i have a new recommendation as a nurse: don't be flexible. when you're flexible, you get screwed. my day yesterday sucked because i was flexible.
7:00 - 11:00 nurse to two straight forward patients. easy day ahead.
11:00 - 15:00 secretary extraordinaire, plus nurse to one of previous patients.
12:45 secretary/nurse who answered emergency light to find patient seizing. assisted the patient's real nurse with seizing patient. transfused platelets for this struggling nurse who was drowning and falling behind.
15:00 - 17:00 nurse to first patient, nurse to third patient of day (same one i found seizing earlier).
17:30 transfer seizing, spanish speaking only patient to different unit, after attending a care conference in which the medical team told the patient and family he was dying and there was nothing more they could do (patient is 35 years old and has terminal brain cancer with metastases all over. he had about 27 family members in the family room, of all ages, 2 of whom ended up in a fist fight the previous shift).
17:45 - 19:30 nurse to first patient/bitch to the rest of the nurses (as in assistant, not cranky). answered call lights. completed other nurses' end of the day tasks.
note to self: don't be flexible. my day would have been nice and smooth if i had just stuck with my original two patients. instead, i wore every hat possible in one twelve hour shift and found myself in just about every patient's room at least once during the day. by night time, i hardly knew my own name.
Thursday, March 10, 2011
Tuesday, March 8, 2011
lucky to know her
cassie is one of my very best friends. she and i graduated from nursing school together five years ago this june. i think highly of her in general. she is a unique soul and one of the most phenomenal friends. i am so lucky to know her.
in terms of nursing, i know that cassie is a fantastic nurse too! she has had several different nursing jobs. she has worked in clinics for vulnerable popultations - women, children, refugees, and the homeless. she excels in crazy, unpredictable situations. and her patients love her because she cares about them - because she offers them something no one else has - a listening and empathetic ear, a thoughtful and professional assessment, and equal care and treatment. her patients are lucky to know her too.
tomorrow, cassie is embarking on a new nursing adventure. she is starting a new career as an advanced registered nurse practitioner (ARNP) in the emergency room at harborview medical center. for those of you who don't know what an ARNP is, think nurse with prescriptive authority. essentially, cassie will be like any other physician's assistant or medical doctor. she will work autonomously, seeing patients, making diagnoses, prescribing medications, and performing invasive medical procedures. she will work side by side with er docs, but because she is first and foremost a nurse, she will think of patients as humans, not diagnoses, and she will treat their comprehensive needs, not just their medical ones.
i see cassie as a confident and strong-willed person. she always shows up with a smile on her face and does her very best (we're both perfectionists, perhaps it's why we understand one another and are such good friends). but today, i know her in a different light. i know she is nervous. she is pacing around her darling home, picking up piles of things, re-arranging furniture, and baking banana bread. she is laying out her scrubs for tomorrow's first day, packing her lunch (although she'll be too nervous to eat the hummus and vegetables tomorrow), and studying note cards in case there is one last thing to learn to prepare her for the unknown.
of course, this new job will be challenging. cassie will see VERY sick patients, people in VERY vulnerable scenarios. but i have confidence that cassie will do her best. and as mentioned before, her patients will be healthier and happier once they have seen her. and they all will be lucky to know her!
in terms of nursing, i know that cassie is a fantastic nurse too! she has had several different nursing jobs. she has worked in clinics for vulnerable popultations - women, children, refugees, and the homeless. she excels in crazy, unpredictable situations. and her patients love her because she cares about them - because she offers them something no one else has - a listening and empathetic ear, a thoughtful and professional assessment, and equal care and treatment. her patients are lucky to know her too.
tomorrow, cassie is embarking on a new nursing adventure. she is starting a new career as an advanced registered nurse practitioner (ARNP) in the emergency room at harborview medical center. for those of you who don't know what an ARNP is, think nurse with prescriptive authority. essentially, cassie will be like any other physician's assistant or medical doctor. she will work autonomously, seeing patients, making diagnoses, prescribing medications, and performing invasive medical procedures. she will work side by side with er docs, but because she is first and foremost a nurse, she will think of patients as humans, not diagnoses, and she will treat their comprehensive needs, not just their medical ones.
i see cassie as a confident and strong-willed person. she always shows up with a smile on her face and does her very best (we're both perfectionists, perhaps it's why we understand one another and are such good friends). but today, i know her in a different light. i know she is nervous. she is pacing around her darling home, picking up piles of things, re-arranging furniture, and baking banana bread. she is laying out her scrubs for tomorrow's first day, packing her lunch (although she'll be too nervous to eat the hummus and vegetables tomorrow), and studying note cards in case there is one last thing to learn to prepare her for the unknown.
of course, this new job will be challenging. cassie will see VERY sick patients, people in VERY vulnerable scenarios. but i have confidence that cassie will do her best. and as mentioned before, her patients will be healthier and happier once they have seen her. and they all will be lucky to know her!
Monday, March 7, 2011
tiddly
what started as a blog about nursing seems to have quickly transpired into a blog about caretaking - about being a caretaker to my dad (who, for some reason, my family calls tiddly).
last time i wrote, tiddly was getting his pacemaker/defibrillator placed. i was in the waiting room, typing away, wasting away hour upon hour, pretending not to worry as my mom and sister paced the halls, ate grilled cheese sandwiches (ok, i had one too), and shed a few tears.
of course, as if the morning wasn't "exciting" enough, a fire alarm went off mid-procedure. as an employee of the hospital, i am used to calls overhead, fire drills, and irritating alarms; we tend to ignore them, as most are not real. but, when the halls started to buzz with people evacuating the area, i couldn't help but wonder... what the hell?!? is this is a real fire? how do you evacuate operating rooms, when wires are laced delicately through veins and into heart muscle?
the surgery ended well, without the need to evacuate the area. thank god! the new leads (wires) were placed successfully, threaded to the most important organ in the body - the heart. and my dad was discharged the following morning (of course, not without one scare and threat to re-open him up to thread a wire a few millimeters closer to cardiac muscle, to get better capture, whatever that means!). one more scary procedure done. one step closer to feeling better. phew...
well, tiddly is not an easy man... never has been, never will. he found himself back in the hospital by friday, two days after his "release." a new problem developed. a new arrhythmia. it is the fault of no one. just a string of bad luck. STAT labs were drawn. multiple EKGs printed and read. a chest x-ray completed to verify placement of the leads. ultrasounds to ensure no bleeding around the heart. interrogation of the pacemaker to see what the "bleep" was going on. and visits by doctors. lots of doctors.
atrail tachycardia - the newest hiccup in the road to improved cardiac function and overall health! damn those erratic and excitable cardiac cells.
the cure - amiodarone. a new drug. one my dad has been on in the past. one that of course, comes with side effects and intolerance. amiodarone, after prolonged use, causes hypothyroidism in my dad. which in turn, leads to worsening congestive heart failure symptoms. blah! what a fine balance! a chemical art to get the perfect equation!
tiddly's current state of health...
he's ok. he continues to challenge the nurses and doctors. he makes us all laugh. he takes pills. he does more than we think he should. and he continues to beat the odds. as of march 5th, tiddly has lived 12 years more than he should have. it was 12 years ago that my dad suffered a massive heart attack and underwent seven bypasses.
as of now, my dad is 100% paced. that means, 100% of the time, his pacemaker is telling his heart to beat. 100% of the time, wires help my dad's ventricles pump blood to the body more efficiently than before.
right now, things are ok. we are going to lunch.
last time i wrote, tiddly was getting his pacemaker/defibrillator placed. i was in the waiting room, typing away, wasting away hour upon hour, pretending not to worry as my mom and sister paced the halls, ate grilled cheese sandwiches (ok, i had one too), and shed a few tears.
of course, as if the morning wasn't "exciting" enough, a fire alarm went off mid-procedure. as an employee of the hospital, i am used to calls overhead, fire drills, and irritating alarms; we tend to ignore them, as most are not real. but, when the halls started to buzz with people evacuating the area, i couldn't help but wonder... what the hell?!? is this is a real fire? how do you evacuate operating rooms, when wires are laced delicately through veins and into heart muscle?
the surgery ended well, without the need to evacuate the area. thank god! the new leads (wires) were placed successfully, threaded to the most important organ in the body - the heart. and my dad was discharged the following morning (of course, not without one scare and threat to re-open him up to thread a wire a few millimeters closer to cardiac muscle, to get better capture, whatever that means!). one more scary procedure done. one step closer to feeling better. phew...
well, tiddly is not an easy man... never has been, never will. he found himself back in the hospital by friday, two days after his "release." a new problem developed. a new arrhythmia. it is the fault of no one. just a string of bad luck. STAT labs were drawn. multiple EKGs printed and read. a chest x-ray completed to verify placement of the leads. ultrasounds to ensure no bleeding around the heart. interrogation of the pacemaker to see what the "bleep" was going on. and visits by doctors. lots of doctors.
atrail tachycardia - the newest hiccup in the road to improved cardiac function and overall health! damn those erratic and excitable cardiac cells.
the cure - amiodarone. a new drug. one my dad has been on in the past. one that of course, comes with side effects and intolerance. amiodarone, after prolonged use, causes hypothyroidism in my dad. which in turn, leads to worsening congestive heart failure symptoms. blah! what a fine balance! a chemical art to get the perfect equation!
tiddly's current state of health...
he's ok. he continues to challenge the nurses and doctors. he makes us all laugh. he takes pills. he does more than we think he should. and he continues to beat the odds. as of march 5th, tiddly has lived 12 years more than he should have. it was 12 years ago that my dad suffered a massive heart attack and underwent seven bypasses.
as of now, my dad is 100% paced. that means, 100% of the time, his pacemaker is telling his heart to beat. 100% of the time, wires help my dad's ventricles pump blood to the body more efficiently than before.
right now, things are ok. we are going to lunch.
Thursday, February 24, 2011
all in a day's work
1. shave female patient's head.
2. read cosmo magazine with colleagues.
3. talk on the phone with friend about boys (she's an RN at work too).
4. stare out window and watch the snowflakes.
5. search for an acupuncturist online.
6. steal diet 7-up from our nutrition room.
7. catch up on emails to long-lost friends.
8. read the most bizarre newspaper articles in the seattle times.
9. scour over pictures from past vacations, trips, and adventures.
10. call mom to check in and see how dad is doing.
11. write on blog.
2. read cosmo magazine with colleagues.
3. talk on the phone with friend about boys (she's an RN at work too).
4. stare out window and watch the snowflakes.
5. search for an acupuncturist online.
6. steal diet 7-up from our nutrition room.
7. catch up on emails to long-lost friends.
8. read the most bizarre newspaper articles in the seattle times.
9. scour over pictures from past vacations, trips, and adventures.
10. call mom to check in and see how dad is doing.
11. write on blog.
Tuesday, February 15, 2011
back in the cath lab
well, here i am again - the cardiac cath lab waiting room. today i am family once again, not a nurse. my dad is getting a new and improved defibrillator/pacemaker combo placed in hopes of improving his cardiac output and congestive heart failure symptoms. i just love spending my days off from nursing hanging out in the same hospital i work at! i can't get enough of this place!
would it be weird to admit that i might actually enjoy spending time here? if my father has to be a patient, i feel privileged to be a part of his care. i feel important having the role of family nurse and patient advocate. and although i would much rather my father be healthy, i enjoy spending the time with him in the hospital during vulnerable moments. my mom, sister, and i spend some of our most quality time together in waiting rooms.
hanging out at the hospital can sometimes actually be comical. my dad is a bit of a celebrity here, i think. he knows people all over the hospital. the phlebotomy techs know him from his frequent visits for blood draw. the entire cardiac clinic knows him from his years and most recently, his weekly, visits to his cardiologist. the nurses in the procedure suite know my dad from his numerous catheterization procedures. even the EKG tech came to wish my dad good luck this morning (and there was no EKG ordered).
my dad, with his infamous swiss accent and occasional ridiculous english and/or grammatical errors, is almost a comedian. to entertain himself and his audience, he tells off-color jokes; he laughs hysterically at himself while the rest of us are uncomfortable. and to our embarrassment, he even dances around in his hospital gown, showing off his chicken legs and tighty whities. thankfully, he makes these anxiety-provoking situations kind of entertaining. he walks in and out of the offices here as if he owns the place; he must feel that his years of care here give him special privileges. and they do! he gets royal treatment and exceptional care.
would it be weird to admit that i might actually enjoy spending time here? if my father has to be a patient, i feel privileged to be a part of his care. i feel important having the role of family nurse and patient advocate. and although i would much rather my father be healthy, i enjoy spending the time with him in the hospital during vulnerable moments. my mom, sister, and i spend some of our most quality time together in waiting rooms.
hanging out at the hospital can sometimes actually be comical. my dad is a bit of a celebrity here, i think. he knows people all over the hospital. the phlebotomy techs know him from his frequent visits for blood draw. the entire cardiac clinic knows him from his years and most recently, his weekly, visits to his cardiologist. the nurses in the procedure suite know my dad from his numerous catheterization procedures. even the EKG tech came to wish my dad good luck this morning (and there was no EKG ordered).
my dad, with his infamous swiss accent and occasional ridiculous english and/or grammatical errors, is almost a comedian. to entertain himself and his audience, he tells off-color jokes; he laughs hysterically at himself while the rest of us are uncomfortable. and to our embarrassment, he even dances around in his hospital gown, showing off his chicken legs and tighty whities. thankfully, he makes these anxiety-provoking situations kind of entertaining. he walks in and out of the offices here as if he owns the place; he must feel that his years of care here give him special privileges. and they do! he gets royal treatment and exceptional care.
Sunday, February 6, 2011
nurse on vacation
i've recently been noticing that nursing seeps its way into all aspects of life. nursing is not just a profession; it's a mindset. we nurse everywhere we go. we take care of those around us, whether or not they are our patients. and sometimes, nursing rears its ugly head at the strangest and most inopportune of times.
i work with this fantastic nurse. she recently acknowledged that she needed a break; not a long one, but a good one. we've had numerous deaths recently on our unit. and it just becomes overwhelming sometimes. so, on a whim, she decided to fly to cabo san lucas. she and her husband spent 6 days sunning themselves without a care in the world. it's just the kind of break from nursing one needs. self-care is important.
but then, just when you least expect it...
A and her husband were on a boat. they were spending their last afternoon on the water. then, all of a sudden, in the distance, people were in the water, waving for help, signaling distress. turns out, a couple walking/wading on the beach were carried out to sea by an undertoe. with help from locals, the female drowning victim was pulled into A's boat and A did CPR. the woman was cold and blue. her pupils were fixed and dilated (not a good sign). but as a nurse, you do your best. you try to save lives. whether you're in the hospital or on vacation, once a nurse, always a nurse.
once on shore, the mexican paramedics took over. and within minutes, A left the beach and headed to the airport - not knowing the outcome of her heroic works.
so much for a relaxing vacation.
both the female and male drowning victims died. see this article for more information. oh, and by the way, never go swimming on divorce beach. the name says it all...
http://www.calgarysun.com/news/alberta/2011/02/05/17170151.html
i work with this fantastic nurse. she recently acknowledged that she needed a break; not a long one, but a good one. we've had numerous deaths recently on our unit. and it just becomes overwhelming sometimes. so, on a whim, she decided to fly to cabo san lucas. she and her husband spent 6 days sunning themselves without a care in the world. it's just the kind of break from nursing one needs. self-care is important.
but then, just when you least expect it...
A and her husband were on a boat. they were spending their last afternoon on the water. then, all of a sudden, in the distance, people were in the water, waving for help, signaling distress. turns out, a couple walking/wading on the beach were carried out to sea by an undertoe. with help from locals, the female drowning victim was pulled into A's boat and A did CPR. the woman was cold and blue. her pupils were fixed and dilated (not a good sign). but as a nurse, you do your best. you try to save lives. whether you're in the hospital or on vacation, once a nurse, always a nurse.
once on shore, the mexican paramedics took over. and within minutes, A left the beach and headed to the airport - not knowing the outcome of her heroic works.
so much for a relaxing vacation.
both the female and male drowning victims died. see this article for more information. oh, and by the way, never go swimming on divorce beach. the name says it all...
http://www.calgarysun.com/news/alberta/2011/02/05/17170151.html
Friday, February 4, 2011
control freaks
as a nurse, i'm a caretaker. i like to take control of a situation and make things better. it's very hard for me to take a backseat. i'd hate to admit that i'm conceited or arrogant, but as a control freak, one often thinks that she can do things better. and in this situation, i want to take control and make things better.
(i know i can't. and even if i tried, the final result would be the same. i am no better equipped to handle the situation than the people in charge. but i'm bad at being a spectator.)
we have a family friend, let's call him C. he is one of the kindest men i've known. he is only a few years older than i am. he's the father of two boys - A is 16 and D is 12. his wife has a 19 year old daughter and he takes his parenting role very seriously, even with her. he works hard all week, working two jobs, to support his family, so that on the weekends, he can spend quality time with his children. they go to church. they play an active role in their hispanic community. C wants to give his children more than he had growing up. he wants them to be educated, upstanding citizens.
but sadly, all of their lives changed this week when A pulled a gun on D and shot him in the mouth. i wish i could say it was an accident. but bottom line is, the boys were rough-housing and A got out a gun and pulled a trigger. certainly A did not mean to kill D; and thank god, he didn't. D is in serious condition and will hopefully recover with minimal side effects (once the reconstructive surgeries, physical therapy, and possibly speech therapy is complete). but the fact of the matter is, A had a gun. it was purchased illegally. it has been discovered he is a part of a gang. and now he is in jail. he is being tried as an adult. and will forever be haunted by the fact that he shot his own brother over a video game.
because C is so devastated and in such a state of shock, i'm worried that he won't know how to navigate the medical and judicial system. he doesn't have the money to pay for high quality lawyers; and he's not in the right state of mind to research law offices who take pro-bono cases. i'm worried he won't demand the best care at the hospital. what if he doesn't know that you can request interpreters, certain nurses, social workers, and special treatment. i hate to admit that the system works in this way, but i truly believe that unless you demand high quality care, you often get just mediocre care.
and so, because i can't just sit and watch, my dad and i went to visit C and D in the hospital yesterday. it was a strange site to see; i've only seen one other child intubated and in serious condition (it was my sister when i was just 12 years old and she was 16). anyway, D looked peaceful and amazingly, in one piece after a GSW (gun shot wound - those of you who watched ER or Gray's Anatomy should know the abbreviation). he is well taken care of. his nurse was doing a fine job, likely her best. and in the brief time i was there, a social worker showed up to provide assistance.
it was good for me to see that D is getting good care. that the system is working to support C. many people are working hard to save this little boy, to give him the most normal life possible after being shot by his brother.
and it's sometimes okay for me to watch others do their job. sometimes it's okay for a nurse to just be a person. to just hug C and offer him human support instead of nursing support. it's okay to not be in control. very infrequently do my attempts at control work out anyway!
(i know i can't. and even if i tried, the final result would be the same. i am no better equipped to handle the situation than the people in charge. but i'm bad at being a spectator.)
we have a family friend, let's call him C. he is one of the kindest men i've known. he is only a few years older than i am. he's the father of two boys - A is 16 and D is 12. his wife has a 19 year old daughter and he takes his parenting role very seriously, even with her. he works hard all week, working two jobs, to support his family, so that on the weekends, he can spend quality time with his children. they go to church. they play an active role in their hispanic community. C wants to give his children more than he had growing up. he wants them to be educated, upstanding citizens.
but sadly, all of their lives changed this week when A pulled a gun on D and shot him in the mouth. i wish i could say it was an accident. but bottom line is, the boys were rough-housing and A got out a gun and pulled a trigger. certainly A did not mean to kill D; and thank god, he didn't. D is in serious condition and will hopefully recover with minimal side effects (once the reconstructive surgeries, physical therapy, and possibly speech therapy is complete). but the fact of the matter is, A had a gun. it was purchased illegally. it has been discovered he is a part of a gang. and now he is in jail. he is being tried as an adult. and will forever be haunted by the fact that he shot his own brother over a video game.
because C is so devastated and in such a state of shock, i'm worried that he won't know how to navigate the medical and judicial system. he doesn't have the money to pay for high quality lawyers; and he's not in the right state of mind to research law offices who take pro-bono cases. i'm worried he won't demand the best care at the hospital. what if he doesn't know that you can request interpreters, certain nurses, social workers, and special treatment. i hate to admit that the system works in this way, but i truly believe that unless you demand high quality care, you often get just mediocre care.
and so, because i can't just sit and watch, my dad and i went to visit C and D in the hospital yesterday. it was a strange site to see; i've only seen one other child intubated and in serious condition (it was my sister when i was just 12 years old and she was 16). anyway, D looked peaceful and amazingly, in one piece after a GSW (gun shot wound - those of you who watched ER or Gray's Anatomy should know the abbreviation). he is well taken care of. his nurse was doing a fine job, likely her best. and in the brief time i was there, a social worker showed up to provide assistance.
it was good for me to see that D is getting good care. that the system is working to support C. many people are working hard to save this little boy, to give him the most normal life possible after being shot by his brother.
and it's sometimes okay for me to watch others do their job. sometimes it's okay for a nurse to just be a person. to just hug C and offer him human support instead of nursing support. it's okay to not be in control. very infrequently do my attempts at control work out anyway!
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