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I walked into the station this morning, and the night’s charge nurse asked, “You know you’re charging, right?” Ummm…no. I ran through the list of senior nurses who are always there. Not today.
The day was okay. Not too much went on as far as charging duties, but it was my first day to charge alone. The nurses working with me were all fairly new except for the ICU nurse who was pulled to our station, though she was unfamiliar with our routine and discharge procedures.
I had to get the right people to come down and fix our copier. It had an error message (F-77-o2 something or other) and a sad-faced man wearing a tie and carrying a suitcase. Seriously weird, never seen it before, and it took all day to get it fixed.
I took care of assignment changes at 3pm. I checked our crash cart. I helped my nurses with whatever they needed. My patients were great.
It really was a good day, and yet I left with a headache over the additional stress of responsibility. Nothing happened, but the idea that something could happen kept me on edge.
I had a patient tell me that the reason his blood pressure went up the night before was that he was watching UFC.
My God, today sucked.
Our hospital is currently doing a number on our hours. Overtime is no longer able to be scheduled. This means that we’ll be having a lot more people working 8 and 4 hour shifts rather than just the usual 12. This means our assigned groups change more often as we take on the patients of those leaving.
On top of this change, the lovely people above us decided to “tweak” the matrix as well. Our unit and the neighboring one are now considered one single unit to staffing. This means there are technically two nurses charging now. Though they each tend to their own unit as before, they have to do a lot more together to figure out assignments. While we occasionally would cover a few of their patients (and vice versa) when they were short, it is now a regular occurrence. It sucks for us, because we are literally having to work in two different stations. Our assigned group of patients are split onto two different sides of a floor. It’s a long walk. Charts are kept in different locations. You miss your doctor rounding because you’re at the other station. The other station can’t find you quickly. Our poor aides have to deal, too. Due to the “single unit” change, we now will have a total of 3 aides instead of the usual 4 when staffed as separate units.
In order to cut back on hours even more (temporarily they say), the two units are having to share one ward clerk. It makes for a massive jam on busy mornings. I try to put in at least my own orders, but I can’t keep up and get my regular work done, too.
New busy work: a sheet of paper is now put up in each patient’s room that is supposed to be initialed and checked ever hour. Even hours by nurses, odd hours by aides. I suppose to prove to someone (patients? families? administration?) that the patient has been seen every hour. (After 10p or so it drops to every 2 hours.) A useless paper that proves nothing because anybody could fill in however many time slots at any given time. It doesn’t go into the patient’s chart. (I don’t really know where it goes. To the manager?) And I know I didn’t get to it all tonight. It’s a new change, and by the end of the shift I have everything but that stupid little paper on my mind. I thought about it just before I clocked out, and I swiped my card anyway. What the hell. I was seeing some patients a lot more than once an hour.
Another new change thanks to a recent Walmart lawsuit: clocking out for lunches. Before we simply had 30 minutes automatically docked for lunch each shift. Apparently if it isn’t done just right, we’ll get put on some list that gets sent to administration. Cue the scary music. Ooooohhh
All of this was enough, but today Maria (New Nurse) worked with me since her precepter was out sick. My orientee Cindy was on her 2nd day officially on her own, and she had an overwhelming shift dealing with many, many new (to her) issues. So, I was basically precepting two nurses and covering two groups. My charge nurse was busy dealing with the clusterfuck of staffing issues all day long, rounding with all the docs, putting in orders, taking care of her patients,and at times covering for the other unit’s charge nurse.
And I was handed some packet (that I should have gotten months ago) to fill out and turn in at the end of the day. A packet that had to detail the time Cindy spent with me, the patient diagnoses we covered, her progress and goals week-by-week, and a whole lot of other bullshit. To be done and left in education’s box before I left. So that Cindy could work her next shift.
Today sucked hairy monkey ass.
*That didn’t occur as a direct result of patients and/or family
Sometimes I just don’t know how to respond to the things patients say. Two recent cases:
I had a elderly direct admit with a hemoglobin of 6.6 . I’ve got to transfuse 2 units, and I’m in his room taking his history and making a quick assessment. As we’re talking, I ask if he’s had a blood transfusion before and when.
“The last one was in August. I think I got some nigger blood because I’ve been craving watermelon ever since.”
He caught me off guard. I laughed… once. It was involuntary and out of shock over what I was hearing. He later told me something one of his friends had said about President Obama, and we both agreed that it was inappropriate.
***
Another patient of mine had just hung up the phone after talking with her daughter. She turned to her husband and explained that their granddaughter had skipped school again.
Her: “And do you know where she went? To a black boy’s house. A black boy’s house.”
Him: (shaking his head) “I’m not surprised.”
***
Even more amazing to me are the offhand comments patients say to me about Mexicans. How they’re ruining the country. How they’re taking all our jobs. How they’re lazy. (And wanting all our jobs?)
Living in the south most people think I’m Mexican. (Colombian, actually.) So why the hell would you say things like that to me? And even if you can’t tell what I am, I think its pretty damn obvious that I’m something different from you.
I’m not going to change my elderly (almost always Caucasian) patient’s mind-set that shift. If there’s an actual fact I can give, I’ll give it. I figure the best ways to combat the stereotypes is through my own actions and the patient’s experience with me. However, they’ll probably just consider me the exception to the stereotype.
I don’t take those things personally. Most of the time I find the situation humorous. And then sad. Another person living his or her life in ignorance.
You know it’s going to be a good morning when you walk into the station and the night’s charge nurse calls you from the hall to hold pressure in Room 16. Yeah, that cath she had yesterday afternoon? She’s now got a massive hematoma.
My preceptee is almost done with orientation, and she is awesome. This was her first experience with a bleed. We were in the room together, and I talked her and our patient through what I was doing. I had to sit tight for at least 30 minutes. I told my new nurse to get report and take care of the other 4 that were good. I’d handle the bleed for now. For now turned into hours.
She’s a big lady, so I had to hold pressure longer. I escorted her to ultrasound to check on the site. That took a while. We were good. Then I took her to CT for a chest scan. She came in for atypical chest pain. Her cath was clean, and we were experience that chest pain again. (No respiratory distress, clear breath sounds, good sats – but we’re looking) The machine would not work right. The table kept getting hung. We take her to another machine. We get her set to go, the contrast is started, and the contrast is not showing up on her scans. We go check the patient’s site. Blood is everywhere. Her arms are over her head (so she doesn’t see this), but the pillow and table are covered in blood and contrast. I glove up and take a look. The contrast tubing is loose at the clip. We take it off, clean her up, and set up again with new tubing. A towel over her head because she’s now feeling claustrophobic and doesn’t want to see the machine.
And on and on went my morning. Anything that could go wrong did. Thank God for New Nurse. I was so proud of her. This was the first time she completely went on her own as she’s always been a bit hesitant. She got patients ready for procedures, handled orders that were needed, rounded with doctors,etc. She’s knows when to get help, and she went to my former preceptor to check out what she thought might have been symptoms of a DVT. Turned out to be a flare-up of his gout, but she did the right thing to ask and then talk to the doctor about her concern.
I praised her and praised her all afternoon.
Debbie and I are both precepting new nurses. Her new nurse is struggling with time management. Everyone takes a little time to adjust to the pace of our unit, but New Nurse hasn’t been improving. Debbie asked me if I had any advice.
New Nurse’s problem appears to be that she hasn’t adjusted yet to a big picture plan. She focuses on specific tasks so much that she loses sight of all that needs to be done.
Most brain sheets I found on-line are great for keeping together information about each patient. New Nurse doesn’t need this. We already have a working system for that information through our morning reports: a detailed print-out with additional/current information written in. She needs an hour-by-hour schedule for her day. A worksheet that shows all the work to be done for all her patients on one page.
I played around on Word and created a shift worksheet that fits our unit’s needs. It’s not fancy, but I think it’ll do the job. Since we already have pages with the detailed info, this worksheet is simply for writing in tasks (meds, treatments,etc). I put in places to fill in timely info such as vitals, accu checks, rhythm strips, and drains. This also serves to remind the new nurse to look at said information.
Update: I gave the worksheet to Debbie who gave it to New Nurse who promptly put it at the bottom of her clipboard’s stack. She told me later she didn’t like it. (She continued to flounder that shift.) Debbie liked it and told me she plans to use it. Another new nurse asked for a copy to use. And asked for another at the end of the shift.
Allergies: demerol, ex-lax, pudding
I received a patient the other from ICU, admitted with exacerbated COPD. He’s still tight and very wheezy. Without oxygen, his sats drop to the low 80s. So what is the first thing he does upon arriving to the floor?
If you guessed take off the oxygen and leave the floor to smoke…you win!
It’s lovely, really. I talked with him about how this kind of activity would land him back in ICU. I explained what was happening to his oxygen levels every time he did this. Did he understand? Lots of nodding. Did he want to talk to the doctor about getting help to quit smoking? No comment.
My orientee was really worried and anxious about this patient repeatedly leaving the floor. I told her there wasn’t much more that she could do. The patient was educated concerning the risks. The doctor was aware of what was happening. It was all charted.
I’ll bend over backwards to help someone who wants my help and is trying to help him or herself. If a patient is alert/oriented and consistently non-compliant, I document the education provided, the patient’s actions, and the provider notification. Then I let it go. I’ll still keep a close eye on those patients, because, as much as I am annoyed by them, I don’t want them crapping out during my shift.
If someone is belligerent and insisting they leave now, I educate them concerning the risks of leaving and not finishing treatment. I educate them about the effects leaving against medical advice has on insurance. I’ll notify doctors of any imminent AMAs. I give the patients all the information they need so that their stupid decision to leave is an informed one. I don’t fight anymore after that. I don’t let it frustrate me.
If you don’t want to cooperate with us and your ordered therapy, leave. Please just leave. There’s always someone waiting for your bed. Someone who wants to receive care.
Nurse Manager was so wrong for that.
Our hospital has quarterly town hall meetings. They always take place during the busiest part of my morning. There’s no way I’m leaving the floor for an hour and getting behind so that I can sit in a folding chair and watch our CNO not answer our valid questions.
This morning was different. Nurse Manager practically skipped through the station and announced that every nurse on our unit had to attend so that we could accept an award for *mumble, mumble* highest *mumble* satisfaction score. (Her mumbling vagueness, not mine.) And she got a neighboring unit and education nurses to come cover the floor. We left no one behind. Our group consisted of Nurse Manager, four nurses, one aide, and our housekeeper.
The general meeting was a blur of statistics and figures from the last quarter. I was content because they provided the breakfast I had missed that morning. Then they got ready to recognize units and departments. First up was the four highest scoring units/departments, scores ranging from 96-99% We were not on that list.
- And can I just say, the top scoring people are always outpatient/radiology/therapy. The places that spend the least amount of time with patients. Inpatient units get screwed in those ratings, because patients will dock us for everything. They are with us long enough that -if looking- they will find something to bitch about. Oh, you don’t like your food? Ding. You think you have too wait too long for your doctor? Ding. You don’t like your doctor? Ding. You get woken up for vitals/lab draws/x-rays? Ding. Your room’s too small? Ding. You were happy until your family came to visit, and now they’ve poisoned your mind? Ding. You’re not my only patient? Ding. The best my unit seems to receive is in the 90-93% range.
The next list to be recognized were the top four most improved units. We were fourth at 88%.
Everyone else only had one or two people go up to collect their goodie basket and balloons. Nurse Manager herded us all to the front of the room while following behind clapping and cheering loudly. We took up the entire first row while grouped together for pictures.
It was ridiculous.
There was a unit meeting last week. I didn’t make it, but one of the other nurses gave me the highlights. There was one item on the agenda that particularly intrigued me.
Day shift has been noticing an occasional lack of vitals, weights (done by night shift), and blood sugars. When this was brought up in the meeting, the answer was simple. If there wasn’t an aide that night, the nurses simply didn’t do it.
What the hell? There are days when there are no aides for us, too. Only we don’t decide , “Oh, well. Not today.” On those days I take all my vitals every four hours and take my blood sugars myself. When I see a weight missing, that gets added to my list. And that’s on top of the regular work that keeps me running even with our aides present: medications, rounding with doctors, getting exams and lab work done, speaking with family, admits/discharges, prepping for surgery, and the other million and nine things I can’t even think of right now. (And that’s on a good shift when my patients aren’t crapping out on me.)
I’ve worked the occasional night shift. Several of the day nurses used to work nights. Besides the random shift when all goes to hell (I know it happens), there is simply no excuse to not do the work.
