tonight's highlight: attempting to scrub blood off a patient's face while he stared and the ceiling and yelled "the space ship is coming!! we have to get on it RIGHT NOW".
you know you work in crazy-town when it takes you approximately 4 hours to realize he was probably mentally ill.
thought maybe he was trying to be ironic. so sue me.
Saturday, February 25, 2012
Wednesday, February 8, 2012
on the topic of dying...
...or more accurately, watching people die.
at 1340 i was washing my hands at the sink outside his room. he was being confused as always, carrying on a conversation with his nurse who was just outside the door.
at 1400, i got the call for help to his room. when i got there he was grey with agonal breathing.
he was a DNR, but nobody expected him to go so fast, so we all swung into action.
call for help call a rapid response call the team.
by the time everyone got there he was already dead.
is this the way that life goes? it's good for him, really. good to go so fast without much suffering. but for the rest of us, it's a reminder of what we know deep down but try to forget. you can be vigilant to the point of stalking and still miss the dying. in the end, nothing you do can stop it. sometimes there are no warning signs, and you just don't see it coming. you can't control when it happens, and each day that goes by that you don't find one of your patients dead in their bed is one day closer to a day where you could.
yes, i realize this is completely morbid and disturbing to normal people. but this is also the reality of being a nurse.
at 1400, the nurse of the patient in question walked into his room. she had been off of orientation for 5 days. she was completely unprepared for what was about to happen.
i've been a nurse for years, and i was also completely unprepared for what was about to happen.
these are the things that they don't teach you in school. these are the things that they fail to mention all together. maybe it's because they don't want to scare us off, or maybe it's because it's really not something you can learn to deal with out of a book. you learn by seeing, you learn by doing, you learn by having it happen on your watch to your people and having to face the reality of it whether you want to or not.
from this, i learned. and i won't soon forget.
at 1340 i was washing my hands at the sink outside his room. he was being confused as always, carrying on a conversation with his nurse who was just outside the door.
at 1400, i got the call for help to his room. when i got there he was grey with agonal breathing.
he was a DNR, but nobody expected him to go so fast, so we all swung into action.
call for help call a rapid response call the team.
by the time everyone got there he was already dead.
is this the way that life goes? it's good for him, really. good to go so fast without much suffering. but for the rest of us, it's a reminder of what we know deep down but try to forget. you can be vigilant to the point of stalking and still miss the dying. in the end, nothing you do can stop it. sometimes there are no warning signs, and you just don't see it coming. you can't control when it happens, and each day that goes by that you don't find one of your patients dead in their bed is one day closer to a day where you could.
yes, i realize this is completely morbid and disturbing to normal people. but this is also the reality of being a nurse.
at 1400, the nurse of the patient in question walked into his room. she had been off of orientation for 5 days. she was completely unprepared for what was about to happen.
i've been a nurse for years, and i was also completely unprepared for what was about to happen.
these are the things that they don't teach you in school. these are the things that they fail to mention all together. maybe it's because they don't want to scare us off, or maybe it's because it's really not something you can learn to deal with out of a book. you learn by seeing, you learn by doing, you learn by having it happen on your watch to your people and having to face the reality of it whether you want to or not.
from this, i learned. and i won't soon forget.
Friday, January 27, 2012
.
i'm trying to figure out why i'm so disturbed by what happened tonight. i think that it could be the fact that things happened so fast. Or that i felt completely out of control. or maybe that i knew in my mind what needed to be done, but in practice i froze.
the facts:
1548. vitals: BP 171/91. HR 83. temp 98.7. resps 28. NG to LIS with bilious output. Patient previously verbally abusive, called me an "evil red-headed bitch" last time i was in his room. tech calls me to say the patient is complaining of shortness of breath.
i was busy with another patient. and frankly sick of being verbally abused and of this patient's mental issues (see yesterday's post). so i fully intended to ignore him. i can't for the life of me remember why i went to his room. maybe it was divine intervention, or maybe it was my habit of OCD checking.
1600. in to assess patient. noticed new bright red blood from NG tube in patient with recent history of GI bleed. Immediately went to RN station and got the chief resident to come to bedside. NG manipulated. bright red blood splattering in cannister. i am getting very worried.
1605. attempted to call day RN but stupid phone system will not recognize her name. attempted to call ICU RN that floated to floor to work day shift, but stupid phone system will not recognize his name. look in back room for anyone to help me, find no one. finally find ICU RN in hall and say "i think my patient is GI bleeding".
1610. ICU RN begins to tell me a bunch of things i need to do and my brain can't handle them all, much less prioritize which is most important. someone takes vital signs, i do not think it is me. BP now 81/52, a drop of 90 points systolic over about 20 minutes. this is VERY bad, and i am getting the feeling of impending doom.
1615. I tell the vitals to the chief resident, and she says that we'll get an ICU bed. i get the bag of fluids to bolus. i find the emergency monitor and bring it to the room. more people have appeared to help me, i have no idea where they came from. i can't get the IV bag in the pressure bag to bolus. the emergency monitor is missing the cord to get the patient's heart rhythm. i feel like i'm drowning.
1620. the bolus is going in, someone else is drawing labs. i run to get the connector to draw off the patient's line. we don't have an ICU bed. i don't know if anyone knows that we need one. i call the manager and she says that she'll work on it. the day RN comes in and she says she will call report. people keep asking me questions that i don't know the answer to. do we have a bed? don't know. did we get those labs? well i didn't draw them. is report called? not sure. i feel kind of useless, actually.
1625. we have a bed. report is called. patient is packed up and ready to go. i have essentially done nothing to facilitate this except call for help and then run around like a chicken. we go to the ICU.
1630. we are going very quickly to the ICU. we have to go in a side door because the attending "would rather be in the ICU than in the hall". the fact that the attending thinks my patient is going to code in the hall does nothing to comfort me. we reach the ICU and 4 nurses descend upon my patient and take off all my monitors, then put him on all of their monitors. once again, i stand there doing nothing helpful. at some point someone hands me my monitors back. i proceed to stare at what's going on until gently pried away by the ICU nurse.
1700. as i stalk my patient via the computer, his heart rate is 150 and his BP is 65/40. he is dying.
1800. apparently my patient is going to IR to get his bleed embolized.
1830. code is called to IR. i know that it's for my patient.
1900. my patient still has vitals in the computer, therefore i know he's alive
2000. someone writes a note. patient required 10 minutes of CPR. needed to be shocked 3 times.
2030. EKG comes back as acute MI. my patient has apparently had a heart attack.
2100. chief resident comes to floor, tells me all about everything that i already know. my patient is in the ICU. he is in bad shape. "good pickup" she said, followed by "there's nothing that we could have done to prevent this".
i know she's right. now i just wish that it would feel like the truth.
the facts:
1548. vitals: BP 171/91. HR 83. temp 98.7. resps 28. NG to LIS with bilious output. Patient previously verbally abusive, called me an "evil red-headed bitch" last time i was in his room. tech calls me to say the patient is complaining of shortness of breath.
i was busy with another patient. and frankly sick of being verbally abused and of this patient's mental issues (see yesterday's post). so i fully intended to ignore him. i can't for the life of me remember why i went to his room. maybe it was divine intervention, or maybe it was my habit of OCD checking.
1600. in to assess patient. noticed new bright red blood from NG tube in patient with recent history of GI bleed. Immediately went to RN station and got the chief resident to come to bedside. NG manipulated. bright red blood splattering in cannister. i am getting very worried.
1605. attempted to call day RN but stupid phone system will not recognize her name. attempted to call ICU RN that floated to floor to work day shift, but stupid phone system will not recognize his name. look in back room for anyone to help me, find no one. finally find ICU RN in hall and say "i think my patient is GI bleeding".
1610. ICU RN begins to tell me a bunch of things i need to do and my brain can't handle them all, much less prioritize which is most important. someone takes vital signs, i do not think it is me. BP now 81/52, a drop of 90 points systolic over about 20 minutes. this is VERY bad, and i am getting the feeling of impending doom.
1615. I tell the vitals to the chief resident, and she says that we'll get an ICU bed. i get the bag of fluids to bolus. i find the emergency monitor and bring it to the room. more people have appeared to help me, i have no idea where they came from. i can't get the IV bag in the pressure bag to bolus. the emergency monitor is missing the cord to get the patient's heart rhythm. i feel like i'm drowning.
1620. the bolus is going in, someone else is drawing labs. i run to get the connector to draw off the patient's line. we don't have an ICU bed. i don't know if anyone knows that we need one. i call the manager and she says that she'll work on it. the day RN comes in and she says she will call report. people keep asking me questions that i don't know the answer to. do we have a bed? don't know. did we get those labs? well i didn't draw them. is report called? not sure. i feel kind of useless, actually.
1625. we have a bed. report is called. patient is packed up and ready to go. i have essentially done nothing to facilitate this except call for help and then run around like a chicken. we go to the ICU.
1630. we are going very quickly to the ICU. we have to go in a side door because the attending "would rather be in the ICU than in the hall". the fact that the attending thinks my patient is going to code in the hall does nothing to comfort me. we reach the ICU and 4 nurses descend upon my patient and take off all my monitors, then put him on all of their monitors. once again, i stand there doing nothing helpful. at some point someone hands me my monitors back. i proceed to stare at what's going on until gently pried away by the ICU nurse.
1700. as i stalk my patient via the computer, his heart rate is 150 and his BP is 65/40. he is dying.
1800. apparently my patient is going to IR to get his bleed embolized.
1830. code is called to IR. i know that it's for my patient.
1900. my patient still has vitals in the computer, therefore i know he's alive
2000. someone writes a note. patient required 10 minutes of CPR. needed to be shocked 3 times.
2030. EKG comes back as acute MI. my patient has apparently had a heart attack.
2100. chief resident comes to floor, tells me all about everything that i already know. my patient is in the ICU. he is in bad shape. "good pickup" she said, followed by "there's nothing that we could have done to prevent this".
i know she's right. now i just wish that it would feel like the truth.
Thursday, January 26, 2012
"those" nights
i had one of "those" nights yesterday. the kind that made me not want to go back to work ever again. the kind of shift that is only remedied by large amounts of alcohol and very good reality tv smut. the kind of night that is followed by the kind of day that requires an extra big coffee.
i have a new rule, and it is NEVER VOLUNTEER TO DO SOMETHING NICE BECAUSE IT WILL BITE YOU SO HARD YOU'LL WISH YOU WERE DEAD. i was having an ok night, so i said i'd take an ICU transfer. the patient didn't sound to bad, just maybe like he'd have some anxiety issues. i have a very good reputation for fluffing pillows and holding hands, so i thought i'd be able to handle him no problem.
well. that was presumptuous of me.
the patient came out of the ICU a hot mess. vitals all screwy, confused, trying to escape. no matter what i said, he would not calm down. no matter what i did he would not stop screaming. after he tried to kick me in the face, he needed to be restrained. this, however, only increased the incessant pleading to "call the police! call the paramedics! take me to the ER! call me a cab!" and so on. he began to tell passersby that i had abducted him. he passionately argued the fact that we were at the lake, at his house, at woodstock, anywhere but the hospital. he pulled the tube halfway out of his nose, then began pooping blood in earnest. his pressures went so high that i thought he might have a stroke, then his heart rate went so low that i was afraid to send him off the floor for fear he would code in the CT scanner. for 3 hours, i did not leave the patient's room. i had an orientee that dealt with my 3 other patients so i could stare at this guy and make sure that he didn't die. i walked off the floor bone tired and feeling like i was a horrible failure.
here are the other new rules that i'm trying to implement:
*there will be nights that you feel like you suck. do what you can and move on.
*be kind to yourself, because clearly no one else is going to.
*home is for home and work is for work. don't confuse the two.
slowly i'm learning how to cut myself some slack. i've been a nurse for years, and still feel like i'm flying by the seat of my pants most of the time. SO WHAT? the important thing is not that i feel really really smart, or look poised and in control. the important thing is that my patients are safe and well taken care of. and if that happens with me running around like a banshee and cursing the day i became a nurse, so be it. and if i have one of "those" nights? well i guess that's what wine is for.
i have a new rule, and it is NEVER VOLUNTEER TO DO SOMETHING NICE BECAUSE IT WILL BITE YOU SO HARD YOU'LL WISH YOU WERE DEAD. i was having an ok night, so i said i'd take an ICU transfer. the patient didn't sound to bad, just maybe like he'd have some anxiety issues. i have a very good reputation for fluffing pillows and holding hands, so i thought i'd be able to handle him no problem.
well. that was presumptuous of me.
the patient came out of the ICU a hot mess. vitals all screwy, confused, trying to escape. no matter what i said, he would not calm down. no matter what i did he would not stop screaming. after he tried to kick me in the face, he needed to be restrained. this, however, only increased the incessant pleading to "call the police! call the paramedics! take me to the ER! call me a cab!" and so on. he began to tell passersby that i had abducted him. he passionately argued the fact that we were at the lake, at his house, at woodstock, anywhere but the hospital. he pulled the tube halfway out of his nose, then began pooping blood in earnest. his pressures went so high that i thought he might have a stroke, then his heart rate went so low that i was afraid to send him off the floor for fear he would code in the CT scanner. for 3 hours, i did not leave the patient's room. i had an orientee that dealt with my 3 other patients so i could stare at this guy and make sure that he didn't die. i walked off the floor bone tired and feeling like i was a horrible failure.
here are the other new rules that i'm trying to implement:
*there will be nights that you feel like you suck. do what you can and move on.
*be kind to yourself, because clearly no one else is going to.
*home is for home and work is for work. don't confuse the two.
slowly i'm learning how to cut myself some slack. i've been a nurse for years, and still feel like i'm flying by the seat of my pants most of the time. SO WHAT? the important thing is not that i feel really really smart, or look poised and in control. the important thing is that my patients are safe and well taken care of. and if that happens with me running around like a banshee and cursing the day i became a nurse, so be it. and if i have one of "those" nights? well i guess that's what wine is for.
Saturday, December 31, 2011
the phrase I TOLD YOU SO comes to mind
nursing dilemma: fall into bed exhausted, or fall into bed exhausted after drinking large glass of wine?
i told the powers that be that we needed another tech, but nobody listens to me. apparently they want you to feel like you're participating in staffing choices by making you the charge nurse, but they don't actually want you to make any decisions or (heaven forbid!!) voice an opinion. so we had 1 tech tonight, 1 tech for 19 patients which i'm told is "appropriate staffing". 1 person is supposed to get vitals and fingersticks on 19 people? to take them all to the bathroom, and bring them waters, and count the intakes and outputs? to answer the call lights and clean up messes and change sheets and help turn? as fabulous as our tech is and as hard as she works, this is just not possible. but the (holy, almighty) staffing matrix says we don't get a second tech until we have 20 patients.
which is why after we got our first (of several, thank you very much) admits, i went to the powers that be and said "so we got an admission, where's my tech?"
in hindsight, that may have been inappropriate.
long story short, there was no tech. but there was another admission, then 2 more on the night shift. it was about this time that we realized that our second tech for nights never showed up to work.
then my admission rolled in at 2130 and i couldn't get anything done with her until the police finished grilling her about how she got stabbed.
so here i am, finally home after punching out almost an hour and a half late. i'd like to think of it as "revenge overtime".
should have given me that tech, hmm?
i don't think i need the wine tonight. i've got my righteous anger to keep me warm.
i told the powers that be that we needed another tech, but nobody listens to me. apparently they want you to feel like you're participating in staffing choices by making you the charge nurse, but they don't actually want you to make any decisions or (heaven forbid!!) voice an opinion. so we had 1 tech tonight, 1 tech for 19 patients which i'm told is "appropriate staffing". 1 person is supposed to get vitals and fingersticks on 19 people? to take them all to the bathroom, and bring them waters, and count the intakes and outputs? to answer the call lights and clean up messes and change sheets and help turn? as fabulous as our tech is and as hard as she works, this is just not possible. but the (holy, almighty) staffing matrix says we don't get a second tech until we have 20 patients.
which is why after we got our first (of several, thank you very much) admits, i went to the powers that be and said "so we got an admission, where's my tech?"
in hindsight, that may have been inappropriate.
long story short, there was no tech. but there was another admission, then 2 more on the night shift. it was about this time that we realized that our second tech for nights never showed up to work.
then my admission rolled in at 2130 and i couldn't get anything done with her until the police finished grilling her about how she got stabbed.
so here i am, finally home after punching out almost an hour and a half late. i'd like to think of it as "revenge overtime".
should have given me that tech, hmm?
i don't think i need the wine tonight. i've got my righteous anger to keep me warm.
Saturday, December 10, 2011
there are dollar signs where our hearts should be.
my heart breaks a little today, as i just found out that my favorite trauma nurse clinician's position is being eliminated in february. frankly, i'm getting more than a little bit tired of working for an organization that obviously enjoys showing nurses just how little they are valued.
it's ok with "the man" that i am verbally threatened by my patient's family. in fact, it is actually MY fault.
it's ok that i have to walk a half mile in the dark/freezing cold past the mental institution to my car at night.
it's ok that we constantly work short, with equipment that doesn't function.
it's ok to take the best resource that we have as nurses (aka our trauma nurse) away from us. It's not like she's the only one on the service that knows what's going on...oh wait, SHE IS.
i think we should change the motto of the organization to {enter greedy hospital name here}: you are replaceable.
why on earth would the hospital eliminate the person who mediates between doctors and nurses and makes us see each other as people? why would they take away the individual who can build a relationship with even most soulless of patients? why would they get rid of the nurse who has the skills to see when there is something wrong with a patient and the power to actually DO something about it. i'll tell you why
$$$
that is the only reason. and that makes me sick.
it's ok with "the man" that i am verbally threatened by my patient's family. in fact, it is actually MY fault.
it's ok that i have to walk a half mile in the dark/freezing cold past the mental institution to my car at night.
it's ok that we constantly work short, with equipment that doesn't function.
it's ok to take the best resource that we have as nurses (aka our trauma nurse) away from us. It's not like she's the only one on the service that knows what's going on...oh wait, SHE IS.
i think we should change the motto of the organization to {enter greedy hospital name here}: you are replaceable.
why on earth would the hospital eliminate the person who mediates between doctors and nurses and makes us see each other as people? why would they take away the individual who can build a relationship with even most soulless of patients? why would they get rid of the nurse who has the skills to see when there is something wrong with a patient and the power to actually DO something about it. i'll tell you why
$$$
that is the only reason. and that makes me sick.
Saturday, December 3, 2011
so we saved a life before 1500
nothing good starts with the sentence "I don't like the way my mom is breathing". of course i would have to be the one to answer THAT call light...so i sent the nurse down to the room to see what was going on. she came out a few minutes later reporting that the patient was breathing at 8 a minute. not good, not good at all. she grabbed a vial of narcan to reverse the narcotics the patient had gotten earlier and i went to page the doctor. i looked everywhere for the patient's chart to find what resident was taking care of her and couldn't find it, so i just sent out a general page through the operator and went in to help. the nursing student got vitals, which showed that the patient's O2 sats were 78%. my coworker started pushing the narcan and i ran to grab a face mask and put the patient on 10 liters of oxygen. less than a minute later, the patient's sats came up to 100% and she woke up, thanks to the miracle of narcan. we titrated her O2 down to 3 liters and the nursing student stayed with her to take more vitals. it wasn't until this point than the doctor called back. apparently i paged the attending.
oops.
i could tell that things weren't going too well...the nurse was having to explain herself way too much and there appeared to be some lecturing going on. the attending told her that he didn't feel comfortable telling her that it was ok to give the narcan, and he needed to look up the policy. to which i say:
SERIOUSLY?
giving narcan is within our scope of practice. and when i see a patient who is struggling to breathe, turning white, and looking like she's headed to heaven i will give my narcan and have no remorse. feel free to look up the policy, because i'm pretty sure that it won't say that we should let little old ladies die while we wait for you to return my page.
five minutes later the attending called back. he looked it up and had decided that we were indeed allowed to give the narcan. gee thanks. oh, and YOU'RE WELCOME for helping your patient live to see another day.
oops.
i could tell that things weren't going too well...the nurse was having to explain herself way too much and there appeared to be some lecturing going on. the attending told her that he didn't feel comfortable telling her that it was ok to give the narcan, and he needed to look up the policy. to which i say:
SERIOUSLY?
giving narcan is within our scope of practice. and when i see a patient who is struggling to breathe, turning white, and looking like she's headed to heaven i will give my narcan and have no remorse. feel free to look up the policy, because i'm pretty sure that it won't say that we should let little old ladies die while we wait for you to return my page.
five minutes later the attending called back. he looked it up and had decided that we were indeed allowed to give the narcan. gee thanks. oh, and YOU'RE WELCOME for helping your patient live to see another day.
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