New nurses and nurses to be

Just a few thoughts...for all of you nursing students and new nurses. Please use the time at clinicals to learn and do new stuff, not look in your books and hide in our breakroom. You only get so much time to learn, pretty soon you will be expected to do it. Please treat your patients like they were a beloved family member, or just how you would want to be treated. Spend your down time talking with them, walking with them and getting to know them, it will help you to better care for them.
Please stop whining about how much you have to read, how hard your papers are and how long it takes to get your test scores, it's meant to be stressful, because nursing is stressful. Be grateful you can see your test scores online in a matter of hours, we had to wait until the next class (up to a week,OMG)
I would like to remind you that you are lucky. There was a time when the NCLEX was only offered twice a year in major cities across the country. It was an eight hour a day 2 day test.It was a paper and pencil multiple answer exam. You waited up to 3 months for the results. During those waiting periods you could work as a graduate nurse, similar to an externship until you got your results.
It's more than a job, it's a calling.
Non noc nocere.

this weekend

Ya gotta love the full moon. It brings out the interesting people. And the beloved change of shift code....classic Torsades de pointe. The worst part was that he was a relatively young man and his Mom was in the room when he went out. We tried to get her out but, the code cart was blocking the doorway out of the room, not to mention the numerous bodies that filled the room. I think she got to see the first shock...pretty traumatic, but, it was life or death at the time.We got her out to the desk and spiritual care was there to be with her.He was intubated and sent to the ICU and returned to our unit later the next day. Lucky.It just seems I am seeing younger and younger MI and coronary artery disease patients.38 and 40 year olds having triple bypass and more. Most of them preventable with the right lifestyle changes...you can't change what's inherited but you can keep from adding to it.It's a choice. Life is a choice. Your life is your choice.
Non noc nocere

Cardiac stuff

I had a great weekend, went to a cardiac symposium put on by one of the local cardiology groups. It was held at the Arizona Golf Resort..very nice and great food. The speakers were informative and some of them were even funny. No, really, Cardiologists, funny, I swear. The latest stuff...lets see..not 3 nitros for chest pain, if you take one nitro wait 5 minutes if it doesn't help call 911. The newest dose of aspirin is 162mg, 325 after a stent for a month or so then down to 81 or 162 the whole time. Percutaneous valve replacements are being done at certain sites across the country right now but they are a thing of the future. To see all the info...www.tricitycardiology.com.
I had a 75 ya\ear old woman who went into rapid a fib even though she was on a maintinence dose of Cardizem. Her b/p was 100's over 60's...doc ordered 600mg of Rythmol then 150mg bid plus and increase to 240mg Cardizem. I was nervous, he said it would be fine...I warned my coworkers to keep an eye on her heart rate for me. I gave the Cardizem then about an hour later I gave the Rythmol. About an hour later she called and said she felt dizzy, I had the nursing assistant take her b/p but I went in the room as well...good thing, her b/p was 59/30... and she was on her way out. I called for the charge nurse, some saline and oxygen but I stayed with her, then I called the code. She was out not responding, couldn't get a b/p, eyes rolled back. I put the head of her bed down and was doing the "Annie Annie are you ok" thing when she opened her eyes, I was relieved ,somewhat ,but not out of the woods yet. Luckily the doc was still in the hospital and came when the code was called...we gave her fluids, some atropine, cuz her heart rate was 30, then she started to throw up...gave her some Zofran...and another bolus of fluids. The code team left and I was there with her and the doc. I stayed with her and explained a little bit of what happened, I called her family and at her request, asked them to come to the hospital. Her daughter ended up staying the night with her. She made it thru the crisis and went for a cardioversion the next day. To my surprise, when I asked the monitor room, they said she never did lose her heart rhythm, just her blood pressure.
Moral of the story...listen to your gut instinct. I didn't want to give the meds... I just had a feeling. The doc explained that the Cardizem would slow the rate and the Rhythmol would make her heart beat faster and that would hopefully convert her rhythm..it sounded good but I was still uncomfortable, which is why I enlisted my coworkers help to watch the monitor. Ah, the joys of cardiac nursing.
Non Noc Nocere

On the road nursing

So, I got a text message last week that my sister was on vacation and had chest pain. She was sitting in a hospital in Las Vegas and her kids were in Oklahoma City freaking out. I took the short 1hr flight to be by her side and translate the medical system for her and her husband. She is not the easiest person in the world to please, she has very high standards. Since she had gone by cab to the hospital, she ended up at a low standard small facility just off the strip. (no name, at this time) I had never heard of it before, nor had anyone I know heard of it.
The hospital was small, maybe 5 floors, and not modern in anyway. Unfortunately it was not kept very clean either, much to my sisters horror, she thought hospitals were clean places. Funny how most people think that. She had her ekg and her serial cardiac enzymes which were all negative and she was pain free. She was in the middle of her stress test when I arrived. I walked back up to her room with her. The transporter said he would let the nurse know that she was back,my sister had not yet met her nurse. The "nurse" didn't come in to say hello for an hour and a half. And that's all she did was say hello, no stethoscope, no vital signs, nothing about whether she could eat or drink...just, hi I'm your nurse I'll be back with your pills. About 2 hours later she was back with her pills, no beta blocker though, just aspirin and nitro, and of course Protonix.(wish I had bought stock in that drug company). That was it, didn't see her again. Twice in a twelve hour shift, really...are you kidding me? That is acceptible nursing care?
Then we met the doctor with a chip on his little shoulder. Did not want to hear about letting my sister leave and go back to Oklahoma...granted her stress test was positive for reversible ischemia, but, she's pain free and there's no positive enzymes. He ordered a cardiology consult...ok here's my irritation...it is now 6:30 at night on a Friday in Las Vegas...could we not have called doctor attitude when we got the results and told him so he could ask for a cardiology consult earlier? Frustrating. Not to mention that my sister was not offered so much as a washcloth or a towel (not even one left in the room) let alone to be set up to bathe or change her linens. Plus the fact that one of her telemetry leads was off for over an hour, yeah I put it back on after I helped her get a bath...yeah, no one came in when they were all off either. Thank goodness the night shift charge nurse and nurse were excellent. They came in and introduced themselves and did an assessment and told her about her meds and everything a good nurse should do.(thanks Cheryl and Joy)
We saw the cardiologist by 11am on Saturday, he talked about a cath until we told him she was there on vacation, was pain free and wanted to go home to follow up with her cardiologist there. He said fine, as long as she flew home and didn't drive back...Dr attitude said no, he would not sign her discharge, she has to sign out AMA. What a power play. So, we eloped instead...lots of people don't know it but, you can just walk out without signing the paper.
It was a long ride home with an emotional sister, she hates flying, but we made it safely. She had her echo and her cath and no MI or blockage thank goodness. Probably the rare cardiovascular artery spasms...leave it to my sister to be one in a million.
I came away from the experience with a new view and appreciation for my patients and their families and what they have to go through with our messed up medical system. Minutes literally are hours when you are waiting. Keeping people as informed as possible will keep them happy...most people anyway.
Send me an email before you decide to travel to Las Vegas and I'll tell you the name of the hospital to avoid.
Non noc nocere

Nurses Week

Talk about cutting back.... how was your nurses week? Mine was anticlimactic to say the least. On Nurses day we got these info cards on bright green card stock... the info was how we could do better. Things like answer the phone (within 3 rings) with a smile on your face as if you were on video. Before you leave any patient room or visitor encounter ask if there is anything else I can do for you. And if , I'm sorry when (within 1 minute)you answer a call light own it and play it through...yeah it was that kind of Nurses day. Not a thank you or a nice job or any of the positive things we should hear..just work harder. No lame lunch bag, no water bottle, not even so much as a free pen...how about ya'll?
non noc nocere

Depends on the day

The first picture was from our second day at the Grand Canyon...thank goodness we had the first day (second picture) otherwise we wouldn't have seen any of it's beauty. Sounds like work...some days you see the good things you do, others there's just so much in the way you can't see at all. Hope you are having a good day.

More good news

Well,this proves the determination of my husband. He looked at this hole, and the ones in each of the other 2 bedrooms, figured out the tools he needed to fix them, and just did it. I really wonder how our renter made this hole in the hard wood flooring? Any ideas? There were boxes for air mattresses left in the house amongst all the rubble, so, it wasn't a bed, what else could it have been? It is still very disheartening to me. Is it really true that people just don't care any more? The have no pride in ownership or being self-sufficient anymore? That is really sad.

Work is ,unfortunately, just as depressing. I really dislike working in the downtown inner city hospital. People are different than they are in suburbia. They demand things instead of ask for them, they act as though they are entitled to demand them...like some how I owe them something. I am not saying everyone, but a larger majority than I see out in the suburbs. I took care of a guy who refused to leave the hospital, he was discharged and refused to leave...he stayed there an extra 3 days...at whose expense? ...he refused to call medicaid to appeal his discharge, he just refused to leave, he had demands before he left...everyday they were the same, he wanted to see each one of his doctors, though he had seen them or one of their partners the day before. He wanted his dialysis time changed, he wanted new medications, he wanted a different diet. But, he knows his patient rights....whatever dude. Why can't we demand he take care of himself, eat right and exercise, not do drugs or drink alcohol, take his medication and follow up with his doctors like he's supposed to? We ask him to ,but we still take care of him when he doesn't, we still allow him to come in to the hospital and get care even though he can't pay the bill. What has happened to taking care of yourself? Guess we've shown that you don't have to do that either, America will take care of you. And you don't have to be nice or ask politely or anything, we just have to do it...patient satisfaction you know.

Ok, I'm off my soap box...on a good note I might be able to make the move back to the hospital that is closer to me...they have a job available. I just have to convince my new boss that she should let me leave. That one's gonna take some thinking....

My orientee is close to being out on her own, I think she needs a little more time...they only get to be with us 2 days a week, the other day they spend in class. I thought they just got done with all that learning stuff...guess not. I will ask for another week for her but I'm sure the budget will rule the answer.

Until next time...non noc nocere.

When life gives you lemons

This is my fixer upper in Columbus, Ohio. My husband and my brother, with a little help from me and my nephew, turned this 1930's 3 bedroom 2 bath into a nice home. Granted it's not in the best neighborhood, but, it's not in the worst either. November of 2007 we finished it and put it up for sale, the market sucked of course, but we got a renter/buyer March of 2008. We thought we were helping out a single Mom who was moving to a new city, couldn't afford to buy a home yet but we gave her the opportunity to rent our house and build up her credit enough to buy it and become a home owner. I guess it was a fairytale for both of us. She has not paid rent in 4 months. We were nice enough to give her 30 days to move (Ohio has a 3 day eviction process) again shooting ourselves in the foot. The house is full of trash, they changed all the locks, holes in the hard wood floors, completely turned off the heat so the pipes could freeze in the 30 degree weather, and took the alarm remote. I am so disheartened. Please someone explain the rationale. Why would you trash something nice someone is trying to help you own? I watch Extreme Makeover Home Edition and see people who fall on tough times get help and they are so grateful...do they end up trashing their home as well? I'm very disheartened...but that doesn't mean I quit. I know what I did, by trying to help this person out, was the right thing to do. I know it can work. I still believe that real estate is the way to go..it's something tangible, something real, not worth as much as it was a few years ago but, still worth money. It is just a game of numbers. Thomas Edison tried over 10,000 times until he finally got the light bulb to work...where would we be if he had stopped trying? In the dark, like my poor husband because the renters broke ,stole or unscrewed all the light bulbs in the house...lol. Ya gotta laugh..pick yourself up, dust yourself off and try again.
Work has been steady...4 or 5 days a week. Anything I can do to help pay 2 mortgages. I thought about a job in education. Monday - Friday 8-4:30 no weekends no holidays, a nurse's dream...but, also not a sure thing. Budget cuts are looming in the shadows and I see educators on the top of the list. I have an orientee with me...she is a really bright girl, very sweet and kind. I think she is there, at that big downtown hospital, for the experience. I think she would fair much better up in Scottsdale once she gets her experience. But, again, jobs are pretty scarce these days, you don't get the luxury of coming in and naming your price and hours and which days you'll work. You are glad to have a job that pays your bills.
Well, wish me luck and, if you can, please help me to understand people. Non noc nocere.

Coming home

As most of my readers know my nephew is in Iraq right now, and has been since early last year...I am happy to say he will be joining us back here stateside within the next 2 months. I am happy and relieved that he has been safe and admire his dedication and all the sacrifices he has made for our country. Wonder what he thinks of is new boss?
The cardiac cath I went to Oklahoma for went well, no complications. The new diagnosis and changes in lifestyle were a little difficult to get across at first but, I think they will do just fine. The number of Americans with coronary artery disease is rising everyday. I take care of these people everyday, and everyone says the same thing. I don't eat that bad and I just need to exercise more. Ok, there are other risk factors, some you can control, some you can't. Yes, you will most likely have to take medication for the rest of your life...many studies have been done to prove the efficacy of this routine. But, you are ultimately right, diet changes (low fat, low cholesterol, low sodium) and the addition of exercise will only have a positive impact on your life. Sorry, guess I'm just tired of taking care of people who drink excessively, and smoke and don't exercise. I don't like exercise either, but...I know what will happen if I don't.
Work has been ok. The day of the Superbowl was less quiet than I thought. I figured I would get all my work done before it started and people would just watch the game..no really so, they still wanted their beverages and ice and pain meds. The downtown hospital was actually a little slow, they closed one pod (15 beds), guess nobody felt sick that weekend. The worst part were all the people wanting to go home to watch the superbowl. I actually had a patient who was in with severe vertigo, like she couldn't even walk to the bathroom without help and she bugged me all morning about going home for the superbowl. The doctor came in and tried to walk her and said no way...it ended up she couldn't even watch the superbowl on the tv because she was so dizzy it was making her sick. People.
The weather is getting warmer...78 degrees today...and sunny. Sorry all you Northeasterners...non noc nocere.

Barrett-Jackson or Cardinals?

This is a car made for Pope John Paul II but he never rode in it, it was deemed unsafe for him. You'll only see stuff like this at a museum or Barrett Jackson.

If you know me , you know my answer. I love Barrett-Jackson and all the fantastic cars. I watched it on television for years, God bless the Speed channel, and finally 2 years ago I was here during the blessed event. If anyone says there's no money being spent in America all they have to do is turn on the speed channel, $200,000 for one car...and it's not even Saturday. These cars are amazing, the restorations are superb. Just the sound of the engines sends chills up my spine. I thank my brother for introducing me to muscle cars and helping me learn to appreciate a great sounding engine, and my husband for keeping the thrill alive. He has patiently taken me to the auction for the last 3 years, and answered all my questions with out making me feel stupid.

As for the Cardinals, I am not a fan. Only a fan of whoever beats the Steelers...I am a true blooded die-hard Browns fan...sad as it is, year after year I keep hoping. Most people think it will be the Cardinals vs. the Steelers for the Superbowl...guess we will find out tomorrow.

Work is crazy as usual, I now have a tail for the next 12 weeks. I hope I can help to mold her into a useful, well adjusted, thinking nurse. (Without making her quit or driving her crazy first.) Non Noc Nocere

Close to home

Like the title says, I have some family issues, and they are hitting close to home. One of my family members is headed to the cath lab for a cardiac cath. Now I can really put myself on that side of the bed. I am used to being the one coming in and reviewing what the doctor told them, answering any questions and sending them off to the cath lab. I am also used to getting people back from the cath lab and doing the normal stuff, checking their vitals, checking their pulses, checking their groin site...I guess I will see what it feels like to not be in control of anything. Nurses really are, or become control freaks, I think. Ok.Maybe it's just me, but if I am in control of a situation I can 99% control the outcome. That makes me calm and confident...and a control freak. If I am not in control (i.e. things don't go the way I planned them) then I'm irritable and I snap at everyone around me. Yeah, I got issues. I just hope I can be a calming force when I am with my family member during this procedure, because I won't be in control of anything.
On a lighter, happier note my nephew should be headed back from Iraq early this spring and I am so happy about that! I hope he gets the chance to stay stateside for a long time!

HAPPY NEW YEAR!!

Well, Happy 2009 everyone! We brought in the new year in the same old fashion, watching Dick Clark and Times Square. Pretty sad to see him get old though. He looks and speaks pretty darn well for a stroke victim.
So, I worked 5 days (12 hour days) last week and had one day off and worked 3 days already this week. The company I am working for is doing away with their double time for overtime so, I had to get as many hours in there as I could. Smart business move, they have filled most of their nursing positions with the new grads and they are all willing to pick up overtime since they are fresh out of school and money from being in school.No one is really happy about losing the double ovetime but, we can understand. Of course there are the people who just live to complain, I try to stay as far away from them as possible. Some people would complain if you gave them the world.Sad.
What can I say about work this last week. Wasn't too bad, but the new nurses, I think they are so overwhelmed. They don't seem to even know which questions to ask or when. Our unit is post open heart/thoracic surgery. The daily tasks for each patient is a huge laundry list. You have to monitor their weight, vitals, electrolytes,their exercise, their fluid balance, their rhythm,their blood sugars,plus all their tubes and lines. It's really difficult when you have more than one cabg patient.I started out in Medsurg, back then units weren't so specialized, it was med surg or step down or icu. I think it really helped me get my organizational skills together.75% of nursing is organizing your work, the other 25% is common sense.
Case in point: I had a new nurse ask me at about 8:30 in the morning if I thought she should change an IV on a patient that was 7 days old, this was a post open heart patient. I said definitely. I heard her later ask another nurse the same question she agreed with me and said yes as well. At 5:30 pm she again asked me if I thought the iv really needed to be changed, I said I really do, do you want me to change it. She said no, I want to try, but he had a really bad experience and doesn't want it done. I explained to her she has to be comfortable and make him comfortable, if she wanted, she could have someone else do it. She ended up asking the charge nurse to do it, and it got done at 6:30. I just don't get it. The longer that IV stays in the bigger the risk of infection, we have to be able to tell patients what we know is best for them and just get it done, not sit around and wait all day to build up the anxiety of the nurse or the patient. But, how do you teach that?
Can you guess what my picture is of?
Non noc nocere.