I guess we are human

Hi all. It's been a tough week. One of the fantastic nurses I work with was killed in a tragic accident. It hit me like a lead balloon. This guy I had just seen 3 or 4 days before, someone you expect to be there, just won't be there any more. I know, we in the medical field deal with death all the time, but this time it's personal. This was a great nurse, I think he had been there at Good Sam for almost 20 years. He was one of the go-to guys, somebody who knew everything, or at least had an answer for you. If you needed a hand, he'd help you. His passion was hunting and Army stuff. He actually was supposed to go deer hunting last weekend. Just hard to believe he won't be back. There is a memorial service on Monday and I volunteered to work so some of the people who worked with him for years could go. The hard part is that no one is saying what happened, just that it was a tragic accident. Even the obituary was short and to the point, so you all know how the rumor mill is in a hospital. There are so many rumors about what happened, it would just be better if we knew what happened. I have not been a part of the rumor making or passing on. I think he deserves better than that and I tell the people who come to me with rumors the same thing. Hopefully next week is better, and I pray the law of 3's doesn't come this time. Remember first do no harm.

ACLS

So,I have been away studying for my ACLS renewal. Yeah, I've had my ACLS for 6 years now and I still study before the class. Luckily because I have had it before I don't have to go for the full 2 days, you just have to do that the first time. Being a traveler,my company doesn't pay for the renewal. Last time was here in Phoenix, I renewed at the hospital where I was working only it wasn't American Heart. It was ASHI...who ever they are, it was the same content but a different company and some hospitals would not accept it. If you haven't taken it, it's not so bad...and if you are thinking of working in ER,Tele,ICU,OR... it's probably going to be a must have. Years ago I guess it was grueling, it was run by doctors who intimidated the participants and lots of people flunked. Today, it's mostly run by nurses and the atmosphere is one of learning not intimidating. I went to a privately owned company that has the ACLS BLS and EMT classes. The cost was $130, but I got 8 CEU's. (some consolation) Part of this years ACLS courses have to have a BLS component because of all the recent changes. If it's been a while since you took it...I'll give you some highlights. Everyone gets 100 compressions per minute, the ratio is 30:2 for everyone unless it's an adolescent or infant 2 person, then you can do 15:2,the breathing is slow and deep,no more constant checking for a pulse, and big emphasis on good compressions with full chest recoil and early AED use. The instructor I had added another component that I hadn't had before...drugs of abuse. Maybe it's because of being in this lovely border state with no fences and the #1 rating for drug trafficking. The drugs come across the border into Arizona and get trafficked out to the rest of the US. Arizona is #2 in Meth manufacturing. Stuff they don't tell ya before you move here, glad I'm just visiting.
She went over date rape drugs and what effects the different drugs have on people. She sited a great website that gives information about drugs....www.erowid.org. It's a great thing to think about when your patients aren't responding to treatment the way they should...knowing these drugs and how they make people react can be a great tool.
She also talked about working at the poison control center...which I never thought about as a nurse but what a cool job. She had some great stories especially about Thanksgiving. I love nurse stories, so I'll share some I heard today. A lady made mashed potatoes with evaporated milk that was brown. She tried the mashed potatoes because they were white after they were whipped and she said they tasted fine. She called the poison control center to see if they thought she could serve the potatoes....of course the answer was no because evaporated milk is supposed to be white and just because she tried them and they tasted fine doesn't mean she should serve them...she was not happy, because she had to go to the store and start over with boxed mashed potatoes. Another caller said she had a fire in the oven where her Thanksgiving casseroles were, they had put the fire out with the home fire extinguisher. The casseroles were covered with foil. She wanted to know if she could serve them.....Uh...no. That fire extinguisher stuff is airborne it gets everywhere. She claimed it was probably water because she didn't see any foam...water doesn't put out grease fires in an oven so, no it wasn't water and no you can't serve the food. The sad thing is she still had the turkey, stuffing, vegetables, mashed potatoes and desserts and didn't think that was enough food. Incredible!!! So, if you are looking for some good stories, you might want to consider working at the poison control center in your town. Plus you get to help people, without worrying about hurting your back...lol. Remember first do no harm.

Just Work

Hello from sunny Phoenix, I still find it amazing,coming from the frigid Northeast, that November can be so beautiful. The mornings and evenings are cool, not cold, but I am finally able to wear my jeans and long sleeved shirts. The days are sunny with blue skies and warm air, still wearing shorts and tanks tops, we even have to have the air conditioning on most days. Sounds awful, huh? I just can't believe the number of people who dislike where they live and stay there. Every assignment I go on people tell me how much they would like to travel but.....there's always a but. Your desire has to be bigger than your but or you'll never do it. Recently I've been working with some new grads who are all envious of my traveling, they can't wait to have enough experience to travel and I encourage it. It's a great way to see the country and learn new things. I also encourage people to become nurses, it's a great career. There are so many different avenues to take in nursing, if you don't like one , try another.
I had a great idea for a blog the other day and now I can't remember what it was. I hate when that happens. Does that mean I'm getting old? I think it means I just have too much information in my brain. Too many drug names and generic names and dosages and calculations, phone numbers ,doctors names, recruiters...just overload ya know. Plus I have been working 4 and 5 twelve hour shifts a week, that will definitely overload ya. I have heard of nurse working 6 and 7 twelves a week but honestly, how long can you keep that pace up without hurting yourself or someone else?
Work has been good, lots of overtime available. I got Christmas off and Thanksgiving too...I am working New Years Eve and New Years Day...but, it's day shift so it's not so bad, and hopefully it will be slow. I feel for some of the travelers that are coming in now and the ones that came after I did, they are all working Christmas. That's one down fall of nursing, someone has to work on the holidays, all the holidays, the place doesn't close ever. It's an amazing concept really, 24 hours a day 7 days a week, 365 days a year, hospitals never close. When I was in Rhode Island the nurses all belonged to the union and they had mandatory overtime..and it was used all the time. I would hate that. I like my overtime when I want to do it.
Well , remember first do no harm.

Learning

So, this past week I had a student. I love students, they make me slow down and think. As a nurse practicing for way too many years I find myself just going about my day, doing what I need to do for my patients. It's nice to be questioned (by someone other than they families of my patients) about what I am doing and why. I had a male student, it's his second career, he was in business. Quite a change! It's nice to see more men in the field, they bring another perspective. Plus, sometimes, when you work night shift and you have a confused patient, they will think the male nurse is a doctor and they will do whatever they say, like staying in bed...but, of course, I would never use this technique, I have only heard that it works.(lol)
I also signed up to renew my ACLS and BLS. Here's my advice on that subject...get American Heart and stay with it. Don't go for the online things unless you test online and do the skills check in person. Lots of places and people will tell you that they are all created equal...which maybe true, but, you cannot argue that fact with a hospital that won't give you a job because your ACLS came from some different company. I have had travel companies refuse to submit me for a tele job because my ACLS was not American Heart. A lot of hospitals trying to get their Magnet status will only accept American Heart as well. It's just not worth the aggravation.
And, since I mentioned it, what about Magnet Status? What are your thoughts? I have worked in both, I don't see a lot of difference in the actual day to day nursing. It's a great theory and all, but I don't see it.
Lastly, I have to talk about travel and registry nursing. Not as a new grad, maybe if you are and LPN turning RN and have had a lot of experience, otherwise I wouldn't suggest traveling for 2-3 years. You really don't get into your groove until then, and you haven't experienced enough general nursing stuff. But, after that, why would you pick up and move across the country , to somewhere you have never been, on the word of a potential employer? What a gamble!!! Their job is to get you hired, and if they pay for your relocation, then you owe them a year or so of service. Why not do a travel assignment to the city you are thinking of moving to? Feel it out, maybe do one day a week of some registry to see the other hospitals, maybe they are better, before you commit. I just don't understand it. I have a few friends that have done it, moved across the country to somewhere close to family or just somewhere they had vacationed and loved. I have one friend who has done it twice, even after I encouraged her to try travel and gave her names of companies and recruiters. Both times she has regretted her move, sad really, to waste all that time and energy just to be disappointed and unhappy. So, travel is the way to go...finding the right company is a whole other day.....Thanks for listening. Remember first do no harm.

Still getting attached

Yep that's me by a palm tree and a pond in the desert, ok it's not really in the desert, it's in Scottsdale/Phoenix area. It's a little park called Papago Park that we have visited quite often. It's a nice little oasis. This has been a long week, just really busy at work. I'm finally allowing myself a few days off to relax. I've been taking care of this patient off and on for the last month, and he finally got to go home yesterday. He was flown from a small town north of Phoenix with bilateral collapsed lungs, and has had chest tubes ever since. The diagnosis came back, and it was not a good one. Mesothelioma, that's my second patient this month with the same diagnosis, both worked construction. I lost my own father to lung cancer so it hits me pretty hard sometime to take care of these guys. So, this guy really wanted to go home as you can imagine, I mean his wife and daughter were here but he just wanted to be home. Good Sam hospital has a floor of rooms that families can rent so they can be in the building to visit the patient whenever they are needed. It's really nice for the patient and the family, especially when they live so far away. Unfortunately, the small hospital that he is going to cannot do any type of extensive surgery if it's needed or anything like that. He had to agree to be a DNR in order to go back home. Isn't that sad? I mean this guy is far from the edge he still gets up every morning and shaves and reads the paper, aside from the chest tubes to constant wall suction, he's what we refer to as a walky talky. I would go in every morning and say hello even when he wasn't my patient for the day. Yesterday we shared a tear when he told me about the conditions of his return to home. He was funny and cranky and made me smile and I think he looked forward to seeing me. It's nice to make that connection with your patients and their families. I know we are not supposed to get attached, but sometimes I can't help it. It may take a little out of me when they go but, if it makes their stay more comfortable, what's the harm? Death and terminal illnesses are not some of my favorite subjects. (Much like trachs and colostomies.) But , they have been a major part of my career. Of course, I think death is as much mental as it is physical. I had a patient quite recently that I helped take out to his car in a wheelchair, he got up into the car and petted his dog who was waiting in the car, he died the next day in his home. I guess he was ready. When you have a terminal illness, a lot of times it's a matter of being comfortable with the situation that makes it ok for you to go. I believe we have some control over it...anyway...on to better subjects.
The weather here has been warm about 100 still and, you guessed it, sunny. It should be cooling down soon...either way it's not going to be cold anytime soon. And, that makes me very happy, coming from Cleveland I have had more that enough cold to last a really,really,really long time. Well, remember first do no harm.

Raining again?

That's right I said it was raining again...only this time inside my apartment. There's a first for everything. Traveling for 5 years never had a flood. And who would think, right here in the desert.The sprinkler head in the living room in the apartment above us broke about 4 in the morning on Thursday. I woke to the sound of water running..only it was coming down inside the window in the living room. It was a pretty freaky sight. The water was coming through the ceiling fan and all the sprinkler heads and the vents from the living room to the dining room to the kitchen. Every phone number I called for the complex went to voice mail so I had to call 911. Yeah the cops came and so did a bunch of firemen, but the alarm that was going off got turned off and so did the water. The firemen did decide to put some holes in our ceiling, it was interesting. The poor guy who lives above us had just had a flood a month or so ago I felt so bad for him. But my company ,Banner professional registry and travel, was right on top of things. They called the apartment complex and got them to find me a new apartment. So we moved in the next day. They made it so simple and they were very caring and helpful. It's so nice to have a company care.
Work is great, I really enjoy working at Good Sam. The staff that is there is very knowledgeable and helpful. I never feel alone. Plus, I am all about the overtime and there's plenty of it. I have been working 4 or 5 days a week. The pay has been great especially after not working regularly for a month. Well, as always first do no harm.

Good Sam

Hi all, I've been kind of busy can you tell? The above picture shows that it's hot in Phoenix even the cacti are starting to die. It's been over 100 degrees since I arrived...but what did I expect it's Phoenix right? The monsoon season is almost over, so they tell me. Hopefully the humidity will go down...100 degrees and 50% humidity kinda sucks.
The hospital is just as I remembered. Orientation was a little brutal 6:45 to 5:00 in the classroom with different people speaking and a lot of movies and overhead projector things. We got to see the facility's bomb dog...first that I have seen in my travels. In fact, I don't think they had them last time I was here. The second day was 6 hours of computer training...not too bad.
My husband got here 2 days after orientation so we were able to spend some time together before I actually had to work. I had my 2 days of orientation on the floor which were relatively easy...then they canceled me on Labor day. Boy was I mad. I had to pick up a registry day which wasn't too bad. I worked at Banner Desert in Mesa on their tele floor. It was set up oddly but I got the hang of it by the end of the day. I have been able to work the rest of my days at Good Sam. A few people have recognized me from the last time I was there and I have seen some familiar faces. It's not a bad place to work but it's really busy. It makes the days go quickly though. We usually have a 4:1 ratio with one NA for 15 patients. We normally have a transport nurse and a charge nurse for resource. The only difficult times are when you have someone to go to dialysis and the nurse has to take them or if the travel nurse is busy and you have to take them.
Most of the patients are cardiac cath or post open heart surgery so they are pretty motivated. Much unlike the patients I cared for in Salinas which were highly unmotivated. It makes the job easier if the patients want to learn and get better.
There is a large traveler population at this facility which makes you not feel alone. The staff is mostly traveler friendly and they don't go out of their way to give you the worst assignments. As with everywhere else it comes down to how you present yourself. I went through my orientation with a couple of first time travelers and they are going to have a difficult time I think. The worst thing you can do when you first start a travel assignment is talk too much about yourself, especially to the staff. It's always better to listen and not get too personal too early. We all want to fit in but do it slowly rather than quickly. Also, the staff really doesn't want to hear about how things are better at your other hospital.
Just a little advice for ya...well as always first do no harm....

The Valley of the Sun

So, the valley of the sun...huh. Did somebody do a rain dance before I got here? Wow, I have never seen rain come off of a roof in a sheet. The roads were flooded but the ones I drove on were passable. It was also a spectacular lightning show. Then yesterday afternoon I was laying in the sun at the pool. Go figure.
The Banner Travel and registry has been wonderful. I went yesterday and met them. I had to do some testing and complete my paperwork. I signed my contract and even got my badge. I am so impressed with this company! They sat down and talked with me , gave me several numbers to call if I needed anything. I spoke with the housing person and with the human resources person and got signed up for my insurance as well. This is how it is supposed to work. I have never been treated so professionally by any other company I worked for. Not even the registries that I have worked for. The next closest would have to be the Cleveland office of Intelistaf. I went to their office and they really worked hard to try to find work for me. I sat down with them and they went over all the hospitals that they had contracts with, they asked which shift I would like to work and even got me in touch with their travel division.
Wednesday this week I went to the Phoenix branch of Intelistaf registry...what a different atmosphere. I didn't even get to sit down. The recruiter brought my paperwork out to a half wall by the entrance door to the office and had me sign my paperwork there. She didn't tell me which hospitals they service, didn't review their timesheets, or introduce me to the staffers (people who I will be dealing with to schedule my shifts). I was not impressed. Makes me think twice about whether I want to make them any money. Yes, I need to work, yeas I need the money but I'd like to be treated better. We'll see.
So, for now I am catching up on my blogging and email and gearing up for a long warm winter...I'll put up pics when my camera arrives.

On the road again

Well, it has been an interesting few weeks. I actually worked about 3 days total since I left Salinas. The Cleveland Clinic didn't come through for me. The interview I was expecting the first week of August just never came. I finally called another company...Banner travel. They are the travel division of a healthcare company that owns several hospitals in the west Arizona, Colorado,California,Alaska, Wyoming and Nevada. It was incredible. I went online last Tuesday, filled out the application and sent an email. On Wednesday I called the company that had my application in with The Cleveland Clinic, they told me that because my ACLS was not from American Heart Association that the Clinic would probably not even interview me. They wanted to know if I could get my ACLS renewed with American Heart before I started work. I lost it. It had been 2 weeks with no paycheck and a 4 day 2500 mile trip across the country and now they want me to pay another $250 for ACLS class? I was furious. Luckily I got a call from Banner, they offered me a job on the first phone call, I declined until I knew which Banner facility I would be working at. 10 minutes after they posted my profile to all the Banner facilities I got a call from Good Samaritan in Phoenix. They asked me how I liked their facility the last time I was there (2004), I told them I liked it and that I had learned a lot. They asked me what shift I wanted and when I could start...I was amazed. I got a phone call 10 minutes later from the travel division and they offered me a job with a raise in 2 weeks, healthcare starting the first of the month with dental and vision, a one bedroom furnished apartment, travel money and a completion bonus. About 6 pm that evening I got a call with my new address and phone numbers for cable and electric. WOW. Now that is how it should work.
So, I got on a plane this evening and landed in Phoenix at 6pm. My husband will be taking his time to get out here, no 12 hour 750 mile days, unless he really misses me. The flight was pretty much uneventful until we got close to Phoenix. It's monsoon season out here I guess. The sky was almost black when I left the airport headed for my rental car. Great....I haven't driven since I was in Napa and here I am in Phoenix in monsoon season....yeah. At least I got a cute car...a Jeep Liberty...a little better than what I thought I'd end up with...I am paying for it though, this company doesn't provide a rental car...which is ok I only need it a couple of weeks til my driver gets out here.
The really great thing is that my nephew is out here. He's been here since February going to motorcycle school. It will be nice to spend some time with him. Well, I need to settle in for the night. Wish me luck with the weather. Remember First do no harm.

Home again

Wow, it's weird to come back to your hometown again. I have been gone for 2 years, didn't think I was coming back anytime soon either. My husband and his great ideas...so, here we are awaiting a call from the Cleveland Clinic. Yeah, that's the down side of travel nursing, you can't always get where you want to be when you want to be there. I understand that the Clinic is a huge corporation and the bigger the corporation the more red tape and time it takes. It just would have been nice to know before we took off across the country (literally) in a big hurry. I was submitted to the Clinic on July 31...it is now August 12th. My company got an email while we were on the road that I was going to get an interview on Friday the 4th or Monday the 7th...neither happened. I did go to an agency to try to pick up some work this week. I have to go through orientation for most of the facilities and the one I did get scheduled for cancelled me.So, here I sit. Now I have to decide how much longer I am going to wait for the Clinic, or is fate telling me I don't belong in Cleveland right now? My company now tells me it can take 12 to 15 days for them to decide to call me. That would have been good information to know before we left California. We could have visited family along the way, taken our time, We got up every morning at 4am drove from 5am to 5pm and drove 2600 miles in 4 days. We saw the country, we drove the turnpike 80 from Reno to Cleveland. We did pass through Iowa, which is a state we haven't been through before, not very exciting, a lot of corn this time of year.So, we are pretty well covered on the central states...we've missed a few on the east coast and the upper northwest and a few of the southern states like Mississippi and Louisiana. I can't complain too much it has been really fun for the most part. I just hate the waiting game. Wish me luck.

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.

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.

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.

Another California Summer

Yep kinda grey...that's a summer in CA. The marine layer they call it...foggy and cool in the morning and afternoon and sunny at noon and warm. It's hard to get used to especially after all the rain this spring in the Napa Valley.
Salinas is a farming town which is why it's called the salad bowl of California. They grow a lot of lettuce and artichokes and stuff here. The fields were full of people picking strawberries this past week. It doens't look like any job I would want, bent over all day. We went to Santa Cruz to the beach but it wasn't sunny, we left about 10 am and got back around 4 or 5 and they were still in the fields when we got back. But, the strawberries are good.
The hospital is supposed to be on the verge of closing because of the debt. I don't think it can because they really need the beds and the services the hospital provides to it's clientele. The clientele is mostly homeless or drug addicts. I have never seen so many MRSA infections in my life. More I & D's than I can even tell you. I & D of the neck, foot, hip, chest wall....just amazing what these people who have no home or job are doing to their bodies. Plus the stabbings and the gun shot victims. Like my own little war zone. Ya gotta love 8 week assignments though. I can do anything for 8 weeks.

Long gone

Hey there, I have had some big changes sorry it's been so long. I was very unhappy on the floor I went to at the Queen of the Valley. It is really hard to work without any support staff like nursing assistants. They are a vital part of nursing and have always been a huge part of my career. It's really hard when the staff themselves are unhappy and not helpful. I am now in Salinas California, also known as the salad bowl of California. I am working at the community hospital which is a totally different client population. It's only an 8 week assignment ,which I have not done before so we'll see how that goes. The staff is very helpful and friendly.
We are much closer to the coast so we have been to the beach several times. We saw a church group on the beach and the preacher went in the water and individuals came in to be baptized in the Monterey Bay....very interesting. If you have never been to the Pacific ocean it's very cold...about 53-58 degrees. So it's amazing that the preacher could stay half submerged for 10 minutes. We also went to Seaside California and saw Amish on the beach...I was a little confused. I thought they were stuck on the other side of the country. It just proves you never know what you'll see in California. Remember first do no harm.

Working hard

Well,it's looking like summer time out there. My husband and I have been able to go walking everyday I have not been working. It's a great stress reliever. I have also been going to the gym but not as often as I should. The stress has been pretty high at work. I think most of it I put on myself. The floor I am working on has no nursing assistants. The patients have multisystem problems and a lot or renal failure so they are not able to do much for themselves. I spend a lot of my day cleaning, repositioning,feeding, and serving patients and their families on top of my regular nursing duties. Granted, I only have 3 patients but it can be really draining. The hospital is having a mock JACHO survey this week so the charge nurses were all stressed out. It was a long week. Plus, I have been trying to get some overtime and there still is none to be had.
I spent 2 days last week looking for other work. I went to Intelistaf to get some agency work and did all their paper work which took about 4 hours. I have the possibility of working at 2 other hospitals each about 20 minutes away. I also went to an open house at St.Helena hospital which is the same distance in the opposite direction. This week I signed up at The Queen (my regular hospital) to work on Monday and the called me off so I called Intelistaf to get some extra work this week. I spoke with some one at Travis Air Force Base and I may get some shifts there. Tomorrow I get to work in Fairfield at their local hospital. It will keep me focused on my goal and hopefully keep the stress level down. Variety is what keeps me doing this job. I love patient care.
So, this week is also my birthday. I have been doing this job 15 years this year. Hard to believe. I wish someone would have given me some advice when I first started or maybe they did and I didn't listen. Everyone said to start in med surg to get my skills honed. I say work smarter, not harder. When I graduated for nursing school there was a big nursing shortage and I could have gone to any area of nursing I wanted. I probably would have gone to the ER or Maternity. In the ER it's stressful but the nurses and the rest of the staff all seem to work together. You only have to have your patients for a short period of time,rarely do they stay with you for 12 hours. Maternity is not a lot of physical work and the patient are mostly preoccupied with their children or families. I'm not saying those jobs are easier but maybe less physically or mentally stressful. I also would have worked lots of hours when I was younger so I could work less now. Live and learn. Remember to enjoy your job and your career. Do lots of different things and don't get sucked into the thinking that you have to do med-surg first. If ICU really excites you or psych or maternity go there if they will orient you. Med surg gives you multitasking and organizational skills for med surg. If that's not what you ultimately see yourself doing then pursue your passion. Time flies, before you know it you've been doing the same job for 10 years or 15 years or 20 years. Primum non nocere.

Still Raining

Wow, it's still raining here in Napa. Everyone says,"It's never like this!" I have heard that almost everywhere we go. In Providence, in Oklahoma, in Florida, in Phoenix...makes me wonder if this wonderful weather is following me and pushing me forward to the perfect place. I thought I had found it here in Napa. Last year when I was here it was almost paradise, aside from the one patient I had to care for that was so difficult rain has to stop sometime doesn't it?
My new contract started last week and I had to float back to my old floor the first day of my contract. I laughed all day. My boss asked me last week if I had signed my new contract. Apparently the person that does the schedule went ahead and planned out the next schedule when all the travelers are gone and the numbers are not so pretty. It seems he jumped the gun and now is scrambling to try to keep the travelers that he wants. I wish he had thought of doing that when I originally asked to stay. It's ok, I'm only a little bitter, I think I made a good choice to move to another floor. The floor I am going to is a med-surg telemetry floor that specializes in dialysis patients. Their nurse-patient ratio was 3:1 with no nursing assistants. It now seems they are going to get back their nursing assistants and I'm sure their ratios will go up. The floor had mostly 8 hour shifts and the nurses were leaving in droves, 12 hours gives you such a better week. 3 days to work compared to 5. Yes 12 hours is a long day but the 5 day a week thing really can burn you out quickly.

My husband is here with me now and we have made some changes. We left the condo with my roommates and found a one bedroom which is a steal in Napa at $820/month. Sad huh? We were paying $350/month in Norman Oklahoma. The prices out here are just incredible. We did stay a few days at the condo and we stayed a few days at my friends apartment who has gone back to Florida for a month. I originally was going to stay there while she was gone until my husband came out here. That particular apartment doesn't have cable and it would be very difficult for my husband to sell on eBay without cable internet.
We spent the past weekend in Reno. There was sunshine there! It was great. Of course we didn't see much of it since we were in the casinos. It still amazes me how many people take their children to the casinos. They can't go on the casino floor and there's not a lot else for them to do. While we were there we tried a few new things. We played a few hands of Pai gow poker...not very fun...difficult to understand. We played keno as well...it's basically the lottery every 5-10 minutes. My husband and I hit side by side jackpots on slot machines. He won 375 and I won 750. That was fun...it would have been great if it had happened just before we left. The drive to Reno takes about 3 hours from Napa and the mountains are beautiful...there's still so much snow up at the summit, pretty incredible.
This week we are hoping to do a little wine tasting. Although it won't be near as fun without my sister and her husband. Maybe we can find some new places to go and find some new wine for them to try when they come back to Napa. There are so many wineries to try it's amazing how the wines can all taste different when the grapes are all from one part of the country. It is a science though, so I guess I shouldn't be too surprised. I have to encourage all of you to come to Napa or Sonoma once. It can be so beautiful...especially when the rain stops.The summers are just beautiful.

Gray days

Will the rain ever stop in Napa? Just when you think it won't, you get a beautiful sunny day with blue skies...yeah and I'm stuck at work for 12 hours. Figures, huh? Does that happen to you too or is it just me?
I went "home" to Oklahoma this past week to help my husband close our store. Sad, but exciting in a way, at least now we'll be together again. We can concentrate on paying our bills and having some fun together. The business was a fantastic opportunity for us to see how we can work together. It was such an awesome learning experience, I wouldn't have given it up for anything.
He is on his way here now from Oklahoma. He says the weather there is gray and rainy, at least he will have a view here with the gray rainy weather. It's about a 3 day drive, unfortunately I have to work so I can't meet him in Vegas like I was planning. It's ok, I'll be off when he gets here.
I have just 3 more weeks on 2North. It will be strange to go to another floor but I will probably have to float from there too. I actually am going to offer to float so that the travelers that have been up there don't have to. There really is no bad place to float to in the hospital, 2North is the hardest floor and I'm used to it. The weekend at work was fairly calm. Friday we had a code. It was not my patient so I helped empty the room for the crash cart and the crowd of people then made sure the other patients were taken care of. I later found out it was a patient I had taken care of last week for 4 days before she went for heart valve replacement surgery. When I heard it was her it felt like someone had hit me in the stomach. I cried. She was a sweet lady with a lot to live for. It's something I see over and over. She was the caretaker for her husband and was neglecting her own health. By the time she came to the hospital, she was very sick. She made the brave decision to go through with the surgery despite the odds, without it she knew she would only have about 6 months. She made it through the surgery and was supposed to go home the day she died. She had gotten up that morning, had her breakfast and her meds, got cleaned up and even washed her hair. It just goes to prove that you never know. When it's your time, it's your time and no amount of live-saving measures will change that.
The week before I went on my little vacation I had a similar experience. There was a patient I had taken care of for a few days and had a day off so my assignment changed and he was no longer my patient. The heart monitor started to alarm and everyone went running to the room. He had a roommate so I grabbed a wheelchair and took him down the hall to our waiting room. Luckily the roommate was mobile enough to get in a wheelchair otherwise we would have had to find an empty room (not very common) to move his bed into. That was a hard one because the code lasted about an hour. There were several of the patients doctors in the room and his family had just left so we had to call them back. The roommate, who we subsequently moved to another room, kept asking what happened to his roommate. I was inclined to tell him about the patient not making it but then HIPPA was in the back of my head. I told him his condition was very serious. After all what would you think if the guy you were talking to this morning was dead this afternoon...wouldn't it scare you little if you were a patient. We as medical professionals see it all the time, not that we get used to it, but we know it's a fact of life. What if this guy had talked with the patient who died and they had the same thing wrong with them, wouldn't that be scary? I never did get a straight answer from anyone as to what we could tell the poor guy, luckily he wasn't my patient so I could avoid the situation. I really felt bad for the nurse. He was in there for an hour trying to help the doctors save his patient and when he was done he just had to go right back to the floor and work like nothing happened. Cops get counseling or a debriefing if they are involved in a shooting or a really bad accident, so they can talk about it ,don't they? We as nurses are just supposed to deal with it and go on. I told him to go take a break that I'd watch his patients. It seems to be the norm everywhere I've been...just deal with it and go back to work. Sad, in such a caring field, who cares about our feelings?

Where do I go from here?

Hi all! Sorry it's been awhile since my last post. I have had a nice visit from my husband. He came to Napa for 3 days and didn't want to leave. Isn't that sweet? We've been together for about 12 years and this is the first time we have spent any time apart. It has been difficult. Absence does make the heart grow fonder.

As for my travel assignment, it's coming to decision time again. My original thought was to stay here for the summer as a traveler. When I arrived here my boss told me that as a traveler I could stay as long as I wanted and return as often as I wanted and he seemed really excited about that, genuinely happy that I was here and wanted to stay so long. Initially when I came to the Queen of the Valley they had a policy that you could only have 2 assignments there as a traveler, ever. Last week my boss asked me what my plan was, I began by saying I wanted to stay until the end of summer as a traveler and he cut me off right there. Apparently they have hired enough staff and will not be extending any of the travelers but I could sign on per diem. Now, if they don't have work for me 3 days a week as a traveler, just how much work am I going to get as per diem? He is also implementing changes in the nursing assistants roles and our break time. Sounds like it's time to move on, if only from that floor. The hospital has something like 40 or 50 travelers right now...getting rid of us all is going to be some feat. I understand that travelers are expensive for the hospital and I understand that we will be the first to go but I don't think it was presented thoughtfully. Cold and matter of factly, it hurt a little. Especially after me stepping up and doing whatever I was asked to do (like working night shift) and working extra shifts, the presentation could have been nicer.
So, now either I move to another floor in the hospital or I move to another hospital. My recruiter says Phoenix is paying just as well as this assignment but I dread the thought of Phoenix in the summer.
Another fun thing, the travel company I am currently working for was just bought by another company. This sort of thing happens a lot in the travel nursing world. It means signing new contracts and new insurance and hopefully more assignment choices. My recruiter will be staying on with this new company which is a plus. It's really hard to leave a recruiter you trust. So, we will see where I end up. It's hard to leave a place where I feel comfortable but I have a goal, a financial goal and a time frame in which I intend to reach it. Staying here per diem will not help me reach that goal. So, again I will step outside of my comfort zone to help me achieve it.
I had someone ask me what happens if I hate my assignment...how do you get out of it.... I have really only had 2 assignments I really hated. One was in Columbus Ohio. It was a tele floor that was nicknamed "the dump" I worked night shift, 6 patients. I constantly got to work and had at least one admission on its way up to the floor. The staff was unfriendly and not helpful. I had a patient who's chest tube came out and I couldn't leave him because I had to hold a dressing over the sight, I couldn't get anyone to answer the light. I saw 3 nursing assistants walk by the room and not one of them looked when I called out to them it was awful. I stuck that one out. I worked for RN Network at the time and they were unsympathetic to my pain. I did my 3 days a week and hated it. I clung to the assistance of the other travelers who were also having a rotten time. I left one day early...called off my last shift... and the company charged me for it. The hospital even called me to make up the shift. They said I could not work there again if I didn't make it up, I was glad to hear that.
The other assignment was in San Pablo California, it too was torture to go everyday. I was never on the same unit twice, I had to float most of the time half way through my shift. I had a nursing assistant tell me who she was going to bathe for me because "on this floor the nursing assistants don't do all your baths" . Charge nurses who did nothing but hand out admissions all day.It was really scary...I worked for World Health at the time and my recruiter (who I am still with) was very understanding and found me the Queen of the Valley position I took last summer. I didn't have to pay any penalties and it hasn't affected my ability to find another position. I guess it just depends. Some nurses just quit, end their contract and leave, others decide to see it through. Everyone has a comfort zone and if the assignment makes you feel you could lose your license if you stay then I would leave. I always consider the care I am able to give my patients as a gauge. If I can't care for all of my patients and keep them safe for my whole shift then there's a problem. I live by the creed...first do no harm. (Primum Non Nocere)

Crab Feed

Well, I'm glad that's over. As all my despite friends say,I'm back from the dark side. Well,sort of, I worked my last night shift Friday night and had to work day shift on Sunday. So Saturday was really weird, almost like not a day off at all. The shift thing just has to do with your body's clock I guess. You are either a day person or a night person and the first time you work the wrong shift, your body will tell you. Some people get nauseous, some people get crabby,me, I just sleep all the time when I work nights. So, hopefully I'm done. If my boss asked me again to do it for a short period of time I would probably agree, because I see my role here as helping out the unit. Plus no matter what the night shift says they are not as busy as the dayshift, most nights.
The rain seems to have stopped for the time being here in Napa. The big blue sky I remember is back, it's still a little cool but that will change as well. I went to a crab feed Saturday, kind of a funny name. Being from the Midwest I would have called it a fest..like Octoberfest, Perchfest, but here they call it a feed. The crab was from Bodega Bay, I guess it's crab season here because there is a crab feed almost every Friday and Saturday this month. It was well worth the $45 admission fee for all you can eat crab...not just the legs cuz they aren't Alaskan King Crab, their legs were pretty scrawny. The one we attended was at a High School in the Gym. We sat at long tables with plastic plates and silverware. Some of the more experienced crab feeders brought real glasses to drink their wine from. I was lucky enough to sit with Sue who brought a pound of drawn butter and little butter warmers...it's not what you know...it's who you know. Everyone brought a bottle of wine to share, most of us had to drink out of the little plastic cups that were supplied on the table. Luckily plastic doesn't spoil the taste of the wine, only the appearance. (and if you drink it quick no one will be the wiser...lol) It was a nice time with some of my friends from the Queen. We are planning a trip to Carmel next month...I promise more pictures! Take care all and remember,Primum non nocere!