Welcome

As a nurse for over 20 years I have worked with CNAs, Techs, LPNs/LVNs, and RNs of every caliber. What I have discovered is that each has value beyond measure. Currently I am blessed to work in a staffing pool for a major hospital system that allows me to use all my experience in various fields at six different hospitals to keep me challenged. My goal at Life As A Nurse is to share the experience, good and bad, with all of my nursing peers, those in school to become a nurse and those who are curious and thinking of nursing. May my journey and those of others who share their stories here guide, refresh and most of all, let you know you are not alone. God Bless all nurses at every level. Lord only knows, we deserve it.

Sunday, June 19, 2011

Friday

So Friday turned out to be another split shift. 7-11 in psyche and then over to another hospital for med surg.  Psyche was uneventful unless you count the "meth as a coping skill" moment.  My patient had been clean since December but then got into a fight with her husband and decided to use meth.  When asked why she used the meth, she responded "I was using it as a coping skill."   Was ensued was a lengthy conversation on the differences between coping skills and escape.  I'm not sure she got it.  After arriving to my new assignment and getting five patients the night flew by, mostly due to the fact that I was running my butt off. Three confused patients with bed alarms that kept getting up all night long.  Nothing exciting diagnostically and I had a great tech but these people did not want to sleep. Of course during morning shift change and walking report, I lifted the gown to show the oncoming nurse the abdominal incision and instead ended up with stool on my hand from the edge of the gown. Nothing like ending the shift with a code brown. I collapsed when I got home, that is after I scrubbed my hands for the third time.

Tuesday, June 14, 2011

Another dying patient

So last night I worked on what is supposed to be the ortho unit but in fact is the dumping ground for all things medical.  My patient, 89 years old, just got informed that he had pancreatic cancer.  The doctor told him, per my patient's understanding, that the disease was so far progressed that he had 2-3 months to live and that he should go on hospice.  When I asked him how he was handling everything he responded that he didn't mind dying because he had enjoyed a good life but he didn't want to spend his last months in the hospital when he felt well enough to go home at least for a little while.  As we talked further he voiced his concern that the doctor was going to "force me into this hospice thing and not let me go home."  The doctor had given him so much critical information in one single visit that he was suffering from overload.  He had been alone at the time that the doctor talked to him and so stunned that he had been unable to think of the right questions.
       I'm amazed at times at the thoughtlessness of doctors.  He waltzes in and drops this bombshell and then waltzes out again.  At least I was able to immediately reassure my patient that hospice was for going home, not staying in the hospital.  I asked him to wait up for me and rushed to get my other patients taken care of and though it was nearing midnight when I returned, we were able to talk for over an hour about death and dying, comfort and dignity and what he could expect from hospice.  I also gave him some written information for his family to review the next day.  When we were done he took my hand in his and told me what a difference I had made for him and thanked me for my time.   I've had the death talk with so many patients and families over the last 20 years and it never gets easier and I still cry.
Donna-Blog Admin

Saturday, June 11, 2011

A rough night

        Last night was one of those nights where I was split between two hospitals. From 7-11 I worked at the acute psyche facility.  This particular hospital happens to be located in a rather bad part of town. For example, we had a patient needing medical treatment and transfer to the ER for physical assessment. As security and I waited at the rear doors for the ambulance we noted two people across the street shouting at one another. About a minute later shots were fired, two shots to be exact, and I decided that perhaps I would wait inside the facility.  My co-workers were kind enough to let me leave at 10:30 and with security at my side I bolted to my car and headed across town to my next assignment. 
          I arrived and received report at which time I was told "the admission is done"  Now, I have noted over the past many years that people have varying degrees of the definition 'done'.  If I tell someone an admission is done then I mean that all the orders are checked, noted and initiated.  Apparently the person I followed meant only that the orders had been checked because I soon discovered that my admission still need tube feeding started, IV started, wound vac applied and his HS meds. Whew! Glad the admission was 'done'.
      Moving right along, I soon discover that it  is 12:50 and I have 10 minutes to hang an IV antibiotic or be out of compliance. Patient has a IV lock which I try to flush only to discover that it is infiltrated. Oh yea! The patient with a critical INR of 10 needs a new IV. I run to get supplies and hurry back to his room.  Although he received Vit K today there is still ample amounts of bleeding as I pull one IV and insert another.  Got it on the first stick (go me), scanned the drug, got it hung and all with 3 minutes to spare.  I'm pretty sure that's some kind of personal record.  Of course while I was inserting the IV my phone rang with the news that my patient in room 21 had resps of 44 and so this is my next stop. 
      I enter with the understanding that the family  has not totally committed to comfort cares even though my patient is in multi-system failure with critical labs in multiple values. And of course, no bi pap to ease her breathing and statements like "she really doesn't seem to be in pain."  I review with the family (again-as previous shifts  documented) that her labored respirations is an indication that she is struggling for air and that we can give her something to help relax. Family agrees and I am dismayed to realize that she has only low dose Ativan 0.5mg IV q6 hours.  I page and get it changed to q2 but doc is not interested in increasing the dose or giving Morphine.  I give the Ativan and of course it really doesn't help.  Her respirations remain labored throughout the night. At six am I get the call that now her K+ is critical at 6.2.  MD orders Kayexelate orally or enema if she can't swallow.  I am torn and so I page the palliative care doc. Although I understand it is not supposed  to be my job, under the direction of this doc, I approach the family about the Kayexelate. I explain how it will pull out her K+ by giving her diarrhea no matter if we give it orally or rectally. I continue that even just one hour ago when we lowered the head of her bed ever so slightly her lips and nail beds turned blue and that even if we were to to get her potassium down today, it would be back up again tomorrow because of her renal failure. I also explain that if we do nothing, her elevated potassium could cause her heart to go into an arrythmia, an abnormal rhythm, and explain that this would be a very gentle death.  I ask them again do they want us to focus on comfort and dignity or continue to persevere. Mercifully, the daughter spoke up, "I don't want her to have it. She would just be miserable and I don't want her to spend her last days getting on and off a bedpan." I hold the daughter's hand and commend her for the strength of her decision and let her know that the palliative care doctor will be in soon.  She hugs me and thanks me for the care I have provided.  A very rough ending to a very rough night but at least on this day I don't have to torture a patient with medications as they die. I also managed to get that Morphine order from palliative care and give a dose before I leave.  It is the least I can do.
Donna-Blog Admin

Tuesday, June 7, 2011

Just another night in psyche...

So I spent the night working at the acute psyche hospital.  I often wonder what people think when they come to the facility.  Apparently on this night, they thought it was the love shack.  A guy dressed as a girl trying to hook up with another guy who happens to be schizoaffective.  Schizo guy didn't realize that 'girl' was not a girl at all and responded. Peers tried to cover for them and were shocked when we noticed guy and 'girl' leave together to go to his room.  Of course there was complete denial until we asked why schizo's pants were down.... I love my job.

Donna-Blog Admin

Thursday, September 9, 2010

Epiphany

I had a patient named Betty. She was in the nursing home and she just used to yell out "Bear bear bear bear bear..." Day and night it was all anyone ever heard her say. She could neither eat nor drink and her life was sustained on tube feeding dutifully provided by the nursing staff. Her family had long since stopped visiting for Betty never had anything to say except "Bear bear bear..." Everyone had accepted that this was just a shell of a woman who no longer recognized reality. One night, as my girlfriend and I were taking care of her, giving her tube feeding and meds, we decided to cut her fingernails because they had grown very long. I got a kidney basin to soak her nails because they were also quite dirty and hard and I thought this would soften them up making them easier to cut. When I placed her hand in the water she immediately yelled "It's too hot." I took her hand out and stared at my partner on the other side of the bed wondering if she heard the same thing as me. She had and we were both in awe. Well, I cooled the water down a bit and tried again for a response, asking if it felt okay or if she was in pain or anything else I could think of to elicit some type of response. Betty never said anything besides her chorus of "bear..." after that night but it forever changed my point of view of caring for the long term patient. Betty was 98 years old. It's been nearly 20 years and I have never forgotten. Quantity does not always equal quality.
Donna-Blog Admin