Sunday, January 25, 2015

Having the rug pulled out from under you

Could you imagine being in the prime of your life - so between 20-40 yrs old - in the point of time where you're supposed to find the person you LOVE and get married, have children, travel some, finish school and find a job (hopefully a good one!), apply for health insurance through them so it's coming out of THEIR pocket and not yours and live a GLORIOUS life!!!

So you're in the midst of doing so...



You are hit with a diagnosis of HIV!!!

Thing is, you live a non risky life, you've done EVERYTHING correctly so how the HELL did you get this?! You've never had a blood transfusion, haven't travelled (unless you count going on a cruise 2 yrs ago that the riskiest thing you did was do accupuncture - I wouldn't have but we aren't talking about me!) and don't have risky sexual encounters (have been monogomous their entire life)... so how does this happen?! AND how is that you find out when you're applying for health insurance?! Geeze if THAT doesn't suck, I don't know what does!

And HOW do you, as a nurse respond when your patient just breaks DOWN - and of course you feel like shit for asking about the diagnosis - you try to be empathetic but how the hell am I supposed to relate when I have never experienced this and I can't even try to. But I CAN be sympathetic and try to lend an ear as well as a shoulder. I did that today for my pt. I hope I provided some hope for this pt.

Monday, January 12, 2015


Had to work a dayshift - the BANE of my existance! Of course it was a shift from hell.

Normally we carry four patients on days

#1 - pt with ALS with increased SOB (possibly pneumonia) and has a PEG tube and requires multiple IV things (antibiotics and solu medrol), plus is a total care.

#2 - a nursing home patient who was made palliative - has influenza A - and is doing better. Is a total care plus a total feed and a diabetic.

#3 - pt with GBS who is now a quadrapalegic and thereby a total care and feed, also a diabetic - plus the family is really needy.

#4 - pt is one assist. Had a stroke but seems pretty good other than some memory issues. Needed a follow up head CT and discharge was pending the result. Also a diabetic so several checks and subsequent insulin injections for those who also have diabetes.

So it's a heavier assignment but not ridiculous. The doc comes in a discharges #2 so I have to call the nursing home and let them know that the pt is coming back and asking if they want the MAR faxed or whether a photocopy will do.... package is made up for them and the ambulance is booked.... for 45 minutes later! Well about 30 minutes after that the nursing home calls us back and indicates that they're in an outbreak and the pt cannot come back. I asked what outbreak and am told it's influenza A.... I told my co-worker... "meh, it shouldn't matter, he's already infected"  HAHAHAHA

I told the doc about it and he said that if he came to the hospital during the outbreak and that he could return during the outbreak. And because the Dr decreed it, so shall it went! And off I sent him.

The other doc came in and discharged pt #4 later in the day. So then I had two discharges and two admissions I had to worry about. On top of all the regular things I have to undertake I have these things. Plus try to fit  my break into all this! UGH I hate these kinds of shifts!!!

Saturday, January 3, 2015

The day I threw an epic fit

So I've worked almost 3.5 yrs where I am. So I'm not new. I've had my fair share of assignments. Some good, some really, really crappy. But RARELY do I EVER throw a fit about it. I normally just try to find a team mate and get my shit done.

Yesterday was a different story...

I worked my normal evenings and came in find 5 patients assigned to me...

Bed. 1 - young adult with a new trach (which = a lot of secretions which = lots of suctioning) who already has stage 2 coccyx ulcer (has NO adipose tissue so therefore no cushioning) which = turning every 2 hours and changing at that time as well to try to prevent the ulcer from getting worse. Also has a G tube so that's more work... and is on dilantin which means remembering to hold the feed for 1 hr pre and post administration. And of course lovely family members who are all up in your face about care being done IMMEDIATELY because they're used to one-on-one care like the ICU.

Bed 2 - open but report was already taken and it's a repatriation from another hospital and it's an acute CVA.... so admission and who knows what kind of condition the pt will be in. Although it looks easy to do, it takes at LEAST 1.5 hrs for an admission because of all the charting and such that needs to be done as well as carrying orders and contacting doctors for orders and such.

Bed 3 - CVA who requires little in terms of assistance except for meds and supplies.

Bed 4 - Parkinsons (end-stageish) who is DELERIOUS!!! And absolutely BONKERS!!! Speaks another language and LOVES to climb out of bed! Is a total feed and is incontinent of urine AND stool... also needs to be turned every 2 hrs..... so a LOT of work with this patient.

Bed 5 - a total again who has UBER amounts of dressings that have to be changed multiple times a day. Is obese so it takes several ppl to turn (always takes time trying to find someone to help!) and needs to be done at least q2hrs. Is also a total feed and incontinent of urine and stool. This one makes your back kill by the end of the night.

Now I wasn't going to say a bloody thing until I found out that bed 5 was being discharged back to the nursing home and so I would have all the work of a discharge and then ANOTHER admission....

But to top this all off was that I'm super sick with a head cold and a chest thing (I'm thinking bronchitis - it hurts to breathe but I don't have any wheezing or crackles) and the ONLY reason I went to work was because I knew my friend was working and when I needed help would come to my assistance immediately and would work as my dedicated teammate.

So THAT was where I drew the line....

I knew I couldn't do a total delerious pt, a total trach with many needs, AND two admissions.... if I wasn't sick I probably could but I just knew I couldn't.

So I went to the charge nurse and asked for a change in assignment.... and she went beserk! Talking about how everyone is always complaining about their assignment and how everyone should just put up and shut up. That was where I was like "I NEVER complain about my assignment so you need to stop".... I got another nurse involved (who regularly is charge nurse when I'm working) and even said to her, "when do I EVER complain about my assignment?! I never do" And she agreed which was nice and so the current charge nurse although irritated that she had to change the assignment begrudgingly did so.

So my 5th pt was someone who required IV meds, narcotics several times, a foley that I had to empty but was independent in every other way.... which was just fine by me!

I barely made it through my shift but at least I can say I did. Then I told the next charge nurse that they needed to cancel my shifts for the rest of the weekend cuz I was too sick to work!