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.

The first week of the new year

Ya gotta love that sign..it just exudes fun. Hopefully a sign of what is to come for the new year...fun. The first week was full of work for me. 5 days this past week...not in a row, but I could have if I had wanted to. The last 2 days were pretty exciting. Friday I discharged all 4 of my patients...I just love when that happens, NOT. Yeah because most jobs if you finish all your work you get to go home, right? Not in the hospital, we'll just find you more patients. I'm not complaining, I like to work and make money. I prefer days when I don't have to work so hard though. 3 of my patients went home and I sent one poor soul to the ICU for Cpap.She came in with pneumonia, a chronic copd patient, she just waited too long to come in and what we were doing wasn't helping. She had gotten her lasix and steroids and antibiotics but by noon she was on a venturi mask at 28% with a pulse ox of 90....not good, plus she was really sleepy. All that equals increased CO2 retention and someone who is quickly losing the drive to breathe. I called the resident who ordered ABG's and a trip to the ICU. Hopefully she will be back soon. Saturday I only sent one person home and got one from the ICU and then transferred another one to another tele unit due to staffing issues. Yeah, it always seemed to come at the end of the shift. My patient,who spoke very little English was so nice about moving.That made it all better. Attitude is everything.

So, I survived the first full moon of the year. It was pretty mild for me, thank goodness, as always with a little help from my friends. I can't tell you enough how much it means to be a good team player. I do my work and help my co-workers, including transporters and secretaries , even my nursing assistants. A lot of people beg to differ with me on that last one but, a kind word or a little assistance goes a long way to making you have a good day. You've been there, walk on the floor and you can feel the aura depending on who is working that day. You have to be a little in tune to it, but it doesn't take long. And any one person has the ability to uplift the mood on the unit, if even for a moment, it can make the difference between a good day and one of "those" days. It does take energy and a desire to do it but it's worth the effort most days. If you have the energy.

Remember, first do no harm.

Christmas in Vegas

So, I got to spend Christmas in Las Vegas. One of the reasons I work so hard all year. It was fun. We got to see all the sights, all the Christmas decorations. This is the Christmas tree in the botanical gardens at the Bellagio. They always have a spectacular display. The crowds were massive but, it was worth it. We saw the trees in front of Caesars Palace and the one on Fremont street. The fountains at Bellagio were set to Christmas music and the weather was perfect. We also got to see them take down the tree on Fremont street the next morning. Amazing how all of a sudden it's over and life goes back to normal. Why does it? Why not have that feeling all year. After all it's a feeling in your heart, isn't it?

Yeah, I'm a dreamer.

I heard it was pretty awful at work. Not enough nurses and all the sickest patients of course. Hats off to all the great people who worked that day and spent it away from their families. I have had to do it many times. It's really hard for the new nurses especially if they didn't work in a hospital setting before or during school. Most families don't understand. I remember so well... trying to explain to my friends why I couldn't go out on New Years Eve or to my new husband why we couldn't spend Christmas together. It's a whole new world...one that not many people understand. It's unfortunate because it adds just a little more stress to the holiday season and the new nurses life.

I returned from Vegas and had one more day off then it was 5 in a row. I couldn't have made it through that last day without the help of my friend and co-worker Mike. We laughed and joked through out the day and made it through. Thanks Mike.

This time of year is also when the travelers contracts are ending, usually right before or after the holidays..it's weird it just seems to work out that way. It's odd to stay on and see them leave when I am usually leaving too. My friend Christie is headed to Bakersfield. I wish travelers would talk to each other more before they make their decisions. She is headed to Mercy hospital..I worked there a couple of times before I went to Mercy Southwest...it was very busy and not terribly friendly. Hopefully things have changed and she has a great time. My friend Madessa was headed to Columbus so we will catch up to each other later this spring. And Carolyn, lucky dog, is headed back to Hawaii today. She was great to work with. She mentioned that she is writing a book about travel nursing... I wish her all the luck and if there is anything I can contribute...let me know.

The hospital is still filled with the really sick left over from the holidays, so the days are not so easy. Hopefully we will get a little relief soon, but not likely with the full moon. It was on the 3rd I believe so, we have 3 more days of craziness, woohoo! I know people don't believe it but, it is true, crazy things happen when there is a full moon. So, I have that to look forward to.

The other thing is my traveler friends Jeannie and Don are planning to come to Phoenix. They are currently in sunny, humid West Palm Beach Florida. The gambling is not so good there so they are headed this way next month. I can't wait!!!!! We had a great time here in Phoenix last time and a lot of fun in Napa. It's funny how sometime you meet people and stay in touch forever and some people you really like and want to keep in touch with don't make the effort. Weird huh?

Well, hopefully I'll have a great story next time from this full moon time. Remember, first, do no harm.