Saturday, July 29, 2006

The end result


This is a view of the marine layer coming into the Salinas Valley. Just south of Gilroy CA. It was sunny with blue skies and 70 degrees in Gilroy and 66 in Salinas under a layer of gray marine layer. We had a wonderful couple of days in Reno with our traveler friends. We had a great conversation this morning before we left. It was funny, we were discussing how we had decided to becoming traveling nurses and how glad we were we had. We mostly talked about how most people work all year and get a week or maybe 2 off and they have to plan it around everyone else's vacation. We remembered those days and sighed.
I am done in Salinas this week. It has been a great time. I loved working at this hospital. The staff was great, so friendly and helpful. The physicians were caring and approachable.
This week I got to visit the ER after one of my psych patients went off. She was running down the hallway screaming and had a nursing assistant and a housekeeper against a wall. I was trying to keep her from leaving the unit and she lashed out and scratched both my hands. It took 2 security guards, 2 male ER nurses and a couple of other male staff members to take her down. I don't like psych patients on a med surg unit. The doctors and staff don't know how to handle them...I went through the PACT training and learned some of the ways to protect myself but it didn't come to mind that day. It all happens so fast, it's amazing. I ended up with just a big bruise on my hand but it's something to remember Salinas by.
As for my patient from the last blog, after I picked my jaw up off the floor and held back my laughter, I said "not with this" and pulled the straw out of his penis. At least I caught him before he had inserted it any further, it was only in about a half an inch. I had to tell his resident (new doctor) about the incident and asked if he would tell the patient not to put anything else in his penis. I'm pretty sure it was the first time he heard that. The story ends well, he was discharged 2 days later on antibiotics and voiding well.
Well, we leave Salinas in a couple of days and I still don't have a job. I have been submitted to the Cleveland Clinic but haven't had an interview yet. Keep your fingers crossed for me and I will let you know where we end up.
Remember, first do no harm.

Sunday, July 23, 2006

The Funniest Thing I Have Ever Seen



This is a picture of the beautiful Monterey Bay. It is about 30 minutes from Salinas, we go to there to the coast as much as possible. Which isn't really a whole lot when you work 4 twelve hour shifts a week. It doesn't sound like much but it doesn't leave a whole lot of time off, plus I'm tired. The work really isn't difficult here, I would stay a little longer if we didn't live in Salinas.
So, the search is really on now for my next assignment. I have spoken to about 7 different companies and am down to 2. Nursechoice has an opening in Glendale AZ which is close to my nephew and Agostini (who I am with now) has an opening in Ventura and Oxnard...they don't pay as much but the weather is better...we'll see what happens.
Now, for the heading of the blog...I have to set the stage .I was taking over a patient from an 8 hour nurse who was leaving at 3pm. His diagnosis was rule out CVA .He had been admitted 2 days earlier with confusion. The day before they had discontinued his IV, and his foley catheter.The CVA had been ruled out and his confusion had cleared, so the off going nurse said. He was still on the heart monitor, so I glanced at it while she was giving me report...his heart rate was 125. Already, I'm skeptical, we go in to assess him and his face is flushed and he is definitely not oriented to person, place and time, but he has a history of alzheimers so I wasn't too surprised. I checked his vitals and his temp is 102.3, heart rate 125 but it was sinus tach so it could have been just from his temp. His b/p was 168/94. Ok, what a great way to start the second half of my shift. Luckily the resident was still on the unit so we got some orders. I got an IV started and gave him a bolus, portable chest x-ray was done as well as blood cultures x2 and a CBC and CMP. I also did a straight cath for a UA and C&S. His heart rate continued to be 120-135 despite tylenol and a bolus of 250cc then 500cc. He had no cardiac history so, I wasn't worried about fluid overload. His urine looked pretty cloudy though. So, unfortunately when I left that night his heart rate was still elevated but he felt better and didn't look as sick. The next morning he was again my patient. He had been straight cathed a second time on the night shift because the lab had miss placed my first sample. I went to check on him after his breakfast tray was served and that's when it happened. I swear it happened, I'm not making it up. I walked into the room and he had his sheets pulled down past his waist and he's holding something. He says to me "How do I drain this?" He's holding his penis in one hand and his bendy drinking straw is coming out of his urethra like a little periscope....I almost lost it...what would you have done? I want to know...how do you handle this situation? Next blog I will tell you how I handled it...I should have taken a picture...because I know some of you don't believe me. My guess is he paid attention the day before when he got cathed twice. Reality can be so much funnier than fiction. I do love my job....remember first do no harm.

Sunday, July 16, 2006

Answers


Well it's nice to know people are reading my blog. Sometimes I think I'm just babbling to myself to get it off my chest. Thanks for reading and putting up some comments.
I do love the new nurses and nurses- to- be that read. It's so great to have a dream and have it come to be. Please, all of you new nurses and those struggling through nursing school...please continue, I don't want to work forever!!! It's not as bad as nursing school, I promise. Anyway, an I & D is an incision and drainage...see how we can make it sound not so ugly by just saying the first letters of the procedure... we do it a lot. ORIF...open reduction internal fixation. TURP transurethral resection of prostate.(Oh, just an aside the word is proSTATE not prostrate...two different animals.) LAVH laproscopic assisted vaginal hysterectomy.
The house pictured is the famed Winchester home in San Jose California. It is a lot prettier than the picture shows. See how blue and pretty the sky is way inland from the coast? So deceiving!!!!
I also appreciate the input about finding another avenue of work. I have done that, even while getting paid. I have done mental health and pre-op as well as ambuatory surgery...and it was great..I would go there anytime. At least there you have a definite time that you will go home..not like med-surg when you think you are going home and a patient needs something or your co-worker needs help or you need to finish charting. Just ask my poor husband who waits patiently(most of the time) everyday for me to come out of work. My shift ends at 7:15 and most of the time I am out by 7:30 but some days it's 7:45. Really bad days it's 8:00. Unfortunately it's not like a bank where we can close the door and no one else gets served...not for me anyway. I can't leave knowing the next nurse won't be in with pain meds for at least a half hour. Maybe that comes from living with someone with back pain all my life. That's just how I operate.It's still a great job.
The process has begun to find a new job and a new home. That's my husband's job...he's the travel coordinator. It might be San Diego, it might be Phoenix, it might be Cleveland (go tribe)...I'll let you know. Keep your fingers crossed for something in good weather for the next 3 months..that's as far ahead as I'm willing to look. Can you imagine? Kind of like nursing school...knowing you just have to make it through that next semester or quarter....
First do no harm.