laundry detergent

as i walked in to work today, before i could even settle in, before i had even talked to anyone, the charge nurse accosted me and said, "christa, do you wear perfume?"  as if i wear perfume!  before i could answer, more questions followed.  "do you use tide, kirkland brand detergent, or dryer sheets?"  huh?!?  seriously?!?  did i shower?  might i have hairspray in?  scented lotions?  do i wear deoderant?  really?!?  a patient wants her nurse to NOT wear deoderant.  yes i use kirkland brand detergent; it's cheap.  and i am cheap.

anyway, i was assigned a patient who is extremely sensitive to smells.  one look at her allergy list had me almost chuckling.  seriously, who is allergic to prednisone?  or benadryl?  both medications used to treat allergic reactions.

i guess i've been a nurse for too long.  because instead of being sensitive and accommodating, i kind of laughed, called the patient a freak, and decided to lie.  it may not be one of my finer moments.  but seriously, WHO on my unit doesn't wear deoderant?  i think there's one girl (and she smells horribly) but that doesn't qualify her as the best nurse for this crazy patient.  nope.  somehow it qualified ME!  even though i use kirkland brand detergent.  and decided to LIE!
when i walked into her room, before i could even introduce myself, i got a "stop right there.  before you get any closer.  put your hands up!"  well, i didn't get the "put your hands up" part.  but the rest of it i got.  "what detergent do you use?" to which i replied, "some organic brand i cannot recall the name of."  BINGO!  "oh, i think we'll get along fine then."

and we did.  my kirkland brand detergent didn't make my patient cough or sneeze.  nor did my dove deoderant.  or my cheap tresemme hairspray.  in fact, my patient was discharged today.  and i got a hug!  she got close enough to smell my lunch (which she interrupted) and didn't complain about my garlic breathe or my detergent!

prayers

i said something today at work that i haven't said in a VERY long time. maybe ever. i told a patient that i would pray for her. i haven't prayed in years (despite 15+ years of catholic school). but i found myself saying, "i will pray for you tonight, that your body makes new cells and that your pain goes away." the words slipped out of my mouth before i could process what they meant or why they came out. but as i left her room and reflected, i thought to myself, "if i would pray for anyone, i would pray for V."

V has been my patient for the last three days. my first day with her, i wasn't a good nurse. V speaks little bits of english; her first language is spanish. and for some reason, i felt intimidated. maybe lazy. i don't know. but without communication, nursing is challenging. and i didn't do a good enough job. yesterday though, i worked harder. i wanted to go home proud of the work i had done. and so, i got us an interpreter. i scheduled a meeting with her german speaking physician (too many esl people in the same room can be a riot!). we discussed pain management and made changes to all of her medications. V felt a little better at the end of my shift, and so did i. but today was the best of all. i thought of all the little things. the prescription chapstick for her dry lips. the wet wipes for her sore hiney. i ordered her a commode chair. and delivered attends (AKA adult diapers). when we spoke, i squatted at the edge of her bed so our faces were eye to eye. and eventually, i wound up sitting in her bed, hand on her back, soothing her as she vomited. when i said goodbye this evening, V put her hand on my head (as if in blessing). and without words, she acknowledged my hard work and thanked me for my presence. what a special moment!

V is 51 years old. she is here from puerto rico to receive treatment. she is an educated woman. a minister in her church. but more important than the details, she is human. and she is suffering. and she is kind. and deserving of love. and prayers.

flabbergasted

i'm a bit flabbergasted.

i got called into the principal's office today.  well, not really.  the manager's office.  but i felt like i was getting in trouble.  and i don't like it one bit!

in the last year, two nurses have been investigated on our unit for possible narcotic diversion.  and neither works on our unit now.  interestingly enough, the rumor mill tells me that both nurses who were investigated and asked to leave were in fact innocent.  rumor has it their urine and hair samples came back negative.  but drugs have definitely gone missing.    

in fact...

there have been more than 87 incidences with oxycodone in the last year.  there are inappropriate removals of the common street drug from 33 different nurses on our unit (that's more than 1/3 of or staff).  and to my horror and dismay, i am one of those nurses.  some person on my unit has stolen medications under my name.

Source: funnypk.com via Nancy G on Pinterest

 

this is how it works.  i log into pyxis (where all of our medications are dispensed) with my fingerprint.  when i am done, i press exit.  however, if i forget to press exit, my login remains open for 60 seconds.  in those 60 seconds (before i am logged out), any person can remove medications under what looks like my bio-id.  we have access to all the patients on the floor and to their entire medication profile.  so, even though i am taking care of patient A and patient B, i can remove medication for patient Z.

last november, under my bio-id, SEVEN doses of oxycodone were taken.  they were removed from three different patients, none of whom were my patients that day.  there was never a discrepancy noted in the narcotic count, because whoever stole the medications "counted" them accurately.  they simply never gave the doses.  somehow, this has been happening for almost a year.  and just NOW, our unit is sleuthing and attempting to find the thief.

the thought of me pilfering narcotics almost made me laugh.  i had to tell my manager in all seriousness that there is NO WAY i would take oxycodone.  i don't even drink.  i won't take benadryl.  and i think caffeine is a mood altering drug (one i indulge in frequently...).  but nonetheless, i wouldn't handle oxycodone well!

F*%#! off

last saturday was one of the weirdest shifts i have ever worked.  i wish i had written about it then.  my blood was boiling.  but after working 12.5 hours, i went to bumbershoot until 11:30PM, stayed up until 12:45AM, and went back to work on sunday at 7AM.  the remainder of the week has flown by.  so here i am, home alone on a saturday night, ready to re-hash just a small part of the drama.

are you ready for this?

on friday, saturday, and sunday of last week, i was precepting a new grad.  she was completing her last three shifts of a six week orientation.  and although some new nurses still requires lots of hand holding and are, what i would consider, scary nurses, this new nurse ROCKS!  she is timely, can multi-task, asks appropriate questions, and time manages well.  she was a dream to precept.  hence, my three shifts with her were a piece of cake for me.  i did NOTHING.  literally.  i played on the internet, made lists, did some personal planning and made phone calls.

until 4:45PM on saturday when i had to step in and stand up to my assistant nurse manager who wanted to give my new orientee a FIFTH patient.

i feel like, unless you are a nurse on my unit, most people wouldn't understand the ridiculousness of this suggestion.  there are too many reasons to list why this is a horrible idea.  i will note just a few:

-  no nurse on my unit EVER cares for five patients in one day
-  the assistant nurse manager was not in charge on saturday and had NO clue what was going on
-  my orientee had already discharged two patients in the day and still had two others
-  new orientees NEVER have more than two patients per shift (unless your preceptor thinks you're a rockstar and asks for a harder assignment - but NOT five patients)

when asked if she could handle it, the new grad looked at me, and said rather hesitantly, "i guess so."  but she doesn't understand how the floor works.  she doesn't know that five patients in one day is inappropriate, especially for a new nurse.  she didn't know that there were other nurses on the floor who were less busy and had only had 2 patients ALL day long.  she didn't know (or feel comfortable) standing up for herself and saying she would rather NOT get an admit at 5:30PM.

so i did.  i told the assistant nurse manager that new grad girl would not take an admit.  that she couldn't.  that she was asking too much of her.  that as her preceptor, i was looking out for her.  but the nurse manager wouldn't listen to me.  she kept saying, "christa, i didn't ask you.  i asked a_ _ _ _ _ ."  she spoke to me in a condescending tone.  and despite my rebuttals, kept demanding that new grad girl take the admit.  after awkward discussion in the hall, the nurse manager left me fuming and headed to tell the charge nurse that my new orientee would indeed take a FIFTH patient.

i can't describe how disrespected i felt.  how demeaned.  and belittled.  and i couldn't stand for it.  so, i resumed the conversation at the nurse's station, in front of the secretary, the charge nurse, and my colleagues.  we started duking it out, in public, until it was suggested that we take our "conversation" elsewhere, to somewhere more private.

i won't describe the 20 minute conversation we had.  but suffice it to say, i stood up for myself and what i believe in with all my strength.  i am stubborn ALWAYS; but when i know i am right, i won't budge.  and i didn't.

my assistance nurse manager knew i was angry, upset, frustrated, irate... and so, for some weird reason, she asked me if i wanted to tell her to F&%# off!  i am not joking.  my assistance nurse manager, an elder, and person in leadership on my unit, asked if i would feel better if i told her to F&@! off.  she was trying to bully me, to get me to act unprofessional, because up until then, i hadn't.  but instead of caving and doing what she wanted me to do (so she could get me in trouble), i laughed at her.  told her i had some professionalism.  and would never do such a thing.  at work.  or in my person life.  i may swear.  but i don't tell people to F?%! off.

period.

end of story.

nurse AND girlfriend

last week i had the pleasure of going to kauai with the new man in my life.  it was a rather spontaneous trip.  i don't typically do spontaneous well, but this man helped me to relax and enjoy.

while i worked as a nurse at a camp for developmentally disabled adults for one week, surfer boy (one of his many nicknames) made ALL of our plans.  our tickets were purchased, cars were rented, resort stays scheduled, and everything one could think of for camping was prepared (down to the ever crucial rolls of toilet paper).  C did a fantastic job. and despite my return from camp at 5PM on a friday night and our departure at 9:45 AM on saturday morning, i barely felt crazy.   just a bit!

all in all, kauai was a delightful trip.  surfer boy and i got to know one another better.  in fact, we got to know one another on a very intimate level.  one that is safe to discuss on a public blog that my mother reads.  in fact, it's more than appropriate for a nursing related blog because it has to do with yet another ER visit and hospital stay!  i am proud to say, i remained healthy in kauai - even after our strenuous hike and more bug bites than i can count!

tuesday and wednesday, C and hiked the napali coast.  it's an infamous hike, on the top 10 most dangerous hiking list (which also includes mount rainier).  we trekked 11 miles along the coast line, switchback after switchback, up and down cliff sides in crazy hot, very humid weather.  one misstep could have wound us stranded hundreds of feet below, dead, or in shark-infested tumultuous waters. the 7 hour journey was grueling.  and sleeping in a tent that night was equally as challenging - we were SO hot, there was NO breeze, and any idea of romance i had created in my mind vanished!

wednesday morning, we decided to pack up and hike out.  neither C nor I is very good at relaxing and although the beach on the coast was beautiful, we couldn't imagine an ENTIRE day with nothing to do (it's not recommended to swim there because of the currents).  so, at about 11AM, we began the hike back to our car.   the return trek might have been harder than the approach; we knew what we were in for...

but thursday, friday, and saturday brought about the most challenging part of our trip.  thursday AM, C woke up with right lower quadrant pain.  as a nurse and with C in school to become a physician's assistant, we both worried about his appendix.  did he have rebound tenderness?  was he nauseated?  did he have a fever?

C is an amazing man for numerous reasons.  not only is he very intelligent (which makes his sexy), but also, he is very fit.  both mentally and physically, C is one tough man.  he waited out thursday, coping with periods of nausea and sharp pains.  we discussed getting checked out, but with our "expertise," C felt comfortable waiting to see if things got worse.  which, of course, they did.  on friday at 3 in the morning!  C was smart enough to check which hospitals in kauai have CT scanners.  and so, we headed to wilcox memorial hospital.  should your appendix ever misbehave while in kauai, go there!

this could be a very long story.  it already is.  i'm a blabbermouth.   but suffice it to say, C did indeed have a potential appendicitis.   his CT scan showed an enlarged appendix.   but chronic gastrointestinal issues complicated diagnosis and treatment.  C ended up being admitted for surveillance.  the surgeon wanted to keep an eye on him.  our departure flights were cancelled.  and we set up shop in room #300.  C did his best to be a decent patient.   and i did my best to keep him in line!

C has never been a patient in a hospital.  and i have never been a nurse to a significant other.  it was a new experience.  a new kind of relationship.  and although we both survived the experience and are doing well, back at home in seattle, i think we would both choose to remain healthy in our futures.  it feels weird to be a nurse AND a girlfriend. just as i imagine it would feel weird for C to be a physician's assistant AND a boyfriend.

comfort care

i've mentioned this before, but did you know?  nursing is a strange profession!

on wednesday, i arrived at work.  my patient assignment included a 43 year old, heavily tattooed man whom i had admitted on monday.  and a 69 year old woman on comfort care, dying of pancreatic cancer.

to top it off, i also had a nursing student assigned to work with me; she is sweet and religious and competent, but in a shy, nervous way.  she lost her dad in 2006 to cancer at my hospital (which likely prompted her interest in nursing).  and wednesday was her last day on my unit, her last day of clinicals while in nursing school; in fact, she graduates TODAY!  it would have been nice to help her end her nursing student career in a FUN, HAPPY, POSITIVE way.  but instead, i anticipated and warned her that we would likely see a woman die on our shift, that we would complete post-mortem care, and zip a once-living-loving woman in a body bag...

i haven't cared for someone on comfort care in a LONG while.  which, in some way, is too bad considering i think i'd still like to be a hospice nurse some day (and could use the experience).  and considering how many people die on my unit, you'd think more people would be on comfort care.  but sadly, people die suddenly on our unit, with codes, and CPR, and everything but peace and quiet.

anyhoo, i was not surprised to hear that my patient was on a morphine drip; but i was surprised to hear that she was on 40mg an hour.  that is a HUGE dose.  enough to sedate, if not kill, a large elephant.  not surprisingly, when i assessed her in the AM, her respiratory rate was 4 breaths per minute.  my nursing judgement told me from that and from her cool, mottled skin that she was nearing death.

BUT...  the plan of the day shifted when her team of physicians approached me and asked in a rather gruff, concerned way, "how did we get to 40mg of morphine per hour from the 2mg we started on just yesterday afternoon?"  let me explain.  nurses have the authority, based on an algorithm, to titrate drip rates to patients' comfort.  if a patient is in pain, nurses can give a bolus and increase the drip rate at increments.  but there had been NO documentation of the patient's pain; in fact the previous nurse charted that the patient was calm and comfortable.  it seemed that the nurse prior to me increased the drip rate rather willy-nilly, perhaps expediting the patient's death - which is ILLEGAL.

so, for the first time (and hopefully the last) in my nursing career, i was asked to decrease the rate of the morphine drip.  in essence, to reverse the comfort care orders.  to possibly wake a woman peacefully dying and perhaps cause her pain.

i hated the idea.  and told the team this.  i agreed that perhaps the way in which her morphine drip was handled the day before was inappropriate.  but the fact of the matter is, it hadn't killed her.  and now, she was comfortable.  and i didn't want to play any part in changing that.

after much discussion with one of my managers, and further discussion with her provider, i turned the drip down.  i monitored my patient more closely, with peace of mind, knowing full well that if my patient showed the slightest bit of discomfort, i had the authority, based on MD orders, to bolus the patient with morphine and increase her continuous pain medication.  thankfully, the patient remained calm. comatose. obtunded.  and to my surprise, almost horror, the patient survived my entire 12 hour shift.

and yesterday's.

it's strange to want a person to die.  to hope that the two breaths i counted in one minute were someone's very last two breaths.  but at the same time, it's hard to see a woman, barely clinging to life, hang on.

divorced

mount rainier and i have a love/hate relationship.  i've decided, we're getting divorced!

as stated in my last post, i climbed mount rainier last week - for a second time.  and for the second time, i wound up in the ER.

reminder:  almost two summers ago, i had signed up to climb mount rainier with a guide company.  in preparation, i joined crossfit and got into crazy shape!  however, 100 push-ups, 100 pull-ups, and 100 squats sent me to the ER with severe muscle breakdown in my arms leading to rhabdomyelisis.  i could have permanently damaged my kidneys.  but thankfully, after 5 days in the hospital, and a month or so of recovery, i was fine.  i am fine.  but i did not get to climb rainier.

last summer, the mountain and i got along, fairly well.  it must have been the therapy i attended between summers to mend our broken relationship!  i summited mount rainier last summer.  we seemed to respect one another on my climb.  and although i felt extremely proud of my accomplishment,  i vowed to only visit the mountain's lower-lands in the future.

rewind to last week.  as previously mentioned, for some crazy reason, i decided to test our tumultuous relationship.  i went on a 3 day date with rainier.  and have since decided, we're broken up.  forever.  i descended the mountain on friday morning.  it was fast, sliding thousands of feet on my poor little behind.  i hate glissading.  but i made it safely, in one piece, to the parking lot.  with only a few itchy bug bites and incredibly sore quadricep muscles.

fast forward.  to friday night.  a bug bite on my hand began to swell.  it was itchy.  most bug bites are, right?  but by night time, i started to worry.  i was losing definition of my hand.  my skin grew taut and uncomfortable.  my handsome boyfriend, a PA student, decided i should probably go to the ER.  not wanting to make a big deal of nothing, i decided to sleep on it.  if it was worse in the AM, sure, i would go!  4:30 in the morning came quickly.  and with that, came the realization that something was seriously wrong.  my hand had doubled in size.  i had an infection of some sort.  and since i've seen too many cases of flesh eating bacteria (necrotizing fasciatis) leading to amputations, i decided not to mess around.  my eager to learn boyfriend and i went to the ER at my place of employment.  i was treated quickly and efficiently (maybe because it was serious, maybe because i'm an employee).  i got an IV dose of serious antibiotics and was started on four times daily oral antibiotics.

cellulitis.  of course, i got cellulitis on my hand from a bug bite on mount rainier!  cellulitis is a skin infection.  but i felt like it's an STD from my sketchy date with mount rainier!  we're over.  i'm getting a restraining order.

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(this picture doesn't quite do the swelling justice.  not to mention, it got bigger throughout the day on saturday.  currently, i think i am cured.)