nursewithaunit


The NightShift Resistance

Nursing after dark


(no subject)
nursewithaunit
Pretty much going to start shutting this down.

Moving it over to www.nursedaddy.com

(no subject)
nursewithaunit
As nurses it's very easy to look at the people who roll in the door and spend their last days with us as just another customer. Their name might be John Smith, but all too often they go from being "Mr. Smith" to "the amputee guy in 25A" or sometimes even "that crazy guy who screams all night".

We provide the best care we can, but we are human too and sometimes we might have an unkind thought about Mr. Smith because he's waking up the other residents, and he's trying to ambulate without his prosthesis and damn it he's trying to use his bed table as a walker; he does that every time he tries to get up for the bathroom instead of ringing.

Then they die.

Then a week later we're reading the papers and see Mr. Smith's obituary.

It's a shame we can't read a residents obituary before they die; we'd probably get a better understanding of that persons life and how it made them the person they were and maybe even help to explain how they came to spend their last days in our care.

We might see that the occasionally continent, night screaming, furniture hijacking little old man wasn't always so little. Or old.

When he's gone and we read his obituary we read of his families pride for that Silver Star he was awarded during the Second World War, when his tank was hit and he got his crew out safely before he was able to bail out. Most of him anyway; his leg stayed pinned inside. His wife said that for decades afterwards he would dream about the flames and how he could smell his leg burning. She said it sometimes made him scream at night in his sleep.

We thought he did it just to annoy us.

His son was quoted as saying he learned determination and compassion from his dad. The Old Man couldn't get a prosthesis right away when he got home to an Army hospital. The war was still on and there were other priorities. He didn't want to be a burden so at night he'd use his IV stand as a rolling crutch and toilet himself so that he wouldn't take a nurse or orderly away from someone "...who was really hurt and really needed help...".

We thought he was too lazy to get his walker.

We're going to provide the best care we can, whether a resident is an Army Air Corp Medal of Honor winner or the April 1953 Employee Of The Month at the Middletown Texaco.

Still, I wish I had known...

See ya' Lee. Safe trip pal.

(no subject)
nursewithaunit
It seems that I am turning into a haspice nurse. It's not by choice though. On the 2 40-bed units that I float between (total 80 res/pts) we've had at least 10 got to the Eternal Care Unit in the past 2 weeks or so. It's starting to look suspicious!

One took a dive out of her chair the other day and faceplanted, BADLY, into the deck. The on duty nurse (who relieved be 90 minutes earlier thank god), got in there a started controlling the hellacious bleeding. Told it looked like a GSW to the head, thats how bad it looked. 2 minutes later she was gone. My poor replacement wound up getting her feet sticky and was a bit put off.

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They were short the other night and floated me to cover -TWO- units. I had to cover Unit 2 (46 beds) AND Unit 1 (26 beds). I carried 72 res for my shift!!! MED PASS SHOULD NOT INVOLVE STAIRS OR AN ELEVATOR!!!!!!!!!!!!!

Gee this place looks famili
nursewithaunit

IMAGE courtesy of GurneyCam

Woke up at 2100 Saturday night for work with a pain in my left neck behind and inferor to my L ear.

I figured I slept wrong and just headed into work.

For the entire shift I would get these muscle spasms in my left neck every 3- minutes that would lift me up on my toes, clench my fists with white knuckles, draw back my lips, clench my teeth and generally feel like to top of my head was coming off. These would last about 5-10 seconds and then I'd be good for another 3-5 minutes.

I had some diazapam at home laying around from a previous back issue so I took 10mg of that and figured that would take care of the spasms. No go. Advil and ibuprofen didn't do much either.

It was not a good night. Power failure put the unit in the dark for several hours. The aides and I had to tie all the O2 concentrators, BIPAPs, etc. into the generator lines and I wasn't much use for anything that involved bending or turning ones head, but we got it done.

The supervisor was looking at me for meningitis, but I had no fever or other signs.

0700 comes and I did the fastest (but still accurate) narc count and report you ever saw and hightailed it to the hospital ER.

Caught a spasm right as I was signing in and the got me to the head of the line.

Started off with IV morphine and zofran and contrast for a CAT scan.

Doc did an external exam that didn't pick up much but then he started poking around inside my oral cavity with a tongue blade and he found one spot way the hell back that was causing pain. He suggested diazapam for the spasms and when I told him I had already tried that he decided to investigate a little more and see what was happening.

The CAT scan didn't show anything definitive. Doc asked a bunch of questions and one of them was whether I had had any dental issues lately. Light bulb went on. 2 months ago I had a left lower molar that was giving me some pain for a few days. Cleared up before I could see the dentist so I cancelled and thought nothing of it.

Money right now is on a wicked dental abscess. I'm on clindomyacin q4x10. 5/325 Percocet q4 PRN and Flexoril for spasms.

Went home and slept for 18 hours straight.

The pain is a bit better now. Still hurts but more from movement than the spasms that would come out of nowhere. The percocet is helping a bit.

Doc gave me a note to stay home for 48 hours, so I got someone to cover my shift last night. onights my off night for school, so I have to call my math instructor and see if I can skip tonight without incurring a penalty.

(no subject)
nursewithaunit
I think I'm getting screwed at work, and not in the good 'lets duck into the med room and play naughty aide and stern charge nurse' way.

When I signed on at this new gig I was told that I would float between Unit 3 & Unit 4. I wasn't happy about it, but I needed work.

After a month, one of the Unit 4 nurses moved on the greener pastures and I asked to have Unit 4 made my 'home'. This was done. Once in a while I'd have to float, but once in a while everyone has to float, right?

So they hired a new herd of nurses, one of whom is from my nursing class. We've been booked a few times where they would have us both down to work 4 and each time they would float me to 1 or 2.

So tonight as I am working on 2 and helping do new orders on 1, the nurse from 3 comes down and says a bunch of stuff ending with "..and you're the float nurse."

What? Wait a minute, when did -I- become the permanent float nurse.

If any one should float it should be one of the new hires.

Then I thought about it a bit more: I've been pushed off 4 to make room for my former classmate who it looks like will be a permanent full time nurse on 4, making me a full time float nurse.

Why?

We took our boards together on the same day, so we have exactly the same amount of license time under our belts. I have more LTC experience than she does and I have been at this facility for two months longer than she.

The only thing I am getting a whiff of is that her performance is unremarkable. Lacking in some ways. The supervisor theorized that perhaps I am being floated because I am doing a better job than she and that they want to keep her on one unit to let her concentrate on just one group of people.

So let me understand this. I want a unit to call home but can't have one and have to float because I am a better nurse than the one who just took my spot on 4? So then if I just degrade my performance to below that of my former classmate then I will be rewarded for my poor performance by getting what I want?

I think I just learned how government subsidies and jobs work.

I was going to hold off on looking at that job at the jail, but if they aren't going to be fair with me at work then there is no reason not to move on.

(no subject)
nursewithaunit
Things at work have been generally unremarkable.

I have been staying mostly on my unit and on rare occassion I float to the unit next door.

When I was in nursing class I didn't understand what float meant and once it was explained I couldn't understand why so many people hated being "floated'.

Now of course I understand.

Try this on for size: last night they floated me to a unit I had never been on. Unit 1 AND 2. Thats right, the have a position where one nurse covers TWO units!! It's just you, 4 CNA's (if you're lucky) and SEVENTY-SIX residents spread across 2 floors of the building.

Doing rounds should not involve using an elevator!!!!!

I got blindingly lucky though; just as the supervisor was about to drop this abortion in my lap, one of the other nurses walked in even though she wasn't scheduled for a shift. She misread the schedule, thought she was on and drove an hour to come in. So she and I slit the floor and it worked out.

Still, the idea of having 76 residents is to me borderline illegal. We have a 2 hour window for medpass. If you spent 90 seconds doing each persons meds you might stay in compliance, but you know a fingerstick alone takes 30 seconds, to say nothing of logging out narcs!

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School is ok.

Say the shortest pair of happy shorts out in the hallways when I came in. Followed by several mini-dresses. Schools not so bad. :)

Math class is challenging, both in content and duration.

Psych is much more casual. My instructor is being questioned about her role, if any, in a triple homocide that happened here, so she is somewhat distracted. The quizzes that we are supposed to have gotten are being delayed a bit while she gets her story straight is distracted.

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Working in LTC one thing you notice is that people who are settling in for the long haul bring their photos and albums with them. I love looking at the old photos! I love the fashions and I really find it interesting what people valued enough to go through the trouble of taking a picture of.

Early on, when I saw that everyone was bringing in their old photos, I knew that one day I was going to run across an image that would make you say "might not be the best one to hang on the wall". I also had an idea in my mind of exactly what that image would be; and sure enough, I encountered it on Unit 1.

Walked into the residents room, gave meds, engaged in small talk, started looking at the photos on the wall and there was a very nice b&w portrait about 3x5 of her husband in his uniform, SS runes poorly scratched off the photo but their 'ghost' remaining. Knew I was going to find one of these images one day, just thought it would take more time. Ah the stories some of my residents can tell.....

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Halloween approaches. Appearantly my unit and Unit 3 have a fierce competition to outdo each other every year. I was sworn to secrect and then told that my units theme this year is Alice In Wonderland. So far the unit manager will be the Queen Of Hearts. The bleached blonde punk-type day tour norse with all the metal in her ears is going to be Alice. This is actually kind of cool because I know she'll tweak the image a bit and I have a thing for blondes in pinafores, so I may sign up for an extra day tour.

Unit 3 is doing something but I'm not sure what and really don't care. I did notice that in the back of their Med Room was a shopping bag full of styrofoam tombstones. Really, is it a good idea to use fake tombstones as decor in a nursing home? That would be like decorating death row with candy syringes. I can just picture some clod showing up in a Death costume and randomly pointing at residents and saying "You!!".

RENKO
nursewithaunit
Sitting here at the nurses station. I am orienting a new hire nurse who is someone I went to school with. The result is I am enjoying the pleasure of having an extra nurse around to split the load.

Ah, half a floor......
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I've been thinking about what happens if I get into the RN nursing program for this coming fall. The way things are going now, I'll have all my pre-requisites done by the end of the Fall 11 semester. The RN program doesn't start till Fall 12. Applications have to be in for the program by Feb 12.

The way it looks now, if I get into the program I'll have to take 4 nursing classes and 4 A&P classes and be done. Since my prereqs are done I'll only have to take two (big & major) classes each semester, A&P and Nursing.

This also leaves me with an empty semester, Spring 11.

Now in theory I can challenge A&P1 and A&P2. I'd have a fair chance of successfully challenging (and thus not needing to take)A&P1, though I am told very few successfully challenge A&P2.

If I successfully challenge A&P1, I could take A&P2 as my sole class for Spring 12. Then if I get into the nursing program for Fall 12 I will only have to take Nursing1 for the first semester, only Nursing2 for the second semester and then the last two semesters would be Nursing3 and A&P3 and Nursing4 and A&P4.

That's the plan.......................it awaits approval of the mice (get it? best laid plans....).

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The other thing I have been thinking about is do I want to keep working while I am doing the nursing program (assuming I get in).

I have alot riding on this, so the idea of being able to devote myself 24/7 to schoolwork is very appealing. Then again, I also have to pay the bills.

I figure that if I start squirreling money away now and get my recurring expenses cut down, I can probably get by on about $1,000 a month. By the time Fall 12 comes around I will just about be done with my delinquent property tax repayment schedule ($2,500 every quarter), so that should free up some money and also reduce a huge recurring expense.

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It's funny that I'm thinking this stuff. 25 years ago this definitely not where my mind was. Heck, 5 years ago this is not where my mind was.
Tags: ,

(no subject)
nursewithaunit
I always figured that on my death certificate it would read "Cause of death: Irate husband".

I am now convinced that my ultimate demise will be brought about due to injuries sustained in a fall resulting from tripping over a bed alarm wire. God damn those things are lethal.

Seriously, hardly a night goes by that I don't stumble my way across a room during med pass after getting tangled up in a freakin' bed alarm wire.

(no subject)
nursewithaunit
A day for quotes:

The supervisor corners me as I'm leaving work and headed for school at 0745.
Supv: We're short a CNA on Unit 5. Could you do an extra shift as a CNA?
Me: I'd rather ride a pogostick blindfolded through a minefield.
Supv: (pause) Ok, I think that means no, right?

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After class I come home and HouseHold6 is cooking. She serves me my meal and then starts making a sausage pizza for later. I'm sitting in the dining room eating, she's in the kitchen doing food prep.

Me: Can you bring me another Coke.
HH6: Not right now.
Me: Why not?
HH6: I've got a sausage in my hands.
(pause)
Me: OK, we're in separate rooms so either your being unfaithful or I'm really really gifted.

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At school in deans office going over whether or not I need a microbiology credit.

Dean: Your grade advisor says you're an LPN and that's why she didn't schedule you for a microbiology class. Admissions didn't know you're a nurse so they figured you needed it.
Me: So what now?
Dean: Do you have anything on you that proves you're an LPN?
Me: What? Like an ID card or something? No, I don't usually carry ID.
Dean: But you are a nurse right?
Me: Well if I'm not all those people I gave suppositories to this morning are in for an even bigger shock!

(no subject)
nursewithaunit
An interesting evening.

I’m a little pissed because I made a good catch this morning but should have picked it up earlier.

I came on last night at 2245, got report and started my tour.

The only interesting thing on report was a fellow who had crappy lung sounds. He was started on Levaquim 500mg PO BID x10 a few days ago. Well, this AM he had a chest x-ray done and it came back as likely CHF, plural effusion, etc. No order for furosemide, which I would have expected and right there is where I should have started to get suspicious.

Anyway, since he was on report for the ABX he had to have his temp checked at least once per shift.

I went and checked on him and he was fine. Report said he had some breathing issues earlier but when I checked on him he was breathing fine with 2Lpm of supplemental O2 via NC. No s/sx of cyanosis. No dyspnea, SOB, etc. Basically, he seemed fine.

So I didn’t check his O2 sat. I should have checked it as soon as I saw the CHF dx, but when I saw him and he had no distress…………..

So around 0545 I see him on med pass and he just seems ‘off’. You know what I mean. You can’t put your finger on it, but you –know- something is going on, your nursing Spidey-Sense starts tingling and you start paying very close attention to whats going on.

I corral my CNA’s and ask them if they notice anything different about the resident and they say that he just seems ‘off’.

Now the thing that I and I think everbody else hates about our job is that we get to spend so little time with our residents/patients. I have 40 residents and spend maybe 3 minutes with each one per night. That’s it.

I bang out the rest of med pass as fast as I safely can. Check my watch. 45 minutes until shift change. I grab my stethoscope, sphygmomanometer, O2 meter and thermometer and decide to go play with Mr. CHF for a little while.

I go in and start with a pulse ox reading. He’s combative, as he always is, but I have weight, age and size on him.

Pulse 95. Ok, not outrageous especially since he’s fighting me.

Pulse oximetry…..%79-80. What the?!?!?

Run the pulse ox again in case his fighting gave me a false reading.

Pulse ox holding on %80. All the while he is still getting O2 at 2Lpm via NC.

Check his lung sounds. Bilat crappy w/ expiratory gurgling. Nail beds have good capillary refill, but are a little dusky.

That’s enough for me.

Off to get the supervisor. I tell her what the skinny is and that I want to call the doc and get some Lasix going.

She comes up to the floor and calls one of the admin nurses. The res is the father of one of the admin RN’s. She tells the admin nurse that I called the supv regarding the res and that she should come and join us to see what has got me so concerned that I had to get the supv.

I suspect she thinks I was overreacting. We get there and examine the guy. She greenlights me to call the doc and get some meds rolling.

Note to students and new grads: When you have to call the doc to report a change of status you’re going to find that there are two types of docs. One type will take your report and then say “Do this, this and this and then call me if there’s any change”. These docs are easy because all you’re doing is acting like a stenographer. He dictates the order and your off to the races. The other kind of doc is the one who takes your report and then says “..uhhuh…ok..so what do –you- want to do?”

What do –I- want to do? I want to do whatever the freakin’ guy who went to med school wants to do!! Although in a way I suppose it is a vote of confidence that the doc is asking what the person who actually has “boots on the ground” wants to do. I suggested 40mg IM Lasix and a bump up on the O2. Doc went with 30mg Lasix IM and supplemental O2 at 3Lpm via NC.

Done. 45 minutes later he’s sat’ing around %90 and is visibly more comfortable. His daughter, on the other hand, was a bit of a trainwreck.

Was it a good catch for me. Yes although I should have picked it up as soon as I came on. As soon as I saw CHF on the report I should have gotten an O2 sat right off even though there was no distress at that time.

Other stuff:
The CXR was done that AM. On the 24hr report it stated that the MD was contacted to give the results to but there was no note showing that he ever called back. That’s why he had no furosemide order; doc had never called back. 1500-2300 should have seen on report that a call was out to the MD and had not been returned and then followed up.

Stuff happens.

Lesson I learned: CHF = get a pulse ox right at start of shift/tour.

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Spoke to the admissions folks at the local diploma mill.

My transcripts finally showed up. I have to go by Thursday morning, meet with an adviser and get classes picked.

?

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