra blankets.

five years on the floor has taught me A LOT.  but five years on the floor might be enough for me.

whatever happens, i'm not who i was five years ago.  i always joke and say that i used to be a nice person before i became a trauma nurse, that the floor ruined me.  sometimes i worry that it's true.  but overall i think that i've changed for the better.  i might not be as nice, but i'm not a pushover.  i might feel like the weight of the floor falls on my shoulders a lot of the time, but i actually know what i'm doing.  i might have people who are sick, but i'm confident in my ability to get them what they need.

i started out five years ago, straight out of school and terrified.  i didn't know how i was going to make it from week to week in the beginning, and i'm sure that people thought that a basket case like me wasn't going to make it very long on the floor.  and here we are.  five years later.

the job probably didn't get any easier, i just got better.

i've officially survived five years as a nurse.

thank god. 

it's always the good ones...

there is some sort of murphy's law/perfect storm/cruel fate phenomenon that makes the really bad things only happen to wonderful people.  

as a rule, i would say that i like most of my patients.  but lately i have been REALLY liking them, and have had this groove going the past couple of weeks.  they keep giving me wine and candles and raining complements on me, and it is both creepy that things are going so well and also amazing.  

but the more you care about people, the worse you feel when things go wrong.

i had this lady last week.  young, pretty, with an awesome family and little kids.  so of course she has some rare genetic disorder, and of course this means that she has perfs her bowel and requires a permanent ostomy.  and she's sad, and she's anxious about it, but she still is doing everything that she needs to be doing and trying to have a good attitude and being all around gracious and inspiring.  

so i was surprised, but also not surprised, when i came into work yesterday to discover that she eviscerated bowel through her suture line and needed to go back to the OR.  she did great, but ended up in the ICU postop.  

i kept running into her dad in the hallway during her surgery, and i just felt so awful for them.  and then her sister came down after surgery and cried on my shoulder, just so incredibly frustrated and worried and sad.  it made me feel so helpless, like i should have done something more.  like i should have been able to prevent it.

so i went up to the ICU last night after my shift to see her.  and she looked good, but also exhausted and broken.  being that she's such a good person, all she kept saying was what a good nurse i was and how i have a gift.  

just not the gift of being able to prevent this, i guess.  

sometimes this job just wears on you.  it's exhausting watching bad things happen to nice normal people and not being able to do anything about it.  and while it's flattering when they think i'm amazing and feel well cared for, the truth of the matter is that i can do very little for them in the grand scheme of things.  i can make it feel better, but i can't MAKE it better.  

and while that's definitely something, sometimes it just doesn't feel like enough.

 

omens

so i was fired from a patient within an hour of being at work on a monday.  

she was completely insane.  my offenses?  well first i asked her to put her gown down because she was flashing the hallway.  then i had the audacity to ask her to use the call light before she got up out of bed and set off the bed alarm.  and the final blow was when i tried to assist her into the chair and reminded her not to use her nonweightbearing foot.  

what commenced was a screaming/swearing fit so loud that it sent the doctors running out of the back room and to my rescue.

apparently i'm a "bitch with an attitude".  well if the shoe fits, i suppose...  

i kindly removed myself per my patient's request, and then thanked jesus for sparing me from hours of torment with this psychotic woman.

this may not bode well for the rest of the week...

AMA: you're doing it right.

this one comes courtesy of cardiac nurse bff.

so they got this patient on the floor who was regular.  this guy is a classic manipulative patient in a 'sickle cell pain crisis' who required a PCA, yet spent the majority of his time off the floor out smoking or trying to scam people.  he apparently would get a few hits of dilaudid then disconnect himself from his pump and disappear for an hour, only to return to get some narcs and disappear again.  everyone was fed up with him and his alleged "pain crisis" and the doctors finally gave him an ultimatum.  if he took himself off of his PCA and left the floor one more time, it was going to be considered leaving AMA and he wouldn't get his prescriptions for all of his pain meds upon discharge.  they patient apparently agreed to this, and then went MIA from the floor again.

when he finally got back, the intern went to go talk to him and, wouldn't you know, the patient refused to go AMA.  after much bargaining, threatening, and the like, the intern finally caved and told the patient that he would write him a prescription, but he was still considered AMA as per the original agreement.

so at this point in the story, i'm pretty much livid.  THIS IS WHAT IS WRONG WITH THE WORLD.  entitled people making your life a living hell to the point that you just give them what they want so they will finally go away.  but still, not ok.  shame on that doctor for giving in, i thought.

so the patient signed the AMA papers and the intern handed over his prescription.

it was for tylenol.

and the intern for the win!!  it's about time that someone took it upon themselves to not give in to manipulative, drug seeking bs.

and THAT is how you do AMA.

youtube and a nurses week shout out

first of all, a very happy nurses week shout out to all my people.  go enjoy your dry cake and keychain, or whatever it is that your hospital graces you with.  secondly, i saw this ecard today and almost peed myself, as we got a 'youtube gone wrong' admit a few weeks ago.

the kid was young, like maybe 18, and had decided to jump out of a moving car and try to do some sort of tuck and roll so he and his homeboys could get rich off of being an internet sensation.

...turns out no one really wants to see you give yourself a grade IV spleen lac.  well fancy that.  

HAPPY NURSES WEEK to all...remember that we are fabulous even if no one else appreciates it.  

derp derp derp

do you ever have one of those days where you feel stupid all the time?  i just did.  i deserve it, probably, for thinking that for once in my career i finally kind of have it together.

lies.

so i had this sweet, innocent, kind GSW (no sarcasm intended) who started out the week with me with bile coming out of his chest tube.  oops.  a diaphragm repair and a few days later, he got his chest tube pulled and was going to go home.  except for the fact that he had whooshing sounds coming from under his chest dressing.  we did a stat chest xray, and it was so bad that i could even see the pneumo...because it was like half the lung.  not.  good.  the doctor called me to say that i needed to bring the patient up to the ICU for a new chest tube, so i went to let the patient know.  except for the fact that he wasn't in his bed.

...or in the patient lounge....

....or in the front lobby...

ok.  so my guy with the collapsed lung is nowhere to be found, and now i look like a total tool trying to explain to the ICU nurse that it's going to be a minute until we come up because i can't find my patient.

fortunately, he WAS in the cafeteria.

after an extremely awkward conversation in the checkout line where i tried to explain the situation without compromising patient privacy to the other half dozen people in line, the patient came back to the floor and i delivered him to the ICU.  at this point i'm sweating from running all over the hospital, but felt pretty ok...

...until i realize like 15 minutes later that i pulled out the patient's IV two days before because he hadn't needed it and then i just delivered him to the ICU with an urgent situation and no access.

derp derp derp.

so this nurse already thinks i'm an idiot, because first my patient was lost and now i'm the stupid floor nurse who doesn't have a line in my patient and didn't even notice.

well.  there's that.

so that situation was a loss, but i still was doing ok overall.  and i still had my guy down the hall who totally had an ileus that the doctors were ignoring.  we had FINALLY gotten them to turn the IV fluids back on for this man who had a belly like he was 10 months pregnant, and that was a victory.

so i wasn't a total failure.  until i went into the patient's room and realized that he had gotten a meal tray.

technically his diet was still general, but i had been advancing him slow because of his bowel function. the patient was developmentally delayed, so i didn't think that he'd be able to order dinner without me helping him.  except for the fact that i forgot when people miss two meals, the cafeteria calls them to ask them if they would like to order.

apparently what my developmentally delayed, 3 days post-op with an ostomy reversal, not fully returned to good bowel function patient would like to order was a personal pizza, a plate of french fries, and a brownie.

he ate the whole thing.

derp derp derp again.

and i quote the resident "have fun sinking an NG and sucking out pizza.  i'm going home."

some days you just have to chalk up as a loss.