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Charge Nurse didn’t talk to me the rest of the shift.  I was okay with that.  She was wrong for what she did, and I told her so.  If she wanted to sulk, so be it.

We have a new housekeeper, and she is great.  Patients love her.  The station looks better than ever.  Even our lounge is shining.

She had just finished wiping down our station’s counters when Charge Nurse came back in to sit at her computer.  CN immediately whipped around and started complaining to the housekeeper about the wet counter tops.  Didn’t she realize all our papers will get wet?  Doesn’t she know to wipe over the counters again to dry them?  Doesn’t she know how to do her job?  Over and over again.  She was bitchy and rude to the extreme.  The housekeeper just stood there.  I was standing near by the charts.

I must have been making a face, because CN looks at me and says, “What?  What did I say?  Did I say something wrong? Am I just supposed to kiss butt? What? What did I do?”

I felt a bit stuck, because I wanted to call her out on being a bitch, but I also didn’t think it was appropriate to do that at that time.  I just said, “CN, she just wiped down the counter tops with the alcohol wipes.  It’s probably dry now.”  And it was.  The housekeeper just left quietly.

After the housekeeper left, I came closer and CN repeated her questions.  “You were unbelievably rude.  That lady is new here and does a great job.  There was nothing wrong with the counters.  They were dry by the time you finished verbally assaulting her.  You owe her an apology.  Don’t you dare run off our good help.”

Debbie came around, and I told her what happened.  She went to find the housekeeper to talk with her.  Apparently CN had repeatedly treated her like this, and the housekeeper was ready to quit.  Great. The worst of it is that CN seems to truly believe she did nothing wrong.

I like CN.  I really do.  I know better than to take anything she says to me seriously.  Most of the time her cluelessness makes me laugh.  This time she crossed a line.

A young woman is in need of dialysis and to be placed on a renal transplant list.  She had come to us in failure, and we had finally gotten a 5-year-old renal biopsy result to our hospital.  Not good.

My favorite renal MD came in to discuss those results and the need for a transplant.  He tells her to call a number the next morning.  Then, looking at her face, he says, “No.  22 is too young to be having to do this.”  And he pulls out his own phone to make the necessary calls.

I love this guy.

Work has been better.  Not that its changed, but I feel better even while surrounded by chaos.  Perhaps the cloud is lifting?  Maybe I can get back to planning for higher education again.

I’m having a little trouble with my former preceptee, Cindy.   At work she’ll come find me to ask questions, even if I’m not even working the same unit as she is that day.  She’s called me a few times when I’m not working, too.  I’ve tried talking to her about needing to go to the nurses working with her.  I’ve talked to her about needing to go to her charge nurse when she thinks she has a problem.   I’ve talked about how important it is for her to go to the nurses around her, no matter how she feels about them or how she thinks they’ll respond to her.   No matter how many times she tells me okay, I can’t seem to actually get through to her.

She called me this afternoon to ask if she should start a potassium protocol on her patient.  This has to stop.  Not only is it inappropriate for her to be so dependent on me, but this could get me into serious trouble as well.

I didn’t see this side of her until she was off orientation.  I consider her a friend, but I’m going to have to cut her off in order to help her.  She’s got to go to the right people.  At the very least,  I’m going to have to stop answering calls if I know she’s working, and I’m going to have to send her back to her unit if she finds me on another.   If she doesn’t stop this soon, I’ll have to go to our manager.  I know the nurses she’s working with, and they would help her if she’d ask.

Tough love, baby.

Yesterday was not one of those days that makes me reconnect with the joy of nursing.

I had two psych patients.  One was nice if a little teary, but that was nothing that her meds and some listening didn’t solve.  The other woman was infuriating to deal with, and this most mostly due to her enabling family.

When I came in to introduce myself that morning, the husband actually turned to the patient and asked, “Do you like her, honey?” At the moment the woman was being examined due to these stange “fainting” spells she was having.  Spells that would immediately follow a moment in which she was told by someone that she couldn’t go home right then.  Spells in which she would be standing next to  me and then go limp and throw her head back all the while holding herself up straight.  She displayed a flat affect and wouldn’t look at anyone in the eye… until her baby grandson shows up.  Then she’s all coos and smiles and playful.  She will refuse everything (meds, imaging,etc) and then complain that people treat her badly when all she does is do what we tell her to do.  She was upset at being cajoled by family into taking her meds, so she starts moaning and groaning and complaining that she’s sick to her stomach.  I bring her Reglan.  The moaning and groaning doesn’t stop until she eats a snack that family bring her.  It was a long, long day.

The topping came right at the end of the shift.  My aide (who is all kinds of awesome) came to the station looking for me.  Apparently the family was upset at her and claimed she never brought a dinner tray. My aide says she walked in with a tray.  The patient refused, so she walked back out with it.  I believe my aide. I don’t get how the husband is still believing what his wife is saying after spending the entire day witnessing her lies to both him and me.

I didn’t get the chance to say that to him.  I walked in the room and told the husband I had called dietary and asked them to send another tray.  This sent him into little fury.  “Another tray!  Ma’am, there was never a first tray.  I’ve never left the room, so I would know.”  Our dinner trays come earlier than most expect, sir.  Are you sure you never left the room between 4:15 and 4:45? Stammer, stammer, stammer.  Ok, then.  Dietary confirmed to me that they will be sending up a  tray.  My pager started beeping, or I probably would have gone into it a bit more.

In the midst of the tray fury, I received a transfer from a medical floor.  My report: young man, recently extubated after being in ICU for worsening pneumonia, got up with PT and experienced sob and chest pain, sustained sinus tach 140s-150s,50% non-rebreather with sats in low 90s and dropping when off O2.  There are no other orders in my chart aside from the transfer order to telemetry.

I walk into the room and find a nice young man and family.  The young guy is still wearing the mask he was wearing in ICU even though he sats fine without it.  He says he never experienced any shortness of breath or other symptoms.  He says that PT checked his 02 without the mask during the “incident” and he was satting 92-95% then.  Current heart rate 90-105.  He ambulates and voids. He gets very anxious at times, more so when staff is working with him.  This is stated by the family and confirmed by the patient.  Family says they tried to tell the nurses this, but no one listened.

He looked nothing like the hurried report I received.  He transferred to me a couple of hours after this “incident.”  The order could have been cancelled.  Not a case for telemetry.

I’ve been in quite a funk lately about my job.  I hate it more and more each day.  On rare occasions I get pulled to med-surg or even the neuro floor, and I can’t get over how calm and relaxed these floors feel compared to my own.  No Exedrin Migraine needed those days, but there are no openings on those floors for now.  Any other job I look to outside of the hospital is not likely to match my current salary.

I’m soon approaching my two-year anniversary to nursing.  I’m trying to decide what to do next.  My original plan was to stick it out.  The nurses on my floor say “if you can work here you can work anywhere.”  I was going to stay in telemetry and go back to school part-time to be a nurse practitioner.  I’m just not even sure about that anymore.

These feelings have gotten exponentially worse the last couple of months, so at first I thought that I was being affected by the seasonal changes.  I hate the dark.  I hate the cold.

Deep down I know that, while the feelings may have worsened due to the season, those feelings have been there for a least a year now.  So, what to do?  What to do?

Nurse Manager popped by the station.  “Food’s here!” she exclaims as the food cart rolls by.  Thanks, Captain Obvious!  “Well?” she asks.

I’m on the phone with radiology, the other nurses are down the hall in patient rooms, and Charge Nurse is on the phone with staffing.  The aides have taken the cart and are pushing it down the hall to begin passing trays.  Charge Nurse hangs up. “What?”

Nurse Manager shakes her ponytail.  “Food’s here!  Let’s all go help pass the trays.  Food is one of our problem areas in the patient surveys.”

“What are we supposed to do about the food?”

“No, silly.  The food will get cold if you don’t go help pass it. That’s what the patients complain about.”

“Go touch a carrot.”

“What?”

“Touch a carrot now!”  Nurse Manger looks confused.

“The food is already cold.  What are we supposed to do about that? Unless you want us to micro-”

I clear my throat loudly to interrupt.  “Do not give her any ideas!”

I’ll never understand why stupid policies get put into place that are obviously dangerous and/or make no sense.  Well, I understand why a person far removed from bedside care might do so if it saved a few dollars.  This is not the case.

I work on a telemetry unit, one of four telemetry units on a single floor.   In the past, a person who went for a cath returned to their previous room unless they required more intensive care for whatever reason.  I would send my patient to cath lab, and they would return to me a few hours later.

The powers that be have decided that any person who goes to cath lab and receives an intervention will afterwards be moved to one of the units.  If they do not receive an intervention, they return to their previous room.  There was a vague explanation about the patients being monitored more closely by a specially trained unit.

Bullshit.  Whether or not a person receives an intervention, the care following the procedure is the same.  Patient returns flat with extremity straight for the ordered amount of time.  Vitals taken frequently and site monitored closely.  Pressure held if hematoma occurs.  Repeat.

This change would only make sense if they changed the criteria from just receiving an intervention to having the person transferred to a specialty unit if a sheath was still in place and must be pulled on the floor hours later. That is when the patient is most at risk.

Instead, what happens is what happened to that poor unit tonight.  The cath lab closes at 5-6ish.  Every patient is transferred to them.  They receive 6 at once.  Many of them still with sheaths as cath lab does not hang around to pull the sheaths for late cases.  All require close monitoring for the next several hours… at least.   This is just asking for trouble.

Why do we always have to wait for the sentinel event?

P.S.  Now that I think about it, is this a yearly ritual on this hospital’s telemetry floor?

I checked with Cindy(new nurse) before leaving the station tonight.  “You need any help?”

“Just finishing my charting tonight.”

“Ok, see you later.”

Twenty minutes later I get a somewhat frantic call from Cindy.  Apparently one of her patients had an increasing heart rate throughout shift change and was now sitting at about 160 beats a minute.  The night charge nurse told her it was her responsibility to take care of it.  Cindy had called cardiology and had received orders for a cardizem drip.  She told the charge nurse the orders, and the charge nurse told her “Finish your job.”  Cindy had never started a cardiac drip before and was calling me to find out what to do.  I told her where we keep the protocol orders and to get someone there to help her fill it out and fax it to pharmacy.   I told her at that point her job was done.  She’s already given report to the next nurse.  She could stay to learn if she wanted, but she was not to start a cardiac drip alone if she were unfamiliar with it or felt uncomfortable doing so.  If the other nurses were reluctant or refused to start it with her, then she needed to leave it for them to do.

I know that charge nurse, and I know the attitude she most likely had toward Cindy.  Cindy didn’t deserve that.  She is the most hard-working, conscientious person I’ve ever met.  She’d never ignore a problem or purposefully leave unfinished work for the next nurse.  She’s the first one to help those around her.  And she’s new.  She’s still learning.  Hell, I’ve been there two years, and I grab another nurse when I have something new to me.

It makes me angry that Cindy felt as though she had to call me to get help when there were plenty of on-the-clock nurses around.

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 Happiness Project

1. Set a bedtime.
2. Make my bed every morning.
3. Always be reading something.
4. Move more.
5. Toss and organize.
6. Give proofs of love.
7. Leave the past.
8. Fight right.
9. Don't expect praise or appreciation.
10. Kiss more, hug more, touch more.
11. Aim higher.
12. Find some fun.
13. Ask for help.
14. Smile.
15. Realize it's possible.
16. Don't compare;be inspired.
17. Focus on what I have.
18. Beware of drift.
19. Take a chance.
20. Listen.
21. Be mindful.
22. Cultivate gratitude.
23. Spend out.
24. Do good, feel good.
25. Show up.
26. Have the courage to be imperfect.
27. Find joy in the ordinary.
28. Work smart.
29. Enjoy now.
30. Talk to strangers.
31. Go outside.
32. Start where I am.
33. Show up on time.
34. See art everyday.
35. Love with abandon.
36. Be colorful.
37. Dress the part.
38. Revel in accomplishments.
39. Learn something new.
40. Fear less.
41. Take pictures.
42. Speak with integrity.
43. Don't be critical about small things.
44. Manage my pain.
45. Surround myself with creative people.
46. Practice, practice, practice.
47. Don't force it.
48. Deal with something once.
49. Trust my instincts.
50. Avoid gossip.
51. Choose to see the best in people.
52. Take time to be silly.
53. Throw my own party.
54. Be a mentor.
55. Lean into my fears.
56. Find the others.
57. Do the unexpected.
58. Don't break the chain.
59. Do things others aren't.
60. Slow down.
61. Be cool with not being cool.
62. Be kinder than necessary and more generous than reasonable.
63. Pretend I'm good at it.
64. Keep in touch.
65. Row my own canoe.
66. Do what only you can do.
67. If it doesn't work out, find something that does.
68. Dream bigger.
69. Notice what's right.
70. Stop talking. Start doing.
71. When in doubt, choose laughter.
72. Don't let the perfect be the enemy of the good.
73. Respect everyone.
74. Be early.
75. Delete the unnecessary.

Three Simple Rules

1. If you do not GO after what you want, you will never have it.
2. If you do not ASK, the answer will always be no.
3. If you do not MOVE forward, you will always be in the same place.

All I Need

1. Someone to love.
2. Something to do.
3. Something to hope for.

What I’m Reading

Blood Meridian
by Cormac McCarthy
Their Eyes Were Watching God
by Zora Neale Hurston

U.S. States I’ve Visited

Alaska
Arizona
Arkansas
Colorado
Georgia
Florida
Louisiana
Maryland
New Mexico
North Carolina
Ohio
Oklahoma
Pennsylvania
Texas
Utah
Virgina

Countries I’ve Visited

Mexico
Colombia
Thailand
Vietnam
Bermuda (British territory)

I write about…