Merry Christmas

Yeah,yeah,yeah so, the title isn't very politically correct...cuz, it's my blog, that's why. Sorry, had to say it. So, how was every one's Christmas? Was the Christmas spirit alive and well in your world? Maybe it was if you weren't working. Boy, people are just plain crabby sometimes. So, you can complain about having to take Mom home on Christmas day and have to look for an open pharmacy or you can be happy that you get to take Mom home on Christmas. Maybe people don't realize they have a choice. So, that was my Christmas, most people were happy to be alive and realized they might not have made it to Christmas if they hadn't had their open heart surgery. But, there were the few who just complained anyway...what can you do?
I am working with a gaggle of brand new nurses. Some have only been off of orientation for a month...it's kinda scary. They seem reluctant to ask pertinent questions, or any questions. I had a nurse talk about having to re start an iv for about 6 hours of our 12 hour shift...I finally asked her if she wanted me to do it. She said no, I want to try, but he has so much hair on his arms. She seemed in awe when I told her she could shave his arm...she finally got the iv but, procrastinated about it all shift.I think she might be a little too nervous to be on PCU, med surg might be better for her. It's still busy but, her patients wouldn't be of such high acuity. Guess we'll just pray and keep our fingers crossed. I'm there to help and guide as much as I can, please remember to ask if you have a question...it could save someone's life not to mention your career.
I heard people complaining about some of the cost saving measures that the company I work for is making. Why are people always complaining? This company had a difficult time filling it's empty shifts a couple of years ago and started paying it's RN's and LPN's double time for overtime, they have decided that this is no longer a cost effective measure, yeah it's sad to see it go, but, now they are just paying us like every other nurse in Arizona. Times are tough all over, it's your attitude that will make or break ya.
Non noc nocere.

Downtown

Well, I had forgotten just how sick some of the folks can be when they come into the hospital. Especially the big level 1 trauma centers, they get it all. Here in Phoenix there are a few, 3 I think, level 1 trauma centers. Since the population of Arizona is largely in 2 main cities (Phoenix and Tucson) and then there are lots of little communities throughout the state, when someone is really sick they send them to Phoenix. This is my first week in my new position, I have had one patient with a chest tube, pca and epidural both of which were set up as pca's...yes, she could control the bupivicaine in her epidural, which was in for the sole purpose of controlling the pain at her chest tube site. Never seen that before. I also had a patient with 2 chest tubes, one was attached to a little accordian looking collection bag (never seen that before) an ng tube, a g tube, a foley and a picc line. The ng was to wall suction plus he was using a yankaur suction for his saliva so, we had to get the old fashioned portable suction. Yeah, more tubes than I have seen in a year, I got them all in a week. They call that initiation by fire. The nurses I worked with, although inexperienced, were very helpful and friendly.
I am getting used to the drive, still not liking it, but, getting used to it. Wish me luck. Non noc nocere.

New position

Ahh, Christmas in Arizona. Ya gotta love the decorated palm trees and cactus. Oh, and the weather it's getting a little cooler 40 at night but still up well into the 70's during the day.
I had my 2 days of orientation fro the hospital this past week and I actually learned some things. I had 2 days of orientation on the floor this weekend and next week I'm on my own. The unit I am now assigned to has had a huge turn over in the last few months. There are a bunch of newbies...like less than a year under their belts. It's kinda scary because these folks are some of the really sick. They need people to be on top of their game and to be able to spot a problem in the earliest stages, which can only come with experience. Things like an transvenous pacemaker, gun shot wounds and lots of chest tubes are being sent to this unit. So, wish me luck. As always Non noc nocere.

Stayin in Arizona

Yeah, how bad can it be to live here year round? Well, I've been here over a year already, survived my first summer, and I still love the weather. How can you not? If it's too hot, drive an hour or so and you are in the mountains. If it's too cold or wet up there, come down to the valley. More sunshine than grey, more heat than cool, what more could you ask for. Ok, maybe a beach, but that's it.
I am a victim of the crappy economy. All the hospitals are tightening their belts, they may not need to but, it's a good excuse. I am now officially a Banner staff member. I got a pretty good rate, plus the insurance is incredibly cheaper, and PTO when they call me off like this week. I tried everything this week to work...the only day I wasn't signed up was Monday...I only worked 32 hours...that sucks. But, Monday I get to go to orientation, again. Yeah, free money, maybe I'll get some orientation on the floor or maybe they will send me to computer class again,lol.
It's been a good ride. If I wanted to work nights in Oregon or days in Rhode Island I could have gotten a travel position. But, I'm beyond all that. I've been nursing way too long to put myself in an uncomfortable position again. Not that a staff position is all that, it's just something different for a while.
Non noc nocere

What's next?

Aahhh, Phoenix in the winter. Dang, you just can't beat this weather, how did I live for so many years in the frozen north? It was 73 degrees at 7:30 last night on my way home from work...amazing. And sunny everyday...the days it is gray are so rare, what a switch from Cleveland.
Well, traveling is getting a little more difficult and not paying as well. I got offered $28/hr blended in California...yuck. As a matter of fact, I cannot find a contract in the state of Arizona at all...so, I think I will be making the plunge into staff nursing. Wow, never thought I'd say that. I just really like my life the way it is right now, and I don't want it to change. I don't want to leave my husband for a job somewhere else again...so, I guess Arizona is my home for awhile. My new boss to be seems very accommodating. She has let a majority of her staff take off weeks at a time for personal reasons or for the holidays. No, I don't love everything about the job or the idea of a pay cut, but, it's better than no job. And it's better than night shift somewhere or ending up in a situation like I had a the other hospital I transferred to. I have already been here 11 months...at this hospital, and been here in Phoenix just over a year. It'll be hard to get used to getting paid every 2 weeks but having PTO will be a nice switch. Yeah, everyone is still complaining about not getting any over time but I think they are just complaining to be complaining... I see them at the hospital everytime I am there...and I'm getting my 4-5 days a week. Gotta let it go, let them keep complaining and see where it gets them, huh?
Well, say a prayer for our troops, take care of yourselves...non noc nocere.

Spoiled

Yep, that's me. Everytime I have to take care of myself I realize it again, I'm so spoiled. My husband is such a great guy, he does everything...ok so, he doesn't have to go to work but, he does everything else. This week I've had to do it all myself. Take the dog out in the morning before I go to work, get ready for work, make my own coffee,drive myself to work, (park in the parking garage which I hate and walk to the hospital) drive myself home, walk the dog, feed the dog and myself..ugh it's like 2 full time jobs. When I was in Virginia at least I only had to take care of myself, ok I was lonely, but, I didn't have to get up so early. Ok, yeah I'm complaining...sorry, like I said I'm spoiled! I have been taken care of and catered to for the last 7 years that we have been on the road...I would not give it up for a second! I will continue to work and have him here to clean and do laundry and take out the trash and cook and take care of the dog...I got the easy part!
I'm sure there are others out there who are in my position, I know at least one and she loves it too...yeah nobody wants to work but, if you do have to work this is the way to do it...my normal life: I get up and shower after I start the coffee maker which is ready to go I just have to turn it on, then I get dressed, get my coffee, get driven to work and dropped off at the front door, get picked up at the front door , come home change my clothes have some food that has already been prepared for me and sit on the couch and watch tv or surf the Internet until it's time for bed. Sounds rough huh? I am very lucky to have the arrangement I have and luckily my husband feels the same way. No, not that I am so lucky , that he is so lucky maybe that's why it works for us. Here's to a loving, caring, give and take relationship!!! I wish it for all of you!
Non noc nocere.

Life...

This is part of the awesome metal display by the Bricktown walkway in Oklahoma City. All these pieces are forged in Norman and brought to the site...it is supposed to tell the story of taming the west...the pieces are bigger than life, just amazing.

Well, it has been a good couple of weeks at my old home. Of course I have been able to work a few days on my old unit. I feel really comfortable there. I feel like I know what to do and who to go to which makes it easier to care for my patients. I went to a different hospital about 2 weeks ago and it was a disaster. I couldn't get the hang of the computer system, I didn't know who to call for what...it really made me feel ineffective as a nurse. There is a huge difference between being a traveler and being an agency nurse. Agency/registry nurses go to different hospitals and different units daily, plus they get almost no orientation to the hospital or the unit until they get there. You have to have a lot of confidence in your skills to do it. As a traveler, you go to the same hospital but it could be a different unit and you get at least a day or two of orientation, so you have been to the hospital before you actually start working and you have some idea where to go and what to do. Maybe I'm just getting old.

On a sadder note, my husband lost his mother this past week. She lives in Ohio and she is an old world Spanish woman. She never worked outside the home, never drove a car, and spoke very little English. She mellowed with age and actually tried harder to communicate with us in English. It was quick and unexpected, but she didn't suffer, which is the only way to go. The down side is no one gets to say their good byes. Tell the people you love everyday how much you love them and don't leave the house angry...just a little advice. non noc nocere.

Workin it out

Just a couple of things you will only see in Oklahoma..ok, that's the only place I have ever seen them. The sign was above the water fountain in a Home Depot. The other picture is of the baseball field at Bricktown with a statue of Johnny Bench. We made the 14 hour trip to Oklahoma to visit with my family and see my nephew who was home on leave from Iraq. It was a nice trip...so good to see family.

I guess sometimes it does help to complain when things aren't going right. I got a call just before I left on my little vacation from my travel company..they said I could go back to the other hospital I was working at and be a tele med surg float over there...hell yeah I took it. I was doing my last 2 shifts at the new place when I saw one of my traveler buddies from the other hospital. I had forgotten that she had asked me like my first day there how it was because she was thinking about coming over there. I had told her it wasn't bad...cuz it was too early and I didn't know. But, when I did see her I let her in on what was happening, then Friday I was with her when she oriented.She somehow got stuck with someone I hadn't worked with before and she didn't have her stuff together. It was also the day they in formed their staff that due to some issues with the flooring ,they were going to close some beds and that they would be having patients in the hallway waiting for the beds of patients that were discharged. Can you believe that crap? You are expected to remove the iv and remove the tele box and give your patient their walking papers as soon as you get the order then, another patient will arrive and sit in the hallway with a little privacy screen around them until the other person leaves...or you could choose to put the discharged pt in the hall or the conference room and have them wait there until their ride comes to get them...hmmm, so much for patient satisfaction. Give me your thoughts...

Non noc nocere.

Workin in the desert

Well, it's been another week ...that means 10 more to go before I get to get outta this hospital. How to survive a travel assignment you hate: grin and bear it, make the most of it, just do your job to the best of your ability. It all sounds like good advise doesn't it? Some people would just up and quit..find a different assignment in a different hospital, I've done that as well. Burning your bridges is never a good idea...hospitals can change when the staff changes or they start losing enough nurses they figure out what's wrong. Plus if you like your travel company, you don't want to piss them off either. Yeah, it's a tough spot. If you really feel like your license is in danger I say by all means call your recruiter and tell them and don't put yourself back in that situation. I have done that, when I was in San Pablo CA..it was absolutely awful..I called my recruiter and I got another assignment...never went back. This hospital, it's just irritating stuff.I will refuse to take ER patients when I get sent back to the ER...that's because it is not in my scope of practice...hopefully they will refuse to have me back. Other than that I will continue to communicate my dislike for the units and staff and the assignments I am given in a constructive manner to my agency. Not that it will get me anywhere but it will have it documented. Wish me luck.
Non noc nocere.

Calling all ER Nurses

Hey there all you adrenaline junkies...my hat's off to you! I don't know how you do it but I am glad you do! My question is how do you feel about your ER being invaded by floor nurses, who are clueless as to how your area works (such as myself), when you all are running short?
I got floated to ER "holding" yesterday and it was a friggen nightmare. My first time down there, no here's where your area is and here's who you can ask for help, no here's how we do things in a nutshell...just here's your rooms. I got stuck with a Registry ER nurse who was willing to help when she could, thank God, otherwise I'd have really lost it. The gave me not their floor or PCU holds...but the BHS (behavioral health) holds...all one to ones and a PCU hold..Then they started moving patients on me and not giving me report (apparently I was just supposed to research the pt myself or go find the nurse who sent them over). But, how was I supposed to know any of that? I get a transferred pt from another room, no report, I thought it was someone else's pt since I got no report...guess it was mine..she had a blown iv an was diabetic who hadn't had a blood sugar check since breakfast and hadn't eaten...VERY NICE. Then they kept tossing the BHS pt to me...then they wanted my to take an ER patient...I said, probably for the hundredth time, I am NOT and ER nurse...but they put her in there anyway..bp 75/50...VERY VERY nice. They said "Shawn will help you" well, I never saw "Shawn", the nurse who was doing discharges took one look at this lady and got to work...she ended up being moved out of my room to somewhere else and we looked at her blood work later...let's just say I don't think she made it.
Then they put another patient in that room and the chic who handled the last one says this one is yours, I just gave her that look...it was a 23yr old who took an overdose of somebody elses meds...also not my area of expertise.
I must tell you that at about 12:30 after the incident with the no-report-patient I called staffing and said that they needed to get me outta there...they said we really can't and sent the supervisor to talk to me...I told her I was very uncomfortable and was being given ER type patients not waiting to go to the floor type patients which I was told I would get...and that I wanted to leave. She listened to me blubber for about 10 minutes and said she would try to get someone to come in early...yeah, OK...meanwhile the Registry chic that was helping me had completely disappeared and I was left with Miss Attitude ER nurse who eventually just took all my patients and I got to go home. I guess they realized what I had been telling them all day...I was just in the way.
So, as ER Nurses, how do you feel when we non-ER nurses come to your area? I understand it would be different if you had a bunch of floor holds and I was there to take care of them...I'm just glad I got out without hurting anybody. Absolutely the worst day of my nursing career so far.
First do no harm.

Is it a full moon?

The fountain at the new Palazzo in Las Vegas. Everytime a new casino opens it is more elaborate and more stunning than the last....ya gotta love Vegas.

Was it a full moon yesterday? Wow, my day started out ok. I went to a different floor at the new hospital I am working at , it was the surgical floor. Not a big deal, I can do surgical. It started off kinda crappy because I couldn't punch in, there was no paper to tell me the punch code for the unit, so, I had to walk over to their sister unit and punch in there, only a minute late not too bad. Then I came back and get report, doesn't sound too awful. They came from Interventional Radiology and swept my patient away while I was in another room...didn't get to see him. Then I have the guy who's wife is a nurse (great), someone else going to surgery, somebody with back pain and a copd pt. The morning was ok, trying to find my way around the floor and learning the flow...my other guy goes to surgery, and I get to eat lunch. When I come back, my first guy comes back from IR with a stent in his leg and has to lay flat for 5 hours, my other guy comes back from surgery in pain, my pca has to be changed, my copd pt thinks she has a blood clot in her leg and calls her family who calls me then....

My back pain guy calls me and says he's in a lot of pain in his face...I went to his room and he is squirming around in the bed, his jaw is all clenched he feels like he can hardly breathe, he is majorly freaking out...and secretly so am I ...no idea what is up with this guy. He says he feels like his head is all distorted and he can't close his eyes.or open or close his mouth all the way and he really sounds like he's having trouble breathing. So, I use my calm voice and hold his hand and tell him to breathe through his nose. The cool thing about this hospital is that the hospitalists are on the floor from like 8 in the morning to like 6 at night..literally they see everyone on the unit and they have a little office they sit and chart in. So, I go and get the doc...we give him Ativan and it helps a little...the doc asks what meds he is on and one of them is IV Reglan...you can see the light bulb go on above his head he says give him Benedryl and Cogentin..IV. I have never given cogentin IV before but, it worked! The guy was having an acute dystonic reaction to the Reglan. Never seen it before in my life...I have given Reglan hundreds or maybe even thousands of times...and this guy had been getting it for at least 24hrs...weird. He was very nice and grateful for us being there and helping him so quickly. I told him he taught me something and he thanked me again for being there and being calm.

It's weird how that happens...in that emergency kind of situation...I can keep cool and not look freaked out even though inside I'm going "Oh my God, Oh my God, Oh my God...somebody help me!!!!" I don't like the feeling and that's why I don't do ICU...stuff like that happens so fast and it happens all day long...my little heart couldn't take it.

So, after all that you'd think I'd get a break or something, like in football after a really big play the wide receiver gets to sit out a down or two to catch is breath..nope I'm right back in the game. Giving my pain meds, checking pulses, giving insulin, printing out education materials...constantly moving constantly checking my patients...you'd think I'd weigh about 100Lbs with all the walking I do,huh. Fate.

Non noc nocere.

Vegas

Hi all,took a few days off for my wedding vow renewal. Here we are after the ceremony in the conservatory at Bellagio. Behind us is a miniature of the Bellagio and a miniature Bellagio fountain...only in America. We did a drive up wedding, it was as expected. I would probably pick a different place next time we went to A Special Memory Wedding Chapel on a Sunday afternoon. It looked pretty deserted, we picked from the "drive up menu" but we were told some of the items they no longer offered like the commemorative photo. I was not really happy about that one...our only option for pictures was a package of 6 which would cost $70...no thanks. We did our vow renewal ($25) and had to pay the "minister" her gratuity (no less than $40) for our 5 minute ceremony. It's was an experience. I found that people are really nice to you if you are wearing a veil..they'll even take your picture and not steal your camera!!
This week I started at my new assignment, 8 miles in the opposite direction of the other hospital. I find that a new building and "healing" surroundings doesn't actually change how it operates. It's the same stuff in a prettier package. Same amount of patients going and coming and no team work. The charge nurses are still just a voice on the vocera or a piece of paper on your desk with another patient's name on it. No thought to how many patients you have already admitted or even ask if you've had a break, she was nice enough to take report for me so that I had absolutely no warning that my patient was coming and then poof she was just there in the room. Yeah, it's like that.
I do miss my friends at the other assignment.. I was hoping to go back there prn but, I don't know if that will be possible either. Computer glitches might prevent it.
Sometimes I do wonder why I continue in this field, then I get the paycheck and the reasons are a little clearer...sometimes I even get a thank you and then I know why. Non noc nocere my friends.

Summertime

So, my nephew was here for a week and we went to see the D'Backs play. It was a good time. My sister was here for 3 days and we just shopped and relaxed. I wish she would have stayed longer...but, that's the sign of a good visit huh? That they leave and you wish they would stay longer, not the other way around.

Plus, I get 4 days off in a row (woohoo)then it's off to Vegas for 3 days. Work has been good, not too busy not too slow. The patients have been much of the usual. Too young to be as sick as they are,but, since they didn't take care of themselves ...they are in the hospital. Most of them smokers, who think they are ok cuz they can still talk and walk, they think they can keep smoking...never mind the fact that they couldn't breathe when they came in or that they just had a triple bypass...they are fine now and all they need is a smoke. Or the alcoholic who was back 2 hours after they were discharged so drunk that they ended up in the ICU....pretty sad.

6 more shifts then I'm off on a new venture. I have a computer class next week for the new hospital...the doctors over there have to enter all theire notes and orders into the computer...yeah! No more bad penmanship!!!!We'll see how well it works. Wish me luck!

Remember..first do no harm.

What do you thnk

I just read an email from my nurses e news and I am not sure how I feel. It seems the US government has a proposed bill..HR 5924 to get rid of the cap of 20,000 work visas per fiscal year for nurses and physical therapists from other countries to come here and work. It is proposed as the Emergency Nursing Supply Relief Act. It also allows for more grant money for nursing schools which I wholly agree with. I am just on the fence with the influx of foreign trained nurses.
The floor I work on now is very culturally diverse. The problem I have is not with the nurses themselves it's with the communication barrier. We do walking rounds at our facility when we change shift. I introduce the next nurse and sometimes the patient will make a comment or try to make a joke and the nurse doesn't get it, the patient looks at me with a nervous look like "she can't understand me" I have to say it's gonna be a good night and leave. I feel awful for the poor person in the bed. They have to be thinking, what the heck am I gonna do, I can't understand her and she can't understand me, what country is this? That's what I would think. Most people don't have to deal with the diverse dialects and accents that we do on a daily basis, it's just not as easy for them to understand the accents. It's got to be scary for them.
I also had a patient who complained of a little chest pressure but denied pain so the nurse did nothing about it. When she told me in report that he complained of a little chest pressure since 6 am and it's now 7am. I got right up, didn't let her finish her sentence, and went to check the patient. I think it was a combination of a lack of experience and a weak grasp on the language that caused her not to act. He was complaining of chest pressure, but had not gotten any nitro and didn't even have any oxygen on, very basic stuff. The patient ended up in the cath lab by 8:15 and had 2 stents to his RCA. For the non-cardiac nurses out there...that's a BIG DEAL. It's scary to think what could have happened if the nurse following her also had a weak grasp on the language or was as inexperienced.
I am not sure that allowing more foreign trained nurse to come and work here is the answer to our shortage. How about making it so nurses want to stay in nursing? How about cutting out some of the paperwork stuff so we can spend more time with our patients and give them the care they need? A lot has to do with work ethic as well, which is lacking in the USA in general. Nursing is a career not just a job. It's bettering people's lives, or trying to at least positively impact them, not spending half the day on the Internet and the other half on your cell phone.
There are lots of great people out there who would love to be nurses and they are getting put on a waiting list for nursing school...then they find something else to do because it just takes too long to get in. There has been a nursing shortage since I started back in 1991...I wish I knew the answers...any ideas?
Non noc nocere.

Another fun in the sun week

Hey all, how are ya? We are still having a good old fashioned Arizona summer. Very hot but not humid and no rain to speak of. Today is by far my favorite of the last 2 weeks...it's about 85 and cloudy...of course it's only about 8am but, it's a nice change.
I've done a lot of running around the last week...my nephew is here for his summer vacation. His Mom's idea to send him to 110 degrees for a vacation, not mine. We've been able to do a few outside things but, I'm sure not as much as he'd like. I'm glad he is old enough to entertain himself a little. It's really difficult to get used to having another person around 24/7 when it's just been me, my husband and the dog for so long. I think it would have been great if it was only for 3 or 4 days...but it's been 8.
Headed to a baseball game tonight...D'Backs vs. Pirates. I wonder who will win?lol The D'Backs have been doing very well this season again but, my heart is in Cleveland. I also love the Cubbies (ya gotta have a winning team as the back up). I love Chase field though...how awesome is an indoor baseball field? with a pool? and a/c? Only in America.
Work has been ok...only 3 days of work last week, I haven't done that in ages. It was nice to be home. There was the usual excitement of an alcoholic patient with chest pain going into DTs, I had a COPD pt come back from the cath lab after a pacemaker that I had to give Romazicon to...that was a first for me. Never had to give the stuff before, it works like a charm. This poor guy, if he didn't have his bipap on and a pacemaker in he woulda been a goner...one shot of Romazicon in the IV and he was awake and talking. I'm glad my other patients were stable because he took all my attention for over an hour. Not so lucky was some poor lady the day before. She apparently came back from the cath lab along with 2 other patients to the same nurse in a short period of time...all the circumstances are unclear except the end result, they had to call a code on her and she is now in the ICU. Now, that's a bad day.
My problem is with management. We have a charge nurse or CM as they call it. They walk around asking when our patients will be discharged and handing out the admissions without much consideration for the patient or the nurse. If you have 3 empty rooms they will give you 3 admissions. If you have 3 patients going to the cath lab, oh well. No back up, ya know sometimes you are so busy you don't have time to find them to ask for help, but they are so removed from the idea of real nursing in 2008 that they don't get it. These are nurses who have been in their position for YEARS like 10 or 15, they don't understand what it's like to be in the trenches anymore. They always get their lunch break and their 15 minute breaks throughout the day. They randomly dole out the assignments for the next shift without looking at the day before or what kind of acuities they are handing them...I was in lower management for awhile. I know what it's like, but I got in there and paid attention to how my nurses were doing and helped out where it was needed.Just frustrating I guess, to see the patients suffer from a lack of leadership. Maybe the next hospital will be better. I think that's my problem, I think I like a place then the longer I am there, the more I see, and then I need to go. Just a traveler at heart.
Thanks for listening to the ranting...any comments?
Non noc nocere.

Email excerpt

Just a little bit if the desert for ya. I can't decide which I like best the cactus or the palm trees...you can keep your fall leaf changes and the summer humidity, I'll keep the heat, the cactus and the palm trees.
This is a little excerpt from an email from my favorite nurse:

Long day today. I admitted an Indian woman yesterday from the ER. She had 32 home medications which were not written on the med reconciliation form and No allergy band on from ER. She went to the ICU at 0300 today for respiratory failure. I got her back not bathed, from ICU at 10AM. 25-30 relatives at her bedside. Well at 1820, after being in the room for the last 20 minutes of her life,the nursing supervisor tells the Organ donor bank that she is a white lady. Well,that fried me for some reason and I told him Hey she is no white lady she is Native American. I did not see her grandson standing nearby but, he stopped me in the hall and thanked me for correcting him. She would appreciate it. Long day.

Sometimes it's the little things...they can either make your day or just mess it up. The 32 meds not on the med rec form and the allergy band not on the patient from the ER will most certainly mess up your day. I find it happens a lot from the ER...all over the country. I know they are busy down there, I've worked there a couple of times but, they still need to be held to the same standards as the rest of us...just those little omissions can cause error.
Getting your patient back from the ICU without a bath or at least smelling like they got no bath seems all too common as well. Most ICU's bathe their patients at night but, I have run into some that don't get it at all...maybe it's too basic of a nursing chore for them...that's one of my peeves. I know you are trying to keep them alive and it's really busy but if they are well enough to come to the floor then you should give them the decency to be clean when they get there. Getting a dirty patient half into your shift can really make for a messed up afternoon, cuz then you have to stop and clean them up before the hoards of family members come to see them. Minimal visitors and lots of weird smells in the ICU can mask it for ya but, no so on the floor. Plus, I don't feel like I have cared for my patient if they appear dirty or unkempt.
Just that 2 seconds it took for the grandson to thank the nurse can make your whole day seem worthwhile. After all, it's what we need, just for someone to notice that we really do care. After a long day of family in your face, patients being crabby, poor staffing, nurses whining about their assignments, doctors yelling, and your boss not backing you up, it's nice to hear something positive.If we didn't care, we wouldn't do what we do. Just one sincere thank you for a little thing can make it a good day.
We can do it for our co-workers too...let them know if they helped you, tell them you appreciate it. It just might make them have a good day.
Thanks to my favorite nurse for sharing and for caring enough to be the very best....
Non noc nocere.

Heat is on

That's right, the heat is on...33 days over 100 degrees. But, the humidity has still been low, until this past week. The rain and clouds and the wind, it's monsoon season finally. All the native Arizonans are soooo happy, they actually go outside to be in the rain.

I have had a long week, the beginning of the week my patients were great and I went home feeling like I did a great job. Yesterday was a different story...just really had people that got on my nerves. It should be ok for me to not take care of someone if they refuse to help themselves. If you know what you are doing will kill you and you refuse to even try to stop...I should not have to help you or put my taxes toward helping you. I have 2 examples:

A 40ish year old male with chronic back pain and a HUGE family history of heart disease. He has already had stents placed in the not so distant past. He comes to our unit for chest pain and continually leaves the floor to go and get his Pepsi (since we can only give him Shasta colas from our floor stock and that's not good enough)...yeah he comes back with a Pepsi but also smelling of smoke. I repeatedly explain to him why it is unsafe to leave the unit, especially when he complains of sob and chest pain when he returns. He has not stopped smoking since he got his stents. So, he goes to the cath lab and comes back needing a CABG. He has had a cath before, his bedrest is only 4 hours and he is doing everything he can to try to get out of it. Then, he's up smoking in the bathroom. He says it's driving him crazy that he can't be the one who decides when he quits smoking, he wants to go home and set a date for 3 weeks from now or so and then he will be able to quit...wow, can you believe that logic? Not even the reality that he could have a massive MI and die is enough for him to want to stop doing what is killing him. Amazing, he doesn't think enough of his life...I know all you smokers out there are saying..you don't know how it is, it's hard...well, yes I do and yes it is hard but you have to want life more than cigarettes. I don't think the residents of Arizona or the US should have to foot the bill for this guy to have a CABG when he doesn't even want to try to quit smoking.

Do I sound angry, or bitter? I also had a female patient come in with chest pain, she's about 40 years old, also a smoker and morbidly obese. She says she goes to see her primary care doctor every couple of months for her high blood pressure. Her glucose level was well over 300 in the ER as well as her urine being positive for amphetamines and opiates. Her cardiac enzymes are way out of range (her troponin which should be less than 0.01 is 57). So, off to the cath lab she goes, her vessels are so bad they had to go through her brachial and even then they couldn't see all they needed to see..but what they did see was not good. She ended up going home on meds because the chances of her being able to survive the CABG were so slim...this woman is also on disability and she's out there getting high and killing herself by smoking and over eating and generally not taking care of herself. I was really glad that she wanted to go home on the meds, I don't think she'll make it which is pretty dam sad to say for someone so young, but she isn't doing a whole lot to help herself either.
I think that's my message for today, and why we as nurses can get burnt out. If people are out there and they know what they are doing is hurting them, yet they keep doing it, why should I have to try to help them when they won't try to help themselves? Why do we spend millions of dollars on healthcare for people who turn around and continue doing what got them in bad shape to begin with? When does the responsibility get shifted to the patient?
Really glad I got the day off today. Kinda sounds like I needed it huh? Remember non noc nocere.

Computer Crash

So, I had a great day off yesterday, I slept in, I exercised, I got to swim in the pool and enjoy the sunshine. Oh yeah, it's monsoon season...still waiting on some rain. My dog is thrilled that it never rains...she always hated going out when it was wet. Luckily we bought a house with desert landscaping, so, not much water needed there either.
The last day I worked was Tuesday, we really thought it was April 1st not July 1st...I guess we'll call it July fool's day...what a mess. Some how our computer system at the hospital crashed. It started out running really slow when I passed my morning meds...thank goodness it was my second day with these people and they didn't have a ton of meds. I actually got done at about 8:45, and I took a break...yeah I do it when I can because the opportunity doesn't come along too often. By the time I got back there was an irritation in the air. The doctors had started doing their rounds...there was much grumbling and a lot of mouse punishment going on. You know how it is when the computer just isn't responding so you pick up the mouse and slam it on the table a few times to wake it up...yeah it doesn't work people. It's not a real mouse, it's not sleeping, you don't have to wake it up...the problem is in the computer. Maybe I shouldn't tell them that, they'll be slamming the tower against the desk next...lol. So, first it was just taking a really long time for the pages to load, then they are timing out, then you get kicked off, then you can't even sign on to the program so everybody starts rebooting their computers...because communication is sooooo wonderful in the health care field, there have been zero announcements about the computer problems. But, everybody is complaining. Some of the docs are really verbal, " How do they expect me to do my job? None of my patients are going to get discharged today with all this going on, I was going to discharge 10 people now only 4 get to go home." It was getting bad. The we found out it's not just our hospital, it's not just the hospitals that belong to this certain company in the Phoenix area either. They have hospitals in AZ,CO,WY,NV,CA,AK and they are all down...what a nightmare. Plus the hospital where I work has only been live on the computer system for nurses to chart for about a month...so, there are a lot of people not comfortable with it yet. Now they are being asked to go back to paper charting until the computer comes back up....what a headache!!! Thank goodness my patients were angels and didn't need much charting. The issue was completely resolved at about 6pm just before night shift came in. And they got an extra nurse to help them....WHAT????!!!! the problem is solved what do they need an extra body for? Maybe, the band aid might not stick huh? SOOOOOO glad I had a day off yesterday!!!Guess we'll see what happens when I go back tmorrow.
Remember our troops and have a Happy and safe 4th!!!
Non noc nocere.

IT'S HOT!!!!!

Yep, it's summer in Arizona. I wasn't sure how bad it was going to be and I'm sure I haven't seen the worst of it yet...this past week the average temp was 112. I didn't mind much because I was at work...but we did have a couple of admissions from heat stroke. I had a guy who likes to keep his apartment at 85 degrees and actually called his maintenance guy because there was a draft coming from the fan in his bathroom(WHAT???). His rectal temp on admission was 104.8...nice...and he has 7 college degrees.Bright but not smart.
My boss is trying her hardest to get me to come on staff. I have a really hard time with that. I have been traveling for 7 years now and it would have to be a really exceptional place for me to decide to stay. I had a day last week where I got my cath patient back at 6pm. She had an ablation so she came to the floor with one arterial sheath and 5 venous sheaths in. She was oozing when she got to the floor, I was so thrilled. I called to get my CM (charge nurse) to come up and take a look at her. The CM's get report at about 6:30 so they are usually off the floor at that time. Well, they didn't come to help me. One of the internal med docs came to see the patient and was not happy about the amount of oozing so he called the cardiologist who said pull the sheaths. Ok, well, the patient has been on coumadin her INR was 2.6 and they had given her heparin during the procedure...not a good combo for pulling sheaths..plus it's the end of the shift and I don't pull sheaths.So, I call the CM again..it's now about 6:30. She finally gets there at about 7:20 and says oh it's not so bad...then she takes the dressing down....yeah, she realized then that she should have come up a long time ago to pull them...she pulled at 7:29. Yeah, I know what you are thinking "but, your shift ends at 7:30" yeah most days. I did end up getting out of there about 15 minutes later because the house sup came to help the CM hold pressure. I'm pretty sure they were there for a LONG time. So, that's just one example of why I would not jump at the chance to become staff.I don't feel I have the resources I need to provide the best care for my patients.
There are a couple of other hospitals close by that are in a different conglomerate...they are CHW hospitals. I have an orientation there through my agency the middle of July so, we will see what happens with that. The only time I have had a problem getting a contract here in Phoenix is in the summer and my contract ends the end of August so, I am not too worried.
As always, first do no harm.

Moved in and moved on

So, this is a picture that my husband took of our friends when we went on our boat trip. Jeannie has the hat on and Don is her husband (sitting behind her) and Shirley is sitting next to Jeannie. Jeannie and her husband went back to Napa to be with their daughter. It's been a little over a week and I still really miss them. It was nice having friends in town. We moved into our house officially one week ago, last night I got to sleep in my bed.. it was wonderful. When I came home from work I went out back and put my feet in the pool for a while. Then we sat on our double chaise lounge under the stars and talked. The temperature was about 75 or so it was very comfortable.
I had 8 days off (to move in)and then worked 4 in a row. I don't like working 4 in a row. I get really crabby on day 4...I had the same patients for almost the entire 4 days, which, in a perfect world would be great, but, I had the drug seeker who would follow me around in his wheelchair ( I still would like to know who gave him a wheelchair) and ask if it was time for his Dilaudid; I had the slightly confused old guy who cried and complained all day about how awful he felt, no matter what I did or what meds I gave him he felt awful, but he watched tv and ate ice cream at the same time; and the 300+ lb woman with a chest tube who had to be lifted from her air bed to the chair for all her meals. So, it was a very long 4 days.
Today I plan to catch up on some emails and to sit out by my pool. I am scheduled again tomorrow and the next day. Census dropped a little during Memorial day but, we have been full ever since. My boss is trying to get me to go core staff...she has had a traveler there for the last 3 years who is still there and there was another one that moved to a different floor this month who had been there for 2 years...so, I am not going to cave...there are plenty of travel jobs in this city...yes, I like this hospital but, not for a $10/hr pay cut.
Well, hope ya'll have a great day. Remember first do no harm.

Loss

Above is pictured my favorite Uncle. He had a battle with cancer and copd for the last year.He was put in hospice on Thursday of this week and passed on Friday. It makes it all too clear that you must live your life not just be alive. He had a surgery last year which made it possible for him to travel and visit friends and family. The other lesson this has brought home to me is take care of your body and it will take care of you. You cannot over indulge (in anything) and expect not to have any consequences. Ok, I'm off my soap box. He was a great guy, always had a big smile and a kind word. He had a fantastic voice, bass baritone, I loved to hear him sing. I took a travel assignment last year in Columbus Ohio to be near him and my brother and to buy our house there. I am so glad I got to spend that time with him. I hated the job and the weather but it was worth it to spend that time there.
Thanks for listening.
Remember our troops and all those who fought before them...it's Memorial Day. Be a proud American!!!
Non noc nocere.

Marathon for computer charting

Well, I made it. We are the last of the Banner hospitals in Arizona to go live with their computer charting. I worked the whole first week. Since I used the system before I got to be a "super user" and spent the last 3 days of last week helping the nurses find their way. I have a new appreciation for those of you who know how to type, even just a little. The hardest part was helping to teach those who don't use a computer at home on a regular basis. If you have to study the key board to find the letters, you should have practiced. If you cannot click and drag, you should have practiced. If you cannot scroll without clicking your mouse a bazilion times, you should have practiced.
The biggest thing I learned, a new tool doesn't change old bad habits. If you want to pull all your meds for all your patients for the whole day, you'll still find a way to do it, even with a newer better system. If you didn't check the meds against the mar and check the name band before you gave them before we got computer charting...you won't now.
All I can do is never let my family members go to the hospital or stay in the hospital alone.
Non noc nocere.

Happy Nurses Week

Well, it's that time again. Nurses week, it used to be a day...now it's a week. The hospitals usually give you some free food and some free stuff and say they appreciate us. I think about god old Florence, she did it because she cared about people and wanted to make them feel better when they were sick and hurting. I'll bet her patients were mighty grateful for every little thing she did for them. Her nursing was about fluffing the pillows and keeping them clean, dry and warm. Have we lost sight of that somewhere along the way? Some days it seems like nurses just come to work to see their friends and check their email or surf the Internet. Some days it's like we are there just to pass out pills and food. This May 6th (Florence's birthday) I am going to honor her by wearing all white. I try everyday to be the best nurse I can be to my patients. Looking back, yeah there was a time in my career that I cared more about seeing my friends than taking care of my patients. Traveling has helped to cure a lot of that, when I start somewhere I don't have any friends to worry about. I focus a lot more on my patients needs than what the other nurses did over the weekend. I think that's what it's about. Being the best nurse you can be, every day, like Florence did. Have a great nurses week!
Non Noc Nocere

The Code

Hey all...yeah it happens to all of us. I was transport nurse for 8 hours then took over for a nurse that went home. Things were great at 4pm...all of my patients were happy and healthy just waiting to go home in the next day or so. My best patient had finished her walk around the unit with her chest tube and was sitting in her chair visiting with her friend... when her friend came out and said that her friend (my patient) felt dizzy. I went immediately to her room after checking the monitor and she said she felt dizzy, we immediately got her back to bed and by then she couldn't complete a sentence and her pupils were fully dilated. We coded her for about a half an hour. Thank goodness her friend was there because she was in PEA for a while. It was devastating to me. I hate to code patients,especially my patients, but this one I knew there was nothing I could do. As we laid her down in the bed, she couldn't form a complete sentence, and she looked into my eyes and started to cry. It is really a strange predicament to be in. But, it really makes you think of your life and how quickly it can change. (She didn't make it)
Ok, on to better subjects...today is my birthday. It has been a great day..ok so all of my siblings didn't call or email me happy birthday..but my friend Jeanett called from Ohio to say she missed me at the Louie Run today ( a motorcycle ride named for a guy in North East Ohio that benefits lots of different charities) and my friend Frank called from Kentucky. Frank has the same birthday as me and is married to one of my best friends Frankie. We took a boat ride on Saguaro Lake with our friends Don, Jeannie, and Shirley. We had a great day and went to the marina diner for lunch and it was a great day.
I am still waiting for the bank to decide if I am going to get this house or not but I am finally stabilized here for another 3 months...at least till the end of August. So, another year and none the worse for wear. Non noc nocere.

Waitin on a contract

So, I'm waiting on 2 contracts right now. Number one is for the house pictured above. It is in the neighborhood right next to our apartment. It is a foreclosure and has been vacant for a year. Yeah, the pool is a little low and green... the weeds are a little high in this picture...luckily the HOA has since cut them down for us. The inspection is done but we are still waiting for the OK from the lender...so that's one contract. We are hoping to buy this house at a discount, live in it for a year or two and then sell it for a profit.
The second contract I am waiting for is from Banner for an extension to stay working at the hospital I am in now. About a month ago I asked my boss if she needed me for the summer and she said she wouldn't know for a few weeks. So, now that it is getting close to being a month away from the end of my contract, and with everyone elses contracts ending the end of May too, we are all getting a little nervous. I would just like to be able to stay at this facility for a little longer. I like the people I work with for the most part and the work is not very annoying. Let's just say I can tolerate it for a few months longer. At a increased rate of pay, because I will get a housing stipend instead of an apartment...that stipend should pay my mortgage, plus I will still get my same hourly rate. Of course at the other end I will not get a bunch of write offs for my next years taxes but, I'm ok with that.
All that aside I had a very phlegm filled week this week. Our cardiac unit has turned respiratory on me. I had 2 COPDer's , one CP and a suicide. Yesterday my suicide was discharged to inpatient psych and I got an ESLD. My least favorite was the 49 year old Cerebral Palsy patient...he was nice enough but barely functional and just coughing and coughing and I was so afraid he was going to choke when I fed him. Speech therapy said he was ok, just a delayed swallow, just not in my comfort zone. But, I have 2 days off and next week is another week.
Remember non noc nocere.

Poem Crabby Old Man

This is a great story whether true or not...

When an old man died in the geriatric ward of a nursing home in North Platte, Nebraska,
it was believed that he had nothing left of any value.
Later, when the nurses were going through his meager possessions,
They found this poem.
Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.
One nurse took her copy to Missouri.
The old man's sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the St. Louis Association for Mental Health.
A slide presentation has also been made based on his simple, but eloquent, poem.
And this little old man, with nothing left to give to the world, is now the author of this ' anonymous' poem winging across the Internet.
Crabby Old Man
What do you see nurses? .What do you see?
What are you thinking.....when you're looking at me?
A crabby old man, ...not very wise,Uncertain of habit ........with faraway eyes?
Who dribbles his food.......and makes no reply.
When you say in a loud voice.....'I do wish you'd try!'
Who seems not to notice ..the things that you do.
And forever is losing .......... A sock or shoe?
Who, resisting or not...........lets you do as you will,
With bathing and feeding The long day to fill?
Is that what you're thinking?
Is that what you see?
Then open your eyes, nurse......you're not looking at me.
I'll tell you who I am . As I sit here so still,
As I do at your bidding, .....as I eat at your will.
I'm a small child of Ten.......with a father and mother,
Brothers and sisters .........who love one another
A young boy of Sixteen .with wings on his feet
Dreaming that soon now. ......a lover he'll meet.
A groom soon at Twenty ..my heart gives a leap.
Remembering, the vows......that I promised to keep.
At Twenty-Five, now ........ I have young of my own.
Who need me to guide .... And a secure happy home.
A man of Thirty ......... My young now grown fast,
Bound to each other ...... With ties that should last.
At Forty, my young sons ..have grown and are gone,
But my woman's beside me.......to see I don't mourn.
At Fifty, once more, . Babies play ' round my knee,
Again, we know children ....... My loved one and me.
Dark days are upon me .. My wife is now dead.
I look at the future ..............I shudder with dread.
For my young are all rearing......young of their own.
And I think of the years....... And the love that I've known.
I'm now an old man.........and nature is cruel.
Tis jest to make old age look like a fool.
The body, it crumbles..........grace and vigor, depart.
There is now a stone........where I once had a heart.
But inside this old carcass .. A young guy still dwells,
And now and again .......my battered heart swells
I remember the joys........... I remember the pain.
And I'm loving and living.............life over again.
I think of the years .all too few......gone too fast.
And accept the stark fact........that nothing can last.
So open your eyes, people .......open and see..
Not a crabby old man.
Look closer....see........ME!!
Remember this poem when you next meet an older person who you might brush aside without looking at the young soul within.....
we will all, one day, be there, too!

More days off

This tomb is in Papago park next to the Phoenix zoo...it is a great place to look out over the city...especially at sunset. It was one of our stops with my niece because it's right next to the hole in the rock.
I had another 3 days off this week for my husband's birthday. We didn't do anything spectacular but we did go house hunting. Hey, what can I say ,it's what he wanted to do. We found a cute little house right down the street from our apartment that has been vacant for almost a year...sounds about right for us. It is a 3 bedroom 2 bath with a pool...we'll see what happens.
Work has been frustrating because we still have our doctor's father. I feel badly for the doc...trying so hard to keep dad comfortable. We have been having some staffing issues...people not showing up for their shift and late call offs. Sometimes it can't be avoided...and I prefer if you call instead of not showing up at all or coming in and then leaving because you don't feel well. You know you don't feel well when you get up so, just take the points or the attitude from the staffing people and call. Don't, don't, don't think you will feel better once you get to work because you will just end up going home and leaving everyone in a worse position.
I have to ask...how many people will go into work if the staffing office calls you and asks you to come in? Does it depend on how you feel? How much they beg? Do you even answer the phone? Would you be more likely to say yes if they called you the night before if you are a dayshift person? When is a good time to call a nightshift person to come in? How likely are you to stay a couple of extra hours if you are already at work and the next shift is short?
Here's my position. I will pick up extra days when it is convenient for me...not 4 in a row or more ...don't even ask me if I have been there for more than 2 days in a row. Call me the night before if you have an idea...I will most likely not come in if you call and wake my butt up at 5:30 am and ask me to come in. Now, when I was working agency, that was the norm, I had to wait for them to call and tell me where I was going to work that day so I was up anyway. It also depends on my wallet...and how much cash I need. What's your take on it? Just wondering.
Remember first do no harm.

Desert in bloom

What a great week! We went for a little nature hike one day and got to see the desert in bloom...some really vibrant colors. Not a lot of color, which makes it even bettre just splashes here and there. I had so much fun sitting by the pool and shopping with my niece. We took her to a little restaurant that we had gone to with our friends. They serve a lot of senior citizens...lots of cheap food...it was fun. We went to the workout room at the apartment complex and played racket ball as well. It was fun playing the cool Aunt.
Went back to work on Saturday and Sunday, nothing too exciting. The boss actually came in on Saturday. She told me one of my crazy patients had called administration and told them how nice I was. Yeah, how much weight does that statement hold when they know he's crazy? Does it just show my attraction for the bizarre? This is a guy who has been admitted to the hospital 15 times since the beginning of the year...not to mention all the times he was in the ED and was not admitted...for chest pain. When I had him he got a Psych eval and the Psychiatrist even said he was and odd bird...she couldn't tell if he was schizophrenic, drug seeking or just plain odd.At least he didn't tell them I was crazy,huh?
Headed to class today...at least I got to sleep in. It's a refresher so, hopefully I'll retain something. Then tomorrow, it's back out to the pool. Yeah, traveling sucks.
Remember first do no harm.

a week off

Yep, a whole week off...one extra day cuz I was sick. Beware of food brought in for "pot luck". I usually have a pretty strong stomach, but it really got me. Easter dinner...better with family. So, my neice is here for a week. I get to play the cool Aunt..as close to being a Mom as I ever wanted. Seems weird what with everyone else in my family having one or more off spring. I'm lucky I just get to enjoy them all. So, we will be spending a lot of time at the above scene...the pool, so she can got back home to the frozen north with a little tan and make her friends jealous. My oldest sister is in the happiest place on earth...Disneyland...don't envy her. She is there with her 4 kids and 5 grandkids...sounds like fun to some...can't wait to see the pics. Be safe and find some time to enjoy a day off.
Remember non noc nocere.

Busy,busy,busy

Well, this is one of my favorite places...it's called the hole in the rock. It's in Papago Park in Phoenix. It doesn't look like it from this picture but you can stand in the hole and look out over the city. We stopped there on our way home from a baseball game last week. Yep, baseball is alive and well in the Cactus league..we saw the D-backs and the A's. It was actually a pretty hot day...about 85 and sunny.
My nephew has made the trip to Iraq...he is currently about 11km southeast of Baghdad. Still doesn't seem real to me. Please keep him in your prayers.
Got some bad news from a traveler friend, her husband's sister's body was found Tuesday near a lake in York PA. She was a high school teacher and had gone out for a hike Sunday and went missing. They suspect foul play but are awaiting the autopsy results.It just makes me shake my head, what is happening to this country when you can't even go for a hike in rural PA and return safely? Please also keep them in your thoughts.
I've been working my 4 to 5 twelve hour shifts a week. It's been really heavy at work...one of my patients was on the floor the other morning when I went in to see him...ya gotta love to start your day that way. We had to use the Get-a-lift to get him off the floor...he's a big guy and really sick too. I was really impressed, even the nurse manager came in to help. I've had a couple of nice old guys the last couple of days as well, they love to talk about the state of the country. I love to get the time to talk to them, some of them have such great stories.
Well, headed out to the game again...Cubs vs. Rockies...be back with pics.
Remember first do no harm.

One of those patients

We've all had them...the patient that just won't leave...every time you go into work you just hope they have gone home or to another floor or anywhere that you won't have to take care of them. It's not that they are a difficult patient or even really sick...maybe that's what irritates me. I like my patients to come in sick and go home better not linger in annoyanceville forever. Mine most recent one is still on the unit and I have had him everyday that I have worked now for 2 weeks straight. He has TGV(transposition of the great vessels of the heart) and he needs a transplant...the doc is trying to prove it by bringing him in and putting him on dobutamine, now he's dobutamine dependant. It's a fight with the insurance where to send him for the transplant...but he's not even on the list yet. Makes going to work just a little more annoying.

Had a great trip to Las Vegas...saw the new Palazzo and a great little place just off the strip called Tuscany.It's always changing, they are building a lot of new stuff. We followed our friends advice and took the southern route from Phoenix into Las Vegas. We got to go through little towns like Searchlight Nevada...plus we hit Arizona, California and Nevada...always a plus to hit as many states as possible in your travels. The ever present question...did we win...well, yeah we won some we lost some but, it didn't affect our financial standing so, it was a good trip. Still waiting to hit the big one...as always first do no harm.