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The night nurse sat down heavily and asked if I was ready for report. I said I was. He assured me that I wasn’t . “Long night?” I asked. “And you’re going to have a long day.”
She called herself a nurse, but it turns out that her late husband had been a doctor. When I asked about her daughter – who I knew was a nurse , the woman snorted and said disdainfully, “Just a two year degree.” She had a bypass and valve repair scheduled for Monday morning. It was only Saturday.
From the beginning I could see her confusion. She simply could not remember that nurses had given her any of her meds. By noon she was demanding her morning meds, refusing to believe that I had already given them to her. She insisted that no one gave her a single pill for 3 days. She spoke viciously of John, the night nurse, and demanded that he be drug tested. He was lying. She never received any pain meds, and she knew how nurses were with drugs. When I asked her if she’d like me to bring her something, she waved me off and said she took care of it already. I saw a bag of home meds in her closet, so I spoke to her daughter privately of my concerns of over-medication. Her daughter agreed to take them with her when she left.
And all hell broke loose. I would say that she was a holy terror, but there was nothing holy about her. She ranted and bitched up and down the hall, foley in hand. She demanded to have her medications back in her room and threatened to leave AMA, call the lawyer, call the police, pull the fire alarm… She’d stop any doctor in the hall to tell of her mistreatment. There was absolutely no reasoning with her. At one point I was in her way (unintentionally), and she moved to grab my shoulders. I simply said firmly, “You touch me, and I will call security on you.” She soon tired and calmed down enough for me to walk her back to her room. Still very upset, she sat on her bed and attempted to call all her family and friends (not understanding the need to dial 9 first, thankfully).
I went back to the station and printed out a MAR to show it to her. I told her it was a list of all her meds, and we went over each one. I showed her on the print-out when she had received each medicine. I handed her my pen and told her that she could use this paper to document meds received. She seemed wary at first, but then I told her these could be her court papers. That seemed to please her, and she was happy to sign by each med I gave her. (She drew a line through each med administered by the night nurse.) I turned to grab my pen before I left, and she pushed it away from me. Fine. Keep the damn pen.
It worked beautifully. She was still a needy patient, but there were no more arguments about her medications. I printed her a new MAR before I left and told John about our system.
The next morning I was getting report from the same nurse, when she hit the call light. He rolled his eyes and said he’d go in with me. We found her at the bathroom door. She held out her foley and said, “This needs to be emptied, and my bed needs to be straightened.” Whatever. He took care of the foley, and I moved to the bed. I pulled back the covers to find a lot of random objects, including the thin, white turban she wore on her head. I put those things aside and was just finishing folding back the blankets when she and John came out of the bathroom. I took a double take and nearly bust a gut trying not to laugh. We tucked her in bed and made it out to the hallway before asking, “Was she..?” “Did you..?” and bursting out in laughter. And maybe it’s wrong, but I took such great pleasure in seeing this proud, disagreeable woman wearing her panties on her head.
* “Dickie Roberts: Former Child Star – Anyone.. anyone?
Handwritten instructions after “No driving until cleared by your PCP” and “Wash site gently with soap and water”:
Stop cocaine!
This genius decided that, after a CABG x 4 and a mitral valve repair, he had spent enough time at the hospital. Mind you, he still had pacer wires and a pleural drain. (My last day with him had been exhausting. He had refused lab draws, citing old burn scars as evidence of the abuse he’d experienced from the techs. He constantly pulled off his monitor. After being instructed repeatedly concerning his pacer wires, I still caught him showering. This particular day he would complain of pain but refused the darvocet and even the morphine on his profile. According to him, the night nurse had promised to call the doctor and get something stronger.) During the cardiologist rounds that afternoon he insisted that he leave immediately. He’d already called his ride. He just needed to go home and get some rest. He’d come back to his room in the morning so the doctor could see him. Right. The MD spoke to him at length about the grave risks of leaving, but nothing was getting though this guy’s head. The MD made him sign his progress notes. The surgeon was paged, and his PA came by to talk to the guy. This time he needed to get home for a funeral. Whatever. The PA removed the pacer wires and drain. I removed his central line. He signed his AMA form. Sometime later family arrived to pick him up.
Update: This guy returns 3 days later on a neighboring unit, and all day long security and cops are hanging around that room and station. Apparently he decided that no one was allowed to enter his room.
Update #2: The guy became septic and died a few days later.
“Diana, I would like to thank you for being such a wonderful and caring nurse, I wish that I could take you with me to the other floor.
You have helped my stay here more comfortable and pleasant. I hope administration realizes what an assett you are to this hospital. Your knowledge and caring is the epitome of what a nurse should be.
You have such a pleasant and non-Judgemental personality, I don’t think you realize how much easier you have made my stay here.
Thank you for your positive personality and beautiful smile.
Thank you,”
blah blah HIPAA blah
And the Academy Award goes to…
I arrived the night before my scheduled weekend shift, the night before Ike’s projected landfall. I was prepared to stay for several days if necessary due to possible flooding in the low-lying area where the hospital sits.
The hurricane hit early morning and passed over our area fairly quickly. The lights flickered for a while before the generators kicked in and almost completely gave out. This meant that we only had basic power: the nurses station lights, hallway lights, and the red outlets. Patient rooms were dark, only two computers were running for documenting (no orders), and – most importantly – there was no AC. Of course, the windows can’t even be cracked open, or we could have enjoyed the tropical storm winds. Instead, the heat and resulting humity was so great that the walls and floors were slick. We ended up lining the floors with blankets to try to save the nurses who were perilously close to hitting the floor everytime we made a trek down the hall. I was passing oxygen to patients who had no pre-existing respiratory conditions because the air was so thick and warm.
It was a long and scary day for me. The storm had cut out all our communications with the doctors. No answering services, cell phones, and pagers were working. I just prayed that everyone stayed stable. With the exception of one particularly scary moment, they did.
I stayed over again. The next morning the power situation had remained the same, but big utility fans had been placed along the halls for slightly more bearable conditions. I went home that night to find that while we had no power, we had suffered no damage from the storm. My town was lucky. Just a short drive away Hurricane Ike had devasted neighboring cities.
By the time I returned to the hospital 3 days later, it was running at a full power. My power at home was returned a week later, and I had decided that – unless already scheduled – I would not be working through another hurricane. It was so not worth the bonus.
My patient was experiencing symptomatic a-fib. Another nurse came in to see if she could help. The appearance of a second nurse worried the man, and he asked, “I’m going to be okay, right?”
She smiled and quipped (ever so morbidly), “Nope. We’re going to bury you tomorrow.”
Ummm… my guy is scared and feeling very sick. Thanks for dropping in, but could you leave your deranged humor at the door?
Before I could even say something, he looked her squarely in the eyes and said, “That’s not funny, and I don’t need to hear that right now.”
It was all I could do not to laugh loudly at her face. Good for him.
My hospital has mandatory scrub colors, and I thought I’d hate it. I gave all my patterned and multi-colored scrubs to my sister who works in a doctor’s office (on the condition that I can have them back if needed) and went out to buy new scrubs. Eight months later, I wouldn’t change a thing… about the scrub policy, that is.
As a new nurse it helped me identify my co-workers. I can glance down our long hall and know exactly who is going into my patient’s room. And if it is helpful to a new nurse who doesn’t know anybody, it makes sense that it would help a patient identify those strangers in his or her room. I don’t think name tags alone would be enough. The tags get turned around all the time, and the writing would have to be much bigger. Also, it is early morning when the most number of people come through the patient’s room. We all introduce ourselves to the patient, but usually all the patient can remember when telling me who came by is the color that person was wearing. The patients don’t usually remember which color belonged to which of the various positions, but they quickly pick up on at least two colors: those of the nurse and the nurse aide. Three if they get regular breathing treatments.
Consistent, solid colors look much more professional than a sea of clashing colors and patterns. It shaves off the 5 seconds l used to decide which pair of scrubs to wear. All my tops and bottoms match. Most of our assigned colors go well with a lot of other colors, so our staff are able to use colors and patterns as layers (though not technically sanctioned by administration)- still uniform with a touch of individuality. I have one blue jacket with multi-colored stars. One of the colors matches my uniform perfectly, and patients comment on it every time I wear it. Silly, but I think it shows how our patients are sensitive to our appearance.
And there’s room for change. Our LVNs recently got together and voted on a color change. Unfortunately for the male LVNs, it was to a bright, quite feminine-looking color. One big guy now refers to his new uniforms as his “gaydar.”
*** Disappearing John RN: Mandatory scrub colors…
On Saturday morning we were discharging everyone possible; my unit’s census dropped 50% by noon. By Saturday afternoon there was a team going around making up evacuation packets for each patient remaining: copies of the chart, facesheets, patient worksheets, updated contact info (to add cell phones), armbands with said contact info, etc. All that was left was to include copies of the latest orders/progress notes/lab and imaging results, current medication administration sheets, and a bag with enough meds for 24 hours. Saturday night we were told we wouldn’t be going anywhere. In fact, we’d probably be taking on patients from other hospitals.
Sunday was quiet. We had five nurses with three patients each. A few discharges that were soon replaced with ICU transfers and ER admissions. Supervisors came by regularly. There were no immediate plans to evacuate. Nope. Still nothing. Then…BOOM! Or, rather…. RING! Our charge nurse got a call just after 5pm to inform us that there were 60 previously unavailable ambulances out front waiting to be filled. Go!
Oh, and someone was coming up right now for one of my patients. It was insane. I’d never seen our unit trashed so quickly. Papers were flying everywhere. Lines formed after our unit’s one copier and the two Pyxis medstations we shared with another unit. All the phones were being used to call patient’s families to let them know of the transfers. People were called to come in early to help with the evacuation. By the time I left, I only had one patient remaining. (The first one gone was that first transfer. The other I was able to get discharge orders from his surgeon.)
This morning I arrived prepared to stay a few days if necessary (in case of severe flooding around the building and parking garage). The hospital was dark and silent. The only floors operating were ICU with 10 patients and mine with 4. The ER was open but empty. Surgery had a possible 3 cases. I spent the first part of my day preparing my one patient for surgery, but then the MD decided to wait another day and another set of imaging since the GI issue appeared to be slowly resolving.
It was a long day. And, thankfully, Gustav was a no-show.
I come to work a little scared every day. I like what I’m doing, but I’m afraid of screwing up. I’ve never been someone who took a failure easily, and now that potential failure involves a human life. That fear keeps me on edge.
I know I’m new. I know I’m not alone. I work with wonderful nurses who don’t even wait for me to ask for help, but they seek me throughout the shift to make sure I’m not drowning. I work with a group of nurses who are always available to answer any question, though one jokingly keeps a tab: one nickel for each answer. Her goal is to get a Coke out of me, but she writes off my debt at the end of each day.
I hate constantly feeling like I don’t know what I’m doing. Worst is not knowing if I should be panicking. Working in telemetry, I get calls and faxes from our monitor techs frequently about my patient’s rhythms. Usually it’s just artifact or an incorrect reading. Whenever I’m not sure what I’m seeing or what to do about what I’m seeing, I show it to someone else to gauge their reaction. Then I do what they tell me to do and store that rhythm/reaction for future use.
The other day I got a print-out for a supposed run of v-tach. It definitely wasn’t v-tach, but instead a short run of widened QRS complexes. My guy was asymptomatic; all vitals stable and labs normal. I didn’t really know what to make of it, so I did what I always do. I showed the rhythm to an experienced nurse at the station and asked, “Is this something I need to do more about?” She took a look and told me not to worry about it. The next day the guy had the same run. Cardiology took a look and decided he needed an immediate pacemaker/defibrillator. I don’t write this to put any blame on the other nurse, because , ultimately, it would lie with me. Now I know, and I’ll make a call if I see such a run again. But what about the people I’m learning on? That makes me nervous.
I find it incredibly humorous when a student nurse or orientee is assigned to work with me.
It does help that I run into situations that stump my former preceptor/ now mentor with over 15 years of experience at that same unit. Logically I know that it’s impossible to know everything. However, that knowledge doesn’t diminish the lingering fear. So, I subscribe to several nursing journals and buy books on cardiac care and pharmacology, but I’m often too tired to do more than glance over a few pages. On the days I’m not working, I want to focus on other interests. Anything but nursing.
It’s the regular positive feedback from my patients, their families, and fellow nurses that keeps me going. If you work with new nurses, please tell us when we do something right. Let us know that we handled a situation well. When we’re weighed down by fears and doubts, it’s those words of praise and encouragement that help keep us afloat until we’re able to release those burdens and finally feel like a Nurse.
*** In response to a great post by Jo of Head Nurse.
It wasn’t an emergency. One of my patients had been accepted into an impatient hospice center. There was still enough time in the shift for me to prepare him to go so that the next nurse may only have to wait for his ride. The last few consults still seeing him had all agreed that he should go to hospice, but all progress notes included the words “stable at this time” and “considering hospice.” So I had no actual orders. I paged the three consults still rounding and the MD on call for his attending. All the consults gave me the orders I needed. Just the attending to go. I called the answering service again to find that that MD on call had changed. Ok, let’s page that person.
An hour later I paged again. Nothing. 45 minutes later I paged again. The answering service told me she had a new pager, and maybe it wasn’t working. They would keep trying and checking back with me to see if she called. Still nothing. This was getting ridiculous. I called the hospice center to let them know what the hold-up was and to make sure there wasn’t a deadline for when they could accept him that day. No time limit. They could accept him anytime. I told my charge nurse what was happening, and she paged the house supervisor. What if a patient had been coding?
While they worked on it, I went on with the rest of my work. When I got back to the station, I was told that apparently this doctor was not answering any pages since another MD was going to be taking over that evening. They had gone ahead and paged him. He called back soon and gave me the discharge orders as I was giving report to the next nurse.
He stared blankly ahead and never made eye contact except to sneak quick glances at me while I was talking. He was a poor historian. Any answer to any question would inevitably begin with “Twenty-five years ago I was in a pedestrian accident. A car hit me going at 50 miles per hour. I was a pedestrian.” He was from a neighboring state and couldn’t explain why he was here with us, only saying “I rode a Greyhound bus. It was a nice, clean bus. I need to get to the bottom of this. I’m from ****. I don’t know the zip code. I’m in ****, now. I don’t know the zip code.” He was wearing the hospital gown over his jeans and t-shirt.
Psych was not a favorite class of mine, but I tried to remember everything I had been taught about his psychosis. He wasn’t exhibiting any paranoia, just the flat affect and disorganized speech. His room door opened away from him, so I would call out to him and identify myself before I was even in his sight. Just in case. Despite his condition, I had an easy morning with him. His blood pressure was very high, so he had regular IV meds to lower it. Cardiology rounded and scheduled a heart cath for the next morning.
Nearing the end of my shift, he complained of his IV site hurting. I looked at his wrist, and I could see a small irritated area forming around the site. I explained to him that we didn’t want to keep using an IV that is hurting him, so I would need to start a new IV. He verbalized his understanding. I came back with the supplies, and once again explained to him what I needed to do. He held his arm out stiffly to me and turned away. I continued to talk out loud and narrate what I was doing. I had his arm prepped and ready to go when I opened the needle packaging. He took one look at that needle before pulling his arm to his chest, yelling “I know what you’re doing. You and your blood samples and needles. This isn’t right.” His other fist was clenched, and I had backed away during this rant.
Therapeutic communication was another silly class I didn’t care for, but right then I wished I had a memorized dialogue. Instead, I stood quietly and as non-threateningly as possible. I was very direct with him. “Mr. Schizo, are you going to hit me?” No. “Then please open your fist.” He did. I turned and sat down in a chair across from his bed and began to talk calmly to him. We had worked together all day long. He could trust me. It was important that he have another IV for his medications and for the procedure tomorrow. Did he understand why he needed an IV? No answer. Did he need a few minutes to himself? A almost imperceptible nod. Ok, I was going to leave now. We’ll try again later.
When I came back, his arms were thrown over his face. He would not look at me or talk to me. Not even a nod or shake of his head. Right. I came back again 10 minutes later to let him know that I was leaving now. He would have a new nurse for the night. Did he need anything before I go? He shook his head no. Ok.
The night nurse was a big, burly man. When I came back the next morning, Mr. Schizo had a beautiful new IV.
