Working in VA

It's been about a week now, I can officially say I have survived. I got my car from Enterprise, after a couple of changes I got one that wasn't so used. Only 10,000 miles and it still smells pretty new. I went to Nursefinders and had my first shift yesterday. I branched out to psych, which I have done only a little bit of. It doesn't scare me just makes me sad. I went to a boys inpatient center in the next town, about 30 miles each way. The staff was very helpful and friendly, although I didn't get much of an orientation they helped me through it. I think I'll go back for the extra cash. Still no luck picking up extra time at the hospital where I am.
Today we are going to the coast. It's a little gray out but, maybe it will be nice on the coast. I'll try to get some good pictures for y'all. Remember first do no harm.

Virgina

So, there's nothing I like more than to get into a city on the wrong side. It was quite a sight, not to mention the 98 degrees and 80% humidity. The company I decided to go with this time does not get housing for you but will put up the security deposits and make the monthly payment out of your check. They offered one suggestion, an off brand of the extended stay...not so nice. Especially not for $950/month. So, we have spent the last few days on Craig's list and looking through the apartment guide. It's really quite frustrating, I know I should look at it like an adventure...but after the first 2 days it's pretty hard. I did look into rooming with other people as well but, that didn't work out so well. It's amazing how some people live.
Luckily, we found a furnished studio which is really cute for one person who is going to be working all the time and not entertaining at all. The apartment itself is tiny 228 sq.feet but it's a one story place so no loud upstairs footsteps and it's very quiet.
I had my first day at work yesterday. It's a really friendly place, the staff is nice and the patients are cooperative and mostly grateful for what you do. The big plus is not having to use my Spanish at all. The hospital is in a really rough part of town but, my apartment is not. We went to Enterprise today to get my car. I got what was left for the week and will be going back tomorrow to get a better one. This one is well used and I don't really want to drive it for the next 3 months. Luckily, they were also very nice and it won't be a problem to get another car.
So, things look pretty good here in Virginia so far. Hopefully the pay check will match. That's the bottom line here for me this time around. Will let you know if anything fun happens.Remember first do no harm.

Holidays

I will miss seeing all the scarlet and gray when I leave here. Maybe I'll be back for football season...probably not though. The work here is just not worth it. I work twice as hard here as in the west for half the cash. The gray also describes the sky most days. I still don't know why people stay here all their lives...the weather really pretty much stinks.
So, the holiday is Monday, but, if you work night shift, the holiday is Sunday night. This hospital pays all 12 hours of holiday pay on Sunday. Guess who doesn't get to work in Sunday? The travelers. But, we're scheduled Friday and Saturday, Monday and Tuesday...pretty slick. If it was Christmas or New Years you can bet we would have been scheduled. Just a little irritating, makes me want to call off on Monday night.
The morale is just so awful on the unit it can be so draining. All night hearing nothing but complaints being thrown freely about the floor. You would think they would complain to someone who could change things, like their boss. But, instead they just complain about her. Just one more reason not to become staff, it's too easy to get caught up in the complaining and I just don't want to go there.
I am still waiting to hear from a hospital in California for an interview. The company I was with in Arizona will take me back, but, I have to come down a week early to get another physical (which was done in August of last year) and take a couple of tests. At this point, I am not willing to give up a week of pay to do that. I think it's totally ridiculous since I was there less than 3 months ago. I suppose I could go back to the same hospital with a different company but the pay would be $4 less an hour. It's a toss up...maybe I'll just wait till it's cooler there like I originally planned. I will be missing my friends though, hopefully they won't mind too much and we can pick right up where we left off. I will probably end up going there alone as well so, it could be a totally different experience. My husband will most likely be staying behind here in Columbus to further a new business we started. We've done it before, it's not fun, but you have to be willing to do what it takes to get the end result you want.I would just like to work a little less hard for my money, ya know?
Hope you all have a great holiday or at least got some good holiday pay. Remember first do no harm.

A change of pace

Well sports fans...this is one of the things I will miss when I leave Ohio. I am a huge Cleveland sports fan, sad but true. I love the Indians and the Browns. I love to watch Ohio State football as well. I think I got it from my mother. Funny thing is I married a guy who doesn't know sports. He could care less if it's football season or baseball season. He does, however, care about keeping me happy...which is most important...cuz we all know if the wife ain't happy...ain't nobody happy. So, Saturday night at work he text messaged me with a picture of an Indians ticket and asked me if I wanted to go. It helped me get through the night I tell ya. Sunday was a little rough, trying to sleep in the truck while he drove the 2 1/2 hours to Cleveland. It was typical Cleveland weather, gray and cool and a little damp but, I didn't care. Our seats were pretty good for being free. Oh, yeah, he got them off of Craig's list for free. My sister and her boyfriend go to all the games, he has season tickets, so we went to see them after the 7th inning stretch. That's were we got the first picture...just an awesome view. Plus, the Indians won!!! It was a great day.

Now we are in the hunt for a new job. I am not thrilled with my company, or my recruiter, so we are searching elsewhere. One company I am trying is called Nurse choice..check out their website..www.nursechoice.com. It gives you the pay rate right on the first page. I have been submitted to Tucson AZ, St.Mary's hospital. Almost all the hospitals in AZ belong to an association who decides the pay for the state it's 28 or 30/hr. This particular hospital doesn't belong to the association so they can pay more, which is the only reason I would consider heading back to the desert in June and July. Ok, maybe it's not the only reason, I do miss my friends..you know who you are. And it's not far to drive to Phoenix to see them.

I am considering a couple of other companies, we'll see what they come up with. I don't enjoy the hunt. It's like looking for a new car. You know what you want and the money you want but no one seems to have the exact thing so, you have to pick from what they have to offer. It can be frustrating. And, the closer you get to the time you want to leave, the more frustrating it gets. Will keep you updated.

Remember first do no harm.

Questions

Ok folks there are these things running around the blog world called MEME's. Basically someone asks you five questions and you answer them. kinda like a get to know you type thing. My questions come from a blogging friend Jleonard at Adventures in nursing. So,here we go with the questions:
1. Being a female, what are the top five pick up lines used on you? And did they work?
Uh, pick up lines, I'm trying to remember. Pick up lines.... I got nothin. Are you looking for some new ones? lol.

2.You are to be sent to a deserted island. You can not take a cell phone. What do you take and why?
No cell phone, no recruiters calling me while I'm trying to sleep!!! How long am I staying on the island? I need more information. I probably would take a box of lighters and matches (I assume it gets cold at night and I hate to be cold), sun tan lotion (I don't like to burn), a new bikini (with little food it will be a great time to diet and I'll be looking hot in no time),that stuff that purifies water (assuming it's salt water), a knife, and a tent (to keep out the bugs, I don't like them either). There's a lot more I could bring, but, I assume I'd have to carry it all, so I can live with that.

3.Your luggage is lost at the airport. What would you miss most?
Being a traveler, I am used to replacing my stuff when I forget it or lose it... if it's the luggage from question #2 I am pissed!!! I need all that stuff!

4. Where would you like to retire to and why?
It's funny people usually ask when I am going to stop traveling and where I want to live...but I want to retire to the Rocky mountains. Some place like Estes Park Colorado, absolutely beautiful scenery, and peaceful.

5.You are a tape worm in a celebrities small intestine. Who is it and why?
Ok, I just want to say gross. I would have to pick Mario Batale the chef...have you seen him? He eats whatever he wants and he's a chef so it's all the best food.

So, who's next for the interrogation?

You too can get in on the fun of the FIVE QUESTIONS., Here are the Interview Meme rules:1. Leave me a comment saying, “Interview me.”2. I will respond by emailing you five questions. I get to pick the questions.3. You will update your blog with the answers to the questions.4. You will include this explanation and an offer to interview someone else in the same post.5. When others comment asking to be interviewed, you will ask them five questions.

Nurses week gifts

Tell me what things your company or hospital has done for you for nurses week. My current travel company sent me a plastic light that attaches to the bell of my stethoscope. I am unsure of the purpose, I don't remember finding a heart beat with a light before...maybe I'll give it a try (lol). I think it might be for checking pupils, perhaps they are encouraging me to multitask and check them as I am headed to the chest to check the heart beat all in one sweeping motion. Can you picture it? Maybe it would work if the patient would hold their eyes open with their fingers for you... aahhhh, that's funny.
Oh, and I got another one of those stretchy thingys to hang my badge from. They always seems to turn my name and my face around. No matter how many times I turn it so my face can be seen, someone is always asking my name and when I look down to see if maybe they can't read,I see that my badge has once again turned around to face me. Maybe it's trying to rub off that awful picture I took, nah, couldn't be just a design flaw I'm sure.
So, my last day at work was much better. I still got an admission but, only one. Last week when I worked I didn't think I would make it through the shift. My night started out with one patient asking for pain meds, one alzheimers patient, and one with a heart rate of 170. I asked the nurse who had given me report how long the patients heart rate had been high, she said she couldn't remember but they had been telling her that it was high. She said she was just really busy. At least she called the doctor before she left. I went and told the charge nurse, so maybe she could come and help me, but she just said oh,ok. So, I gave the cardizem bolus, the charge nurse looked at me crazy when I asked her to keep an eye on the monitor for me while I was giving it. Reluctantly she turned the monitor on at the nurses station and sat back down. Then it was every 3 hours dilaudid for one patient with zofran in between. She was going for surgery in the morning so I had the check list to do and she was going to have an insulin gtt after midnight as well. So, there's two drips. I have an alzheimers patient who's lungs sound awful. I got her a breathing treatment, then the GI doc comes in and says she needs Mag citrate so she can get a PEG in the morning. I was a little confused, but, she couldn't drink it...dysphagia, so I had to put down an NG. Plus I had 3 other patients, luckily they were pretty stable. I mentioned to the charge nurse that I was having a hard time and she said oh I know isn't it busy? And walked away. Finally, at midnight ,when I was just about to lose it completely, she appeared and said she had come to help me and ,by the way, she was giving me an admission. Yeah, it was a fun night. Then last time I worked I got called into the asst mgrs office because the charge nurse from the other night had written me up. She wrote me up for giving iv dilaudid that was ordered for my patient because we are supposed to try p.o. first. The patient had refused the p.o. but I didn't chart it, apparently it warrants charting at this facility. I said the nurse before me told me she had tried p.o. but the patient had refused but, I guess we have to chart that they refused every shift...what a pain in the butt...that's the stuff that makes me hate nursing...it slows me down.

Nothing else for nurses week, just a card from my sister the nurse. She always remembers to send a card. Hope yours was a good one.

Remember first do no harm

Happy Nurses Week

Thought you all might get a kick out of this picture. We often talk about the Jesus bus coming to get our patients, but how often do we actually see it? I hope when mine comes it's in a little better shape! I thought I would write about the good parts of nursing and leave the dark side for a while.
Nursing has been a great career. I have been able to travel to some really awesome places. I've ridden a horse in Rocky Mountain National Park. I've stayed in a little cabin by a river in Estes Park Colorado. I've picked shells off the beach in Maine at sunrise which was breathtaking. I've driven on Daytona Beach and seen all the bikers during Bike week. I've para sailed over a beautiful Florida lake. I've seen cactus wrapped in Christmas lights. I've watched sea lions play in the Pacific. I've watched hot air balloons hover over the hospital in Napa. And I've watched the full circle season of the grape vines, from dry looking twigs to lush green to harvest.
I have met some of the best people. I wish I had the space to name each one. So many have made the extra effort to make me feel at home in their cities and hospitals. I wish I could put all my favorite nurses to work with together on one unit, then I might actually take another staff position. All of my friends from Hillcrest Hospital in Mayfield Hts Ohio, Florida Hospital Orlando,Mercy Southwest in Bakersfield,Good Samaritan in Phoenix and The Queen of the Valley in Napa. I am especially glad to have met all of my traveler friends, they have given me some good tips over the years.
I have seen some interesting patients and disease processes. I never would have known about Valley Fever if I hadn't gone west of the Mississippi. I have seen patients who had robot assisted coronary bypass surgery, never thought I'd see that. I've taken care of inmates in a locked unit, never thought I'd ever do that either.
All in all ,I think without travel nursing I wouldn't be this happy. I want to thank my mother and my sister for inspiring me to become a good nurse like them. I want to tell everyone how proud I am of my niece who started out as a CVICU nurse.She is now getting her masters and is helping to run a pain clinic. She does it all, works, goes to school and has 2 beautiful children to take care of. I have no idea how she does it. Just amazing.
Lots of days, if I take them by themselves, I would tell you how much I dislike my job. The day to day stuff is hard to do, in some places more so than others. But, if you look at it over all, it's not a bad life. Thanks Florence, nursing is nothing like it was when you were alive. I wonder if she is glad when she looks down to see what it's become?
Anyway, I hope everyone of you has a great nurses week. I hope you get massages and get fed and get presents, maybe even a little extra in your check. Maybe you'll even get that rogue card in the mail from someone who remembers that it's nurses week.
Remember first do no harm.

6 weeks left

So, can you tell by the title how well my new job is going? The difference from the west coast is just incredible. First the nurse patient ratio is 7 to 1. There is no one watching your telemetry monitor. This hospital (Grant) has one monitor in each of the 4 halls about half way down. At the end of each hall is a LED screen which flashes the room number and the rhythm in orange letters. Any alarms show up in red and there is a slight noise when it happens but, nothing that would really get your attention. I have to wear a pager, a locator and a cell phone. These are issued to me from a department in the basement where 4 -6 people sit and answer ALL patient call lights. Then they page whoever is assigned to that patient. I personally think the money would be better spent on tele monitor techs. All of the discharges are on the day shift so nights gets all the admissions. It's a little hard to get used to.
My first orientation night I got the scoop on the whole floor, why people are unhappy, why they are leaving, how many have left, who to watch out for. It's a great thing. The staff is unhappy, management is all new on the floor and they are very young. I don't think I will be staying past my 8 weeks unless I really have to. I just thank my stars that I know what else is out there as far as nursing jobs, so I am not stuck somewhere like this. I will be doing my one or two days of overtime a week because I need to.
My traveler friend and her husband just went from Reno to Redding CA. They are in a 2 bedroom house with a fenced in yard and loving it. She just started her job, but sounds happier than I am with the facility.
The weather is typical Ohio. Warm and sunny, then hot and muggy, then cold and gray and rainy. It's been nice being around my brother and my Aunt and Uncle. My Uncle got moved to a rehab facility for PT/OT/and speech therapy. It was a shock to both my Aunt and Uncle how these places operate. The beds are old, the equipment is old, and you have to wait a good while for your call light to be answered. I just hope he works hard and can go back home very soon.
Well, say a little prayer for me to tolerate these next few weeks. Remember first do no harm.

Passed my test

OK,I miss the weather in Phoenix. This is me the week we left Phoenix...I haven't been without a jacket since. The gray skies don't help either. It has been great hanging out with my brother and seeing my Uncle and Aunt. But, I miss being able to go out anytime of day in shorts and seeing the blue sky everyday.
I passed my PBDS test. If I return here within 2 years I won't have to suffer through it again. I thought it was just us travelers that had to take it. It turns out all new staff nurses and agency nurses have to take it, only the travelers can be fired if they don't pass. Did I get a perfect score? No, I don' like tests, but I passed so I'm happy. I am still enduring the orientation process, in a classroom. If they want to pay me to sit all day, I'm there. Yeah, it's boring , and yeah I've heard most of it before, but I'll survive. Our traveler portion of the orientation class is small, was supposed to start out with 10, only 6 showed. The staff portion has 25 people and most of them are going to Grant,like me. Makes me wonder what happened down there, and why they need all of us. I spoke with my manager as well, to get my schedule. I have already been offered overtime and they haven't even met me yet...I'm a little nervous. But, it's only 8 weeks. I start my night shift Sunday...will let you know how it goes.
Remember first do no harm.

Ohio weather

Just a quick entry, we have arrived in Columbus Ohio.It is cold and rainy and tomorrow it might snow. Welcome to Ohio! I am attempting to give Ohio Health another try.My orientation starts Monday for a full week...pretty amazing considering I am only giving them 8 weeks. That means staying at an Extended Stay...it will be interesting. I have just completed 3 hours of mandatory online testing prior to orientation. Monday I have the dreaded PBDS Performance Based Developmental System of testing. It's torture. Watch videos and tell what is going on with the patient and what you would do and what to tell the doctor. Ugh.Wish me luck!

Crunch time

It's almost time to leave the cactus behind us. 10 more days to go. I am still in the hunt for a job, but have decided to take whatever Columbus will give me and work with an agency as well. Luckily, I am working with Intelistaf, who does both. So, if no travel contracts come up I can still work. Agency or registry work is more flexible too.

It's been a rough week. Some really difficult patients, not that they were necessarily very sick but, their personalities were difficult. I really don't like being yelled at by patients or families, luckily I was able to keep my cool and defuse the situations without making them worse. Sometimes it works in my favor, sometimes nothing works.

I will miss my coworkers the most from this assignment. Some I knew from my last trip here but, a lot of new friends. There are some outstanding nurses at Good Sam, I feel lucky to have been able to work with them. I also worked with some fantastic nurses aids and secretaries. I wish I had the time and space to name them all...but I would rather just say thank you and if you ever have the opportunity to work on Tele (the first floor or the 5th floor) it's a great atmosphere. I hope to come back in the fall once the weather gets cooler. We'll see what the rest of the year brings.

My husband and I were discussing leaving Phoenix last night on our drive home. I am so lucky to have that time to relax after work. Most people have to walk to their car and fight traffic and be alert on their commute home, I get to step out the door and into the truck, relax and pet my dog on the way home. We will miss the mountains and the scenery. On our drive to work and home we pass through a small mountain, and as you crest the hill you can see all of Phoenix. It's awesome to see all the airplanes in the sky in the evening on our way home...there's usually 6 or 7 just staged across the sky waiting to land. We will also miss the weather, last week was hot in the 90's but this week has been 70 and 80 and always a big blue sky. But I'm in the job to travel...so, will keep you posted. Remember, non noc nocere.

Still waiting

Just waiting. I haven't gotten an interview yet. I have my profile in with Ohio State University hospital and Ohio Health, also with Norman Regional Hospital in Oklahoma. I am in a holding pattern, but, it's not the first time. I can always go to Columbus and work agency until I find something. It's not my first choice because I would not have the housing, but we do what we have to do when we are chasing our dreams. Who thought my dreams would take me to Columbus Ohio?
I had my orientee again this week, it was a rough day. I was back down on the surgical unit. Our thoracotomy patient who had her chest tubes pulled on Wednesday ended up getting them back in on Thursday. It was not a pretty sight. The patient has been in the hospital for almost a month. Lots of hostility and anger on the part of the husband was not making my job any easier. Then we got a transfer from the Dialysis center who was in rapid a-fib. Luckily she self converted before we had to hang the Amiodarone and start heparin. My orientee just wasn't able to keep up with the pace, the language barrier is really tough. I don't know if he is fully understanding me or the patients or the doctors.
Only 13 more days. It has been a fun ride here in Arizona, I really enjoy the hospital and my co-workers, some of them more than others. I would love to come back and work here again. The staff really tries to make you feel like part of the team, it's nice. We'll see what the future brings. Remember first do no harm.

Mistakes

Can't wait for the drive...ok, I really can, but I'm ready to go. My husband has his own personal style of driving and thinks no one else know how to drive. I find it rather annoying but, at least I don't have to drive. I am really not thrilled this time because once again we have a trailer full of stuff to travel behind us. Oh, and not to mention the lovely rise in gas prices. We figure it will cost about $500.00 just in gasoline to get from Arizona to Ohio. Sounds great, huh? Not to be out done by the fact that I don't have a job yet. Ah, the joys of traveling. The above picture was taken somewhere in California, I hate to see these especially when we are pulling a trailer.

So, I had an orientee again this past weekend. He's a nice guy, not the same guy as last time. His English is not the best, and I think I might intimidate him a little. He was looking for one of the patients Med records, I accidentally handed him a different book than the one he wanted. He administered the medication and unfortunately did not follow the 5 rights. Now, don't think that I was not doing my job. This guy is on his last week or 2 of his orientation. He has a nursing license, he has been administering medication for weeks by himself. But, he gave the wrong pills to the wrong patient, he went in the room with the medication record and claims he even looked at her name band and still gave her the wrong meds. I made sure he went right back in the room to assess the patient and take her vital signs. She was fine thank goodness. It wasn't all bad, some of the meds she got were actually right. Some were the right meds but the wrong dose. I reminded him that we are all human and not machines, we do occasionally make mistakes , we just hope no one gets harmed because of it. I had him call the doctor, but, due to his poor English I spoke with the doctor and told him what had happened. Luckily, nothing untoward happened and the patient never knew. When he went back in to administer some medications she needed and hadn't received she didn't ask why she didn't get them earlier. I would have told her they were not available earlier if she had asked. I know how it sounds, like I'm lying right? No, I am preserving the nurse patient relationship. If she had known that he had made a mistake she would not have trusted him the rest of the day. Plus he felt bad enough. I guarantee he will check every name band against every medication record from now on, probably twice. I told him that the way to stay out of trouble is to admit your mistakes, follow protocol and most of all monitor your patient for untoward reactions. It's the worse feeling in the world to know you made a mistake, I try to avoid them by following protocols and safety measures put into place. I always check my patients name bands against the medication record right there in the room. I check my meds 3 times, once when I get them together , again before I go in the room and a third time as I am opening the packages and giving them to the patient. That's why I hated giving meds at the psych hospital. They don't follow any of those rules, you can't even get most of the patients to tell you their name, plus they won't wait for you to sit there and open all the packages, so, you don't get that check. So, as I always say, first do no harm.

In search of a new home

Well, it's that time again. Looking for another assignment is exciting and frustrating as some of you may know. Especially when the company you are with doesn't go where you want to go. That's my current dilemma, Banner travel only goes to Banner facilities, which would be great if I wanted to go to Alaska, Wyoming, Colorado, or California...but this time I want to go to Ohio. I have a goal to put my husband to work and to spend some time with my brother and uncle. Also my friends and some more family are just a stones throw away in Cleveland, so we can see them too. It's lonely being out away from everyone you know but it can also be freeing. No family/friendship demands. Sounds selfish doesn't it? But, I can only live that way for a little while, then I need to reconnect with my peeps.
So, in choosing a new assignment, I have to come up with my priorities. Like this time, location is my priority, then money (it's always on the top of my list), then company benefits. The hard part is weeding out the people who cannot help you at all. It's a game. It's kind of like buying a new car and recruiters are kind of like car salesmen. I have searched hundreds of websites and sent out lots of emails, some return my calls, some don't. Like RN Network, as I have said before I was not going to use them again because they left me high and dry out here in Phoenix last time I was here. They forgot to extend my apartment lease a week until my contract was over and I had to pay out of pocket for a 3 night stay in a motel. But, I called them and a recruiter left me a voice mail about 2 days later. When I called her back, she said she was busy and could she call me back, I said sure, and am still waiting for her to call me. That tells me she is way too busy to help me. So, I talk with the ones who do call me back and tell them a little of my backround and what I am looking for. All of them want you to fill out their paperwork, whick on average takes about a half an hour. I am not spending my time on paperwork if they don't have a position where I want to go. Everyone says "We have new assignments coming in all the time, if you have your paperwork done we can submit you that much quicker." Ok, but it only takes a half an hour to fill it out, how much faster do I really need to be submitted?
I always ask about benefits, like free housing and what that includes, also if their medical benefits start day one of the contract, some start the first of the month after you have worked for them for 30 days...that's about 3 months by my count unless you start on the first of the month then it's only 2 months. That's about crazy to me. I work in health care...I know s@%t happens when you are not expecting it, I need health insurance. Some people go on their own and buy personal health insurance but I am not at that point.
Those are really my priorities, location money and benefits. Other people are hung up on travel money or bonuses, I'd rather have more per hour than a bonus that is going to be taxed away. Yeah I got a $1500 completion bonus and it was lumped in with my regular pay check so it threw me into another tax bracket and I saw about $700 of it. Why don't they just tell you it's a bonus of some kind and you'll be happy when the check is bigger instead of wondering where it all went?
So, right now I have my paperwork in with about 4 different companies, 2 have submitted me for positions in Columbus, one at OSU (go bucks!!!) and the other at Ohio Health which owns Grant, Riverside and Doctors hospitals. Hopefully I will get into OSU. Now I wait for a phone call from the nurse manager on the floor for an interview. Keep your finger crossed...remember first do no harm.

Alone again

That's my quote for the week. My goodness, between my co workers and the patients and the patients families...it was a soap opera week. Starting with a coworker who had some drama on her early (8 am) morning break with her significant other, she called us to say she was having some trouble and would be back soon. At 930 when I went to get some coffee I saw here in the managers office with the Phoenix police. Needless to say, she did not return to work and left us short. The week before I was working with another female who is pregnant and spent the whole weekend sitting in the break room and telling me what she could not do because she was sick. I know it sounds cold but, come on people...leave your problems at the door.

If you wake up and don't feel well call in sick...don't try make it...most of the time it doesn't work. Monday morning I walked into my patients room, she was on the phone, as I stood at the end of her bed she says into the phone, "Ok, I have to go, I have to unload on these people." That's a good way to start your day. She was unhappy about her entire stay and felt the need to tell me all of it before I could even introduce myself. She showed me her arm where she had had blood drawn and "someone" had taken the tape off and also removed her skin. She wanted me to call the doctor to see what I could do for it. I wanted to laugh, was she serious, call a doctor at 8 am on a Monday morning and tell him his patient has a tape burn and wants something for it. Can you imagine that conversation? I told her we usually don't apply anything to a tape burn...well, that was the wrong thing to say, she was livid that I said that to her. Then I asked her what she wanted me to put on the tape burn. I thought she was going to explode right in front of me, "You are supposed to be taking care of me. How is it that you don't know what to do? Why don't you just go call the doctor and come back when you have some answers?" So, I left the room. My poor extern was standing right by my side the whole time. I composed myself and called the doctor's PA, all I had to do was mention who I was calling about and he chuckled and asked what she wanted now. I got her neosporin and she wanted Benedryl cream so, I got her that too. I had my extern take it to her and basically take care of her for most of the day. Her heart rate dipped to 39 so I went to check on her, her husband was there as well. She was fine and proceeded to tell me about the nurse who was in that morning and gave her major attitude and how she gave it right back...then, I told her it was me. Usually I would let it go and be glad that she didn't remember our earlier encounter, but she was so blatantly mean to me I couldn't let it go. I ended up discharging her after much delay and irritation on both parts. It was a week.

I had a patient who lives 2 hours away and was brought by helicopter for a heart cath, she ended up in the ICU and then came to tele, her husband didn't visit the whole time she was there. She could press her call light but couldn't press the buttons on the bed to raise the head of the bed, ya gotta love that. It was sad, she was lonely I'm sure, but the odd thing was that she didn't want to go back to the city she lived in for her rehabilitation. I told her she would be closer to her husband but she said he wouldn't visit her anyway that he was busy. I had another patient who lived in another part of the state who's wife would call me 3 and 4 times a day. She didn't want to talk to the patient she wanted to talk to me and tell me how she couldn't come and visit and how she had bills to pay and on and on and on. These are the things that slow me down and keep me from my patients. That's why I say save the drama for your mama. I want to go to work and care for my patients and do my job. I know we need to take care of the whole person but I think they need to be an active participant in their care. A lot of people just come to the hospital and expect us to fix them without them having to do anything or change any of their ways. And when the return in a week or so with the same problem because they went home and continued to do the same things they did that got them into trouble in the first place. Just frustrating.

So, my extern is gone, he had a great time and I think he learned a lot. He won't be working in tele, it's just too busy for him. At least he got to see what it's like. Sorry for all the complaining but, I had to let it out. Remember first do no harm.

It's just rain people

OK, so it's been raining here. It's like no other place I have ever been in the rain. People actually go outside in the rain. They love it. They can't drive in it, but the love it. We were leaving the hospital the other night, my husband/chauffeur behind the wheel as usual, at it took us forever to get home. It's usually a 20 minute ride...almost 45 minutes! My husband is not the most patient man, especially when it comes to driving. He was like a caged animal between the cars. They were driving like it was ice on the road. Yeah, there were some spots of standing water but not a lot. It was a sight. You can tell a native Arizonan right away , just say it's going to rain and watch them light up. Amazing.
I have been blessed with an extra pair of hands this past week. I have an extern, he is done with school and has to work 96 hours with a preceptor. I feel lucky to be able to help mold new nurse. We had a patient with an amputation and a feeding tube and a central line and oxygen and a catheter. He was so nervous, didn't want to go in the room. I walked into the room and started talking to her, she's had a stroke so she can't talk back very well, but nods her head yes and no. I talk to her like I'm talking to you, like I do with all my patients. We flush her IV and check her feeding tube, reposition her and that's that. It took him the rest of the day to be comfortable enough to go into the room without me but he did it. Later, we sent her home, after we removed her IV and her catheter and flushed her feeding tube. He did finally admit he was afraid to go in the room. It's OK to be apprehensive about something new that you haven't encountered before, but you don't have to let anyone know. Portrayed confidence is just as good as confidence as long as it's believable. I'm not saying to do things you don't know how to without asking questions. I'm talking about walking in that patients room and making them feel confident that you will take care of them and keep them safe. Most of them are scared, even if they don't say it. Make them feel at ease and safe most of all. I have my extern for another 4 shifts so, we'll see what I can get him into.
Remember first do no harm.

Valentines day

What could be more romantic then a gondola ride? I bet the line at the Venetian is way long today. Wish I was there to see it. We thought about going to Sedona for the day but the weather is supposed to be pretty cold and snowy..not my idea of a fun Valentine's day. I think we will stay home by the fire place or maybe take a walk in the sunshine, while it lasts...supposed to rain tonight. It beats working though.
I am actually taking 2 days in a row off. Ok, I have to go to the hospital tomorrow for a mandatory inservice or I will not be allowed to work, I found this out yesterday, so, I was planning on taking 2 days in a row off. I think it's the first time in a month I have had more than one day in a row off. Not that I am complaining, I am here to work and everyday I go in with a smile on my face and a good attitude. I don't always leave that way but, I try. There are still a lot of people leaving and changing positions and new travelers coming in and a lot of new hires being oriented. 2 weeks ago I oriented a nurse who had worked at the hospital a year ago and had gone off to do home health so she could have more time with her kids. It turns out she needs something more stable with a more flexible schedule, so she came back. The 2 days she oriented with me there were actually 7 nurses on the unit..3 orientees in all. It was a little crowded but it worked. Just funny that they pick me the traveler to orient new staff.
Did you ever work with someone who told you their whole life story the first time you met them? What's up with that? I like the people I work with but, we work on a need to know basis. If I don't need to know something about you, don't tell me. I don't care where your piercings are or were. I don't need to see all your tattoos the first time we work together. I don't want to hear about your divorce, your DUI, your bankruptcy, or your love life in our first 12 hour shift together. Is that wrong? Seems like it happens to me alot, is it me?
So, interesting patients....hmmmm...I had a 572lb patient. That's always fun, had to get the special bed. I gave him a bath, with some assistance, he was grateful but it was difficult to say the least. It took only 4 of us to move him up in the bed because he was able to help. Hey I was happy he was able to help. He ended up going to the ICU with a CO2 of over 100 (very bad). Other than that nothing exciting, same old stuff.
As always first do no harm.

Just another day

So, it's been a long week. Not really a difficult one since I had an extra set of hands this week. First I got a new nurse from the Phillipines that worked with me. His regular preceptor was out sick. He's doing very well. I can't even imagine how hard it must be to move to a new country to find work. Then over the weekend I had a nurse with me who is getting back into hospital nursing. That was really easy. Now, finally a few days off to rest.
I went to the uniform store last week and was looking for skirts. I know, don't pass out or anything. Nurses used to were skirts all the time. The store I went to had one style, in 2 colors. Wow, no dresses either. So, I bought the skirts and wore them to work. It was an amazing response. Everyone stared like they had never seen a skirt before. One transporter actually said,"I didn't know they made uniform skirts!" Pretty funny. I actually was more comfortable and no it didn't restrict my movement at all. I'm suprized more people out here in Arizona don't wear them. Just throwing it out there to remind you all that you have a choice.
I worked with a traveler yesterday that I recognized. I thought maybe I worked with her there at Good Sam but, it turns out we worked on the same floor on my first assignment in Denver in 2001. Small world, huh? We talked about where we had been. She actually went to NYC and worked days as a med-surg nurse. 8-1 patient ratio....crazy. She said she had run into another nurse at Good Sam who also had worked at St.Joe's in Denver. It just made me think of how lucky I am to be able to do what I do. To travel across the country and work and meet all kinds of people and see things many people will never see. Some of the people I work with have never been outside of Arizona. Many people have been more places than I have been as well,but I feel very fortunate. Maybe that's why I can remain so positive at work, I really do enjoy what I do and my life as well. I don't think there are a lot of people out there who feel the same. I hear a lot of complaining, I just try not to add to it. Remember............. first do no harm.

Following your patients

Yeah, I got a day off and it's the week of the Barrett-Jackson car auction here in Scottsdale,AZ. I was so excited! We spent all afternoon looking at the cars. We got to see the stage and everything. Now watching it on TV makes it that much more exciting. I was watching it Tuesday night and I remembered seeing some of the cars. Very cool.
So, work has been good. I got to work on a different pod. They reserve 2 pods for post cardiac cath patients and most of the nurses that workover there can pull the arterial sheaths...which is why I don't normally work over there. But,it was a good experience.I got to pull a venous sheath, with someone watching,it was pretty easy, just like pulling a central line.
I love it when I connect with my patients and am able to see that I have made a difference. I took care of a liver failure patient just after Christmas for 5 days in a row.She was really cool to talk to, she's a Army lifer...20 years, and so is her husband. She also has a friend that came from the east coast to visit with her. That, I thought, was a great gesture of friendship. Anyway, she's been in the hospital since before Christmas, waiting for a liver transplant. While she was my patient I had pet therapy come to visit her because she missed her dog. Then I arranged it so she could go outside and her husband brought her dog, you should have seen her face, it was very rewarding. She was moved up to the floor where they take care of the liver patients but I have been going up a couple of times a week to visit her and her husband. They really seem to appreciate it. I went to visit her last Friday and she was sleeping . Saturday I went to visit and she was not there, she had gone to surgery to get her transplant. My heart jumped, I was so happy for her! Now, if you have never had the experience of taking care of a patient in liver failure, I'll paint a brief picture. They are jaundice, skin and sclera, they have a huge abdomen from ascities and we generally make their life miserable by giving them Lactulose to get rid of the ammonia that builds up in their body. They lactulose gives them awful smelling diarrhea, not that there is any good smelling diarrhea, but this stuff is usually pretty bad. They have a difficult time controlling their bowels with it as well. Sounds wonderful, doesn't it? Most of these patients are very discouraged and some are very angry. Maybe that's why I like my patient so much. She really kept her spirits up, she had some down days but she kept her sense of humor. So, I went to see her yesterday because they transferred her out of the ICU and back to the liver floor...she looks so good! No more yellow eyes! Any the worry has eased from her husbands face a little. I smiled the rest of the day! I know her journey is no where near over but I'm so happy it's headed in the right direction. It makes me feel like I can do this for a little longer.
Someone e-mailed me and said it sounded like I don't like my job... I hope I don't come across that way. I do love my job . I just get frustrated. Remember first do no harm.

Doctors Progress Notes

Ok, I had a couple of different ideas for my blog today. Then I was cleaning out my closet, no, really,it's not a metaphor or anything (although I don't mind listenening to Eminem every now and then). I really was cleaning out my closet and I came across some doctors progress notes that I had copied way back when I was working my first job. I had to make them the subject of the blog. Now, as a nurse, you can get a lot of good information from the doctors progress notes, if you can read them that is. They write about their findings and their plan for the patients care. There was this doctor, who shall remain nameless, who wrote all kinds of weird stories and very odd orders. Needless to say he is excentric, but his patients loved him. His handwriting was atrocious which made deciphering his orders and notes that much more difficult.
I hope you enjoy and get a good chuckle from this actual prgress note.
Chief Complaint:
" I fell honey."
History of present illness:
This 92-year-old white female fell out of bed and she was brought here by the squad. Dr.____ phoned me and said she broke her right hip, which is correct. The lady has a history of electrolyte imbalance, hypothyroidism and postural hypotension. She is 92 and demented. I made my way to ____ Emergency Room, while every erstwhile administrator or attorney had taken vacation through Wednesday, because after all, you know it is Independence Day on Tuesday. However, there is no Independence for the lacky physicians, as myself, who struggle along for a pittance of remuneration. Perhaps I ought to have a Boston Tea Party. In any event, 'the patient' was lying there in the gurney with her two daughters present. She knew old Doc ____ , the kindly old soul.
Physical Examination:
Vital Signs. Her blood pressure was 130/80, heart rate 82 and respirations 12
Lungs: The lungs were clear.
Heart: The heart was sinus rhythm.
Extremities: The right hip was swollen with decreased motion.
Plan:
I said I would get ______, an orthopedist, Dr.___ to clear her heart-wise and Dr._________ to evaluate her sensorium. Therefore, we feel it is safe to admit Mrs._____ and we pray for her.
Wow, that is a piece of art isn't it? I am not sure if this particular physician is still practicing. But, I remember him still carrying the old leather doctors bag with him everyday...once we got a peek inside, it was full of saltine crackers and ginger ale from the refrigerator on the unit. Go figure, huh? Remember...first do no harm.