ICE CREAM!
i'm having a good day today for a silly reason. nurses are part chef, part waitress. and so, on occassion, i get to whip up a milkshake with carnation instant breakfast, 2 small cartons of vanilla ice cream, and a splash of milk - the ratio is crucial! and don't knock the strange ingredients until you try it! the best part of making this concoction is not the joy on the face of the patient, but the critical taste test that i allow myself! and today, i've made not one, but two strawberry shakes. and hence, had not one, but two sample spoonfuls. i prefer the vanilla and the chocolate flavors, but i won't complain. i do enough of that and who complains about ice cream anyway?!?
Wednesday, April 28, 2010
Friday, April 23, 2010
to go or not to go!
today was a rough day. and i go back tomorrow.
sometimes, it is so challenging to motivate myself to return to a place full of stress, illness, diarrhea, chaos, blood, nausea, crying, pain... the list is endless.
i precepted a brand new nurse today; it was her first shift on our unit. and i warned her, there are just some days that are plain ol' hard... some days your best isn't good enough. some days you never want to return. some days you wish you worked behind a computer. and some days you stay late, more than the 12.5 hours you're scheduled for.
by 7:40, i was done charting, done giving report, done with patient care; in short, i was done, done, done! but i stayed an extra ten minutes to walk out with nursing friends - to share our days' stories, to unwind, and to motivate one another to come back tomorrow. i'm planning on showing up. i wonder who else will join me?
sometimes, it is so challenging to motivate myself to return to a place full of stress, illness, diarrhea, chaos, blood, nausea, crying, pain... the list is endless.
i precepted a brand new nurse today; it was her first shift on our unit. and i warned her, there are just some days that are plain ol' hard... some days your best isn't good enough. some days you never want to return. some days you wish you worked behind a computer. and some days you stay late, more than the 12.5 hours you're scheduled for.
by 7:40, i was done charting, done giving report, done with patient care; in short, i was done, done, done! but i stayed an extra ten minutes to walk out with nursing friends - to share our days' stories, to unwind, and to motivate one another to come back tomorrow. i'm planning on showing up. i wonder who else will join me?
Thursday, April 15, 2010
back to work
it's been a LONG time since i've written. in fact, it's been a LONG time since i've worked! i took off three weeks of work to go to bali, indonesia! and it was AMAZING. the whole thing - the first week which was yoga, the second week which was adventure, and the remaining days pre and post travel to prepare and then to catch up. what was also fantastic was the time away from sick people, from death, and from sad situations.
now, i'm back. and it's the same. more cancer, more sadness, more death...
an update on things at work from while i was away:
there were SO many sad stories and situations before i left that only got more sad while i was traveling. one of my very favorite patients, a 50 year old filipino woman, got discharged home to die; she was going to fly to the philippines to be surrounded by her 11 brothers and sisters. another 50 year old gentlemen died in the intensive care, with tubes in every orifice, and his parents by his bedside, devastated that they couldn't take his place. the 62 year old woman who had been here since october or november finally passed away (to join the mom whose comfort she had been craving so much). and there are numerous others whose stories go undocumented.
today has been slightly comical for a change. i'm taking care of a patient who is confused; i'm not sure of her baseline mood and behavior, but i think she might be crazy to begin with! anyway, she's totally off the wall today and i got called a name while trying to help her. let's just say, it was not christa - it's something i've never been called before... "you're a smug little shit!" she said with glazed, devilish eyes. how does one respond to this name calling? "why thank you!" i said, a bit taken aback!
time off from work was so restorative. i thought a lot about my patients while away; they inspire me and teach me many things. and i love being a nurse, but mainly in retrospect... if that makes sense. i love the idea of nursing, when i'm not in the midst of a crazy 12 hour shift! but despite the vacation, i'm already looking forward to my next non-healthcare related adventures (of which, thankfully, there are plenty).
in august, i'll be camp nurse at camp parkview, a camp for developmentally disabled adults (my fourth year as nurse, my 12th plus year of involvement). in september, i'm climbing mt. rainier - wish me luck! and the following week, i'll be heading to upstate new york for one of my best friend's wedding and a short rendezvous with my mom in the big city. not long after that, the first week of october, it's off to nepal for 10 days of trekking and 2 weeks of building a home with habitat for humanity in pokhara!
wish me (and my patient) sanity for the remainder of the day and patience as i wait to embark on more trips and adventures!
now, i'm back. and it's the same. more cancer, more sadness, more death...
an update on things at work from while i was away:
there were SO many sad stories and situations before i left that only got more sad while i was traveling. one of my very favorite patients, a 50 year old filipino woman, got discharged home to die; she was going to fly to the philippines to be surrounded by her 11 brothers and sisters. another 50 year old gentlemen died in the intensive care, with tubes in every orifice, and his parents by his bedside, devastated that they couldn't take his place. the 62 year old woman who had been here since october or november finally passed away (to join the mom whose comfort she had been craving so much). and there are numerous others whose stories go undocumented.
today has been slightly comical for a change. i'm taking care of a patient who is confused; i'm not sure of her baseline mood and behavior, but i think she might be crazy to begin with! anyway, she's totally off the wall today and i got called a name while trying to help her. let's just say, it was not christa - it's something i've never been called before... "you're a smug little shit!" she said with glazed, devilish eyes. how does one respond to this name calling? "why thank you!" i said, a bit taken aback!
time off from work was so restorative. i thought a lot about my patients while away; they inspire me and teach me many things. and i love being a nurse, but mainly in retrospect... if that makes sense. i love the idea of nursing, when i'm not in the midst of a crazy 12 hour shift! but despite the vacation, i'm already looking forward to my next non-healthcare related adventures (of which, thankfully, there are plenty).
in august, i'll be camp nurse at camp parkview, a camp for developmentally disabled adults (my fourth year as nurse, my 12th plus year of involvement). in september, i'm climbing mt. rainier - wish me luck! and the following week, i'll be heading to upstate new york for one of my best friend's wedding and a short rendezvous with my mom in the big city. not long after that, the first week of october, it's off to nepal for 10 days of trekking and 2 weeks of building a home with habitat for humanity in pokhara!
wish me (and my patient) sanity for the remainder of the day and patience as i wait to embark on more trips and adventures!
Monday, March 8, 2010
so tired...
nursing can be exhausting! then again, the hours are a bit ridiculous! i was scheduled to work 3 12 hour shifts in a row - saturday, sunday, and monday (which is ENOUGH). however, because we were short staffed on sunday evening, i stayed for 16.5 hours. i got home at 11:35 PM and returned to work this morning at 6:45 AM! ugh. the money is nice; i can't complain. but keeping my eyelids open right now is a real challenge. the best thing about my day... i got a compliment from my patient. after a long bronchoscopy, several conversations with pulmonologists about fungal infections and poor prognosis, coughing up blood and requiring oxygen, my patient said, "you are a very dedicated professional - thank you." i'll take that - and on only 5 hours of sleep! not bad.
Friday, February 19, 2010
mistakes happen
nobody is perfect; everyone makes mistakes. but obviously, some mistakes are more serious than others.
a secretary dials a wrong phone number - no big deal. a bus driver takes a wrong turn - oops, some people are a few minutes late. a barista uses whole milk instead of non-fat - oh well, a customer gets a rich treat!
but when an airline pilot falls asleep - hundreds of people are in danger. when a surgeon mistakes her left from her right - a person ends up losing the wrong limb.
unfortunately, nurses are always the last check when administering medications. it's a huge responsibility. a doctor prescribes a drug. a technician enters it into a computer system. a pharmacist mixes the med. there's room for all sorts of error. but in the end, it's the nurse who delivers the medication and is responsible for the famous five rights:
right patient
right medication
right dose
right time
right route
last night, i caught an error. it could have been hugely serious. a dose of immunoglobulin was ordered for a patient: 60 grams of IVIG diluted in 2 liters of normal saline. the doctor prescribed the right medication and the correct dose. the tech entered the information into the computer. the pharmacist mixed the right medication with some normal saline and filled a 2L bag. and finally, a sticker was printed with all of the correct info.
as the nurse, i received the medication, did my checks, and began infusing it into my sweet patient's central line. it's a serious medication, prescribed for a very serious illness. the medication costs several thousand dollars and is known to cause severe reactions. extra monitoring is required. the medication is started VERY slow and increased cautiously.
after 1 hour and only 62 of the 2000 mL were infused, i noticed something strange. the infusion pump notified me that 1938mL remained; but when i scanned the bag for verification, i noticed the bag did not contain 2L of fluid. i double checked the pump. had i infused the drug too fast? was there a leak? no, no. so, i called pharmacy. they insisted that there was a triple check; they could not have made a mistake. so i asked another RN to assess the bag. perhaps i was crazy and just missing something; perhaps the error was mine.
but then my phone rang; the pharmacist fessed up - there had been a mistake. instead of diluting the medication in 2L, they diluted the medication in 1L and placed it in a 2L bag. my patient had been receiving twice the concentration of the medication. and although the error was made by pharmacy, technically, the error is my fault. i should have noticed the volume; i should have called pharmacy before starting the medication. should my patient have had a serious reaction, it would have been my fault.
when nurses make mistakes, patients can die.
mistakes happen. thankfully this one ended okay.
my patient is safe...
for the time being.
a secretary dials a wrong phone number - no big deal. a bus driver takes a wrong turn - oops, some people are a few minutes late. a barista uses whole milk instead of non-fat - oh well, a customer gets a rich treat!
but when an airline pilot falls asleep - hundreds of people are in danger. when a surgeon mistakes her left from her right - a person ends up losing the wrong limb.
unfortunately, nurses are always the last check when administering medications. it's a huge responsibility. a doctor prescribes a drug. a technician enters it into a computer system. a pharmacist mixes the med. there's room for all sorts of error. but in the end, it's the nurse who delivers the medication and is responsible for the famous five rights:
right patient
right medication
right dose
right time
right route
last night, i caught an error. it could have been hugely serious. a dose of immunoglobulin was ordered for a patient: 60 grams of IVIG diluted in 2 liters of normal saline. the doctor prescribed the right medication and the correct dose. the tech entered the information into the computer. the pharmacist mixed the right medication with some normal saline and filled a 2L bag. and finally, a sticker was printed with all of the correct info.
as the nurse, i received the medication, did my checks, and began infusing it into my sweet patient's central line. it's a serious medication, prescribed for a very serious illness. the medication costs several thousand dollars and is known to cause severe reactions. extra monitoring is required. the medication is started VERY slow and increased cautiously.
after 1 hour and only 62 of the 2000 mL were infused, i noticed something strange. the infusion pump notified me that 1938mL remained; but when i scanned the bag for verification, i noticed the bag did not contain 2L of fluid. i double checked the pump. had i infused the drug too fast? was there a leak? no, no. so, i called pharmacy. they insisted that there was a triple check; they could not have made a mistake. so i asked another RN to assess the bag. perhaps i was crazy and just missing something; perhaps the error was mine.
but then my phone rang; the pharmacist fessed up - there had been a mistake. instead of diluting the medication in 2L, they diluted the medication in 1L and placed it in a 2L bag. my patient had been receiving twice the concentration of the medication. and although the error was made by pharmacy, technically, the error is my fault. i should have noticed the volume; i should have called pharmacy before starting the medication. should my patient have had a serious reaction, it would have been my fault.
when nurses make mistakes, patients can die.
mistakes happen. thankfully this one ended okay.
my patient is safe...
for the time being.
Wednesday, February 3, 2010
broken heart
sometimes my patients break my heart.
because of my fantastic nursing care (!?!!), i have been requested by a patient's daughter to take care of her mom most of the days that i work. as great of an honor as that is, it can also be very challenging. you get to know your patient and their family well; the walls that you build up to prevent heart-ache and sadness start to crumble. and eventually, when the prognosis is bad and the patient miserable, you start to feel depressed and overwhelmed by the reality of your patient's life.
my 63 year old patient (the same one who had the seizure not too long ago and has been hospitalized for months) is having excruciating abdominal pain. i sent her down for a CT scan of her abdomen to assess her pain crisis and unfortunately, we created another one. the contrast that was injected into her IV extravasated (that's a big word for "leaked out of her veins"); she now has been visited by a plastic surgeon, as the contrast can cause serious damage to the surrounding tissue in her arm.
my patient just feels uncomfortable. she is sick of being in the hospital, sick of being in pain. as i watched her grimace and listened to her moans, she said to me, "i just want to cry." i replied with, "that would be okay marcia." then she said, "it's silly, but i just want my mom." marica is 63 years old. her mom is not here - not in the hospital, not on earth.
we always want what we can't have. and today, it's breaking my heart.
sometimes i want my mom and i am blessed to have her.
because of my fantastic nursing care (!?!!), i have been requested by a patient's daughter to take care of her mom most of the days that i work. as great of an honor as that is, it can also be very challenging. you get to know your patient and their family well; the walls that you build up to prevent heart-ache and sadness start to crumble. and eventually, when the prognosis is bad and the patient miserable, you start to feel depressed and overwhelmed by the reality of your patient's life.
my 63 year old patient (the same one who had the seizure not too long ago and has been hospitalized for months) is having excruciating abdominal pain. i sent her down for a CT scan of her abdomen to assess her pain crisis and unfortunately, we created another one. the contrast that was injected into her IV extravasated (that's a big word for "leaked out of her veins"); she now has been visited by a plastic surgeon, as the contrast can cause serious damage to the surrounding tissue in her arm.
my patient just feels uncomfortable. she is sick of being in the hospital, sick of being in pain. as i watched her grimace and listened to her moans, she said to me, "i just want to cry." i replied with, "that would be okay marcia." then she said, "it's silly, but i just want my mom." marica is 63 years old. her mom is not here - not in the hospital, not on earth.
we always want what we can't have. and today, it's breaking my heart.
sometimes i want my mom and i am blessed to have her.
Thursday, January 21, 2010
healthcare dilemmas
like the title of this blog states, nursing involves some of the strangest tasks and interesting predicaments. i just spent 90 minutes in a patient room with a gown, gloves, and mask on; i'm hot, sticky, and sick of smelling my own breath and recycling stale air. but that's not why i am writing. i am simply writing to say, health care is strange in general - not just nursing. are you familiar with HIPPA; it's a healthcare privacy act. so i'm probably breaking major rules. but we just admitted a prisoner to our unit for a stem cell transplant. interesting, huh? he has to wear his orange jumpsuit. and he has an armed guard with him at all times. honestly, i'm not sure how i feel about this... but just think to yourself, who is paying for this gentleman's care? our tax dollars are buying his chemotherapy, his stem cells, and a second chance at life (which typically results in a one million dollar bill). he may have simply gotten three speeding tickets (washington's three strikes and you're out law), but he could also have raped and/or killed people innocent people? hospitals are full of ethical dilemmas. what to do, what to do!
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