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Nov 25, 2009
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| | Description: Graduate sheep...er, nurse
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| I bought a new stethoscope while I'm speed-defrosting a turkey | | I brought a Littmann Classic II SE for myself. I needed a smaller steth than my CD-27 (which I love but damn, is it heavy!) for going to the clinic as well as for work, especially since they're going to be spreading the physical assessments over the entire day now instead of leaving the bulk of them to the night shift. I will actually need to have a steth that works pretty well instead of the behemoth steth we keep in the drawer. Plus, I'll need it for clinical when they start up.
It's also personalized with something important: RN. Meriwhen, RN. Well, my real name plus RN...I don't think I'll be advertising myself as Meriwhen at work anytime soon. Though I'm sure a few classmates have figured out who I am by now...but like I tell people when they call at the nurses station but don't have authorization to talk to the patients: I shall neither confirm nor deny my identity on the board.
I forgot that Turkey Day is tomorrow and I didn't take my turkey out to defrost. So I got a bucket from the garage, put it in, and filled it with cold water. I'm changing the water q1h until I leave for work, then it goes in the fridge, then my better half will resume defrosting until I get home. I hope it comes out OK.
Happy holidays! | | So I call for the nursing supervisor... | | and ask her to come on up to my unit whenever she has a chance, no rush. She appears pretty fast, considering that it’s the end of the shift.
I tell her I discovered that I made a med error yesterday: when I was doing my nightly check of the MAR, I noticed that I missed signing off on an entry the day before (the day I didn’t do a nightly check since I had a late admission). I was about to sign it when I figured that since it was a narcotic...not really–it was Tramadol, but we do keep it with the narcs since it’s usually given with Phenobarbital...but I thought I’d check the narcotic log to see if I did give it. And I didn’t. That was a busy night: I’m trying to pass meds and someone’s knocking on the med room door q5 minutes to ask/tell me something. It was very distracting.
“So what are you going to do about it,” she asks.
I hand her a completed medication variance form and incident report.
“Oh,” she says.
“You need to fill out the back part,” I tell her, “since I was the only nurse here that night as well as tonight.”
I think she was a little shocked that I wrote myself up. In her day job, she’s a nursing instructor, and I think she was preparing to lecture me.
To be honest, the odds are that the error never would have been discovered unless they decided to audit that particular chart. I could have signed it and let it go, and I’d be a liar if I said that never crossed my mind because it damn well did…but my conscience would have gotten to me. And once I start down that road of not reporting errors…pretty soon I’ll be falsifying documentation, diverting drugs and barking at patients, “you’re crazy, just deal with it”. So I did the right thing.
Now I’m up to 2 reported med errors, but this is the first that is 100% my fault (the other was the one due to another nurse transcribing the order wrong then altering the MAR after I gave the dose–I was the one who filed the variance/report. The unreported one was also due to another nurse’s error in transcribing, but since it helped get the patient’s HTN finally under control, the charge nurse and I got a one-time order to cover it).
“Am I going to get fired for this?” I ask…not entirely in jest.
She laughs. “Please…if only more people here did this.”
I probably won’t get fired, I take it.
I don’t like making the errors though…the problem is when I’m the only nurse on the floor doing both charge and meds, it can be distracting especially when everyone is coming to me because I’m the resident RN. I think I need to set a policy that, if I’m the only nurse on the floor, unless copious amounts of blood are involved or a patient is about to go off the psychotic deep end, that I’m not to be disturbed during the med pass. Either that, or I need to get the nursing supervisor down here to cover charge for the 20 minutes. | | Nurses do not get snow days | | Or rain delays. Or bad weather days. Or holidays, really. Hospitals can’t just up and close for the day because there’s three feet of snow or a ton of flooding or because it’s Christmas. Patients need care 24/7.
I say this because today I must set out and face the remnants of a tropical storm as I slog my way to work. The brunt of the storm hit on my day off…though that didn’t stop them calling me at 5am to ask if I could work anything at all. I told them that my preschooler’s school was closed due to the weather and unless they wanted to babysit him on site, I can’t come in. I think they were desperate enough to consider saying “yes.”
My street is flooded. Not horrifically: the house is dry, nothing has floated off, and my car is high enough that the water never reached it. But I know the roads are a mess everywhere and so driving in is going to be quite the trek. I have a SUV, so now I’ll get to see if purchasing one was worth it.
I had to put in my holiday choices for the schedule. Everyone has to put in for two of three winter holidays and two of three summer holidays. We’re not necessarily going to end up working them, we just have to be available for them. I put in shifts for all three–two of them ended up on my regularly scheduled day (Friday) anyway, and I figured I’d put down for Turkey Day as well, in case I change my mind about working Christmas (I will gladly work New Year’s Day, I think it’s the most useless of the three days. After all, the big event for the day is pretty much over by 12:05am–the rest of the day is football and parades).
I don’t want to work all three, though getting all that double-time would be nice. But we’ll see what happens. They do try to divvy them up evenly so no one person gets slammed (or makes a killing, depending on how you look at it).
It’s been busy at work. For all of these new nurses they’ve hired, I’ve only seen a couple of them. Nearly every day they’re calling me to see if I can work or work extra, and all week I’ve stayed late per their request, so much so that half of Saturday will be overtime pay. Unless they decide to send me home early…and given the weather conditions here lately, I doubt they’ll have enough coverage to be able to do that.
Detox has been jumping too: I don’t know if it’s linked to the holidays or what, but it’s been full all week. Of course, that means a ton of paperwork for me…but it’s the unit I know best, so I don’t mind it. I’ve got it down to a science, in fact. I wonder if I’ll be there tonight…lately, they like sending me to stepdown on the weekend evenings. I’d rather be in detox, but I go where I’m told and make the best of things.
Oh, what happened with my group….the other group person was out due to illness: her doctor had her on bed rest. At least she wasn’t slacking, so I don’t feel as bad over having to do the whole thing. The instructor also posted that she had liked the group (my) assignment, though I haven’t gotten the official feedback yet. I turned this week’s assignments in early, since with the bad weather I’m not sure if I’ll lose my internet connection. No more group stuff for a while though. | | *sigh* | | Someone who visits my blog (see my profile for the URL) noted that the dates of the posts there and the posts here don't sync up. That's because I update the blog first. Then the next time I post in the blog I move the previous post over here. Not sure why I really do it...it's part laziness and part out of privacy/HIPAA concerns (altering the dates of events to make them a little less traceable to specific patients), as most people who read my stuff read it here--almost no one goes to my blog. Though it's clear that the few that do are very observant 
Anyhow...
I got my first week’s marks, and I didn’t fare as poorly as I thought I did. Actually, I did very well.
The next two homework assignments were turned in on time. One assignment is utter crap though. It was a group project…except my group wasn’t really there. They sort of got started, but one member had a family emergency of the life and death rank. One member went AWOL.
So that leaves me.
I didn’t mind–I’m not getting a zero by not turning anything in so if I have to do the lion’s share, fine. Also, family emergencies trump schoolwork, so I can respect that. So all night I kept posting drafts and asking for input when possible. All night I got nothing. I wrote a few drafts on the board and countless more in Word.
Finally, with 5 minutes to go before the deadline, I had to call it a game and post what I wrote. After reading it, it’s crap compared to everyone else’s, but I didn’t have a choice. One of the other groups pulled together beautifully. The other group managed to capture the assignment beautifully. Meanwhile my group…er, I…am trying to stay awake after being up for almost 24 hours.
Then I found out after the fact that the group area we were supposed to work this in is visible to not only to the teacher, but to the other students. I had thought the groups were private…so basically, everyone knows I did all the work.
*sigh*
What could I do? Rock to the left, hard place to the right. I’m going to sleep now. | | Going to enjoy the ride this time around | | As an ADN, it was all about grades: I finished with 3.923. I had one B–I missed the A by a fraction of a percentage point. Yeah, it burned for a while. But on the other hand, it taught me an important lesson: the world didn’t end when I didn’t get the A. People didn’t think me any less smart. People thought no less of me…hell, my classmates were still proud of me for what I achieved–and what I did to help them–that they let everyone know it at pinning.
Getting that 3.923 was exhausting work–I went above and beyond in studying for those two years. My health suffered, my social life suffered, my family actually didn’t suffer because my better half was/is a champ at picking up the slack when it comes to the preschooler. My mind suffered though. It was emotionally draining. Everyone said I made it look easy; I tell them they should see the ulcer it gave me.
Now that I’m a BSN student…I still want to do well. I don’t know if my future includes a masters degree so I don’t want to become an entire slacker. But I’m not as stressed anymore over the grades I’m going to get. If I get an A, yay. If I get a B, yay. If I get a C…ok, I have to put my foot down there–I will not willingly be a C student. I already was once in my life, thank you. Point being: I’m going to focus less on getting the GPA and more on the classes itself. Slow down and smell the care plans and concept maps. Look at the whole picture and not just the tests. Enjoy more of what I’m doing. Not let it consume as much of my life…and it being a part-time program, that should be easier for me to do.
Speaking of which, I better get cracking: my homework is due this evening but I still want to go out with my friends tonight. | | Mental Note: Read the Syllabus | | The first week of my first BSN (pre-BSN) class drew to a close. It had a rough start as I got my dates mixed up and ended up turning the first assignment in a day late (thank God I decided to log in–I noticed all of the postings). Participation-wise, I fell short too. I thought I was participating enough but then I counted up my postings and was one post short of the minimum guideline. Of course, had I bothered to read the syllabus fully on day 1, I would have had the answers to A and B and therefore no problems. But I didn’t because I thought I had several days before the first piece of work was even due. I thought about telling my teacher about being sick and pleading for leniency, but you know what: it’s my responsiblilty to know what’s going on in class. I just have to suck up whatever grade I get for the week and do better next week.
Lessons learned.
I’ve combed through the class calendar and added the due dates to my Outlook, printed out the next two assignments and when they are due (end of this week), and today I plan to go through every inch of that syllabus to make sure I understand it all.
I’m looking forward to going back to work. Despite being sick and all the stress, the week off has been nice. But I’m also bored and itching to get back on the floor. | | I now understand why so many at-home moms drink | | I’m not being facetious.
My being under house arrest due to illness means the preschooler is also under house arrest because I’m not supposed to leave the house to take him to school or anywhere. For the past three days he’s been hounding me like the plague…I can’t get a moment’s peace to relax or do my reading for class. What’s worse is that he’s developing the 4-going-on-40 attitude and everything is “I want!” or “No!” or “Mommy, do this!” He deliberately disobeys me when I tell him to do/not do something, and when he does something wrong he gives me that laugh, that laugh that says to me “I know I’m ignoring you and I don’t care!”
I’ve tried everything from being nice to being a *****. Nothing works.
Add to this the fact that I’m feeling much better (ah, Theraflu, how I love thee) and would love to be out and about right now–hell, I’d even like to be at work if I could! But I can’t because I’m still contagious…nor can I go visit friends. So I’m trapped in the house with a demanding preschooler. What’s worse is that tomorrow my better half will be gone until Sunday, so it’s not as though I have someone in the house that I can hand him off to for a while as I go and hide.
It’s all I can do to grab a bottle of wine and up-end it in my mouth. But the Theraflu is keeping me from doing that.
I don’t spank either–I had it done to me as a child and I don’t approve of it. But I’m beginning to understand that “why” feeling too.
Oh well. This too shall pass…I hope.
Oh yeah, I’m officially a BSN student now. Pre-BSN student, actually…it’s kind of confusing how the program is all set up. But I’m taking a 6-week online class that so far is a throwback to my Fundamentals and Management classes. I’m one of two RNs in it–the rest are all brand-new nursing students. I better not let myself get too cocky about it. | | Minutiae | | I was complimented the other day. I'm back on detox; one of the clinical instructors was showing her students around the unit, pointed to me and told her students "that nurse explains detox really well."
Wow.
I've been mastering the basics but I didn't think I was "really well" at the topic. I was flattered. That compliment makes me want to learn even more about detox so I can really be thorough in explaining it to patients and students.
I'm a firm believer in consistency, meaning that if you're going to enforce a policy, you should do it for everyone regardless. Like every other hospital around here, alternate weekends are a must. One of the policies in my place is that if you call out sick over a weekend you're scheduled to work, you may be asked to produce a doctor's note as well as have to work the next "off" weekend you have. Apparently too many people have abused taking weekends off, so they started cracking down.
Now while I don't mind at all being asked to fax my doctor's note (I am indeed sick: I had to call out this weekend because my doctor wants me home recovering until Monday) because I approve of the consistency on their part, part of me couldn't help but feel a tiny bit peeved as I work EVERY weekend. I don't have a "off" weekend coming off--I'm in for at least one, usually two shifts every single weekend since the day I was hired.
And it's not as though I'm abusing the weekends: this will be the first one I am off, and only because I am highly contagious.
Go fig.
So yeah, I'm on an enforced vacation from work. I'd like to say I'm home relaxing...but I can barely keep my head up. I'm chugging Theraflu q4 just so I can breathe, and I'm buried under down comforters while it's 70-something degrees outside. | | Money money money | | I've been on stepdown for so long lately I’m not sure if I should call it my new home.
There have been staffing cuts all throughout the hospital, and a lot of good people (including nurses) were let go. This means we’re now even more short-staffed. The official reason is “budget cuts” and “our census is low”. I don’t know about the budget, but I know that we don’t have a lot of empty beds…in fact, I get admissions trying to admit people to the unit even though I’ve told them we have no free beds.
I really don’t know why I stress over not getting enough hours. Nearly every day I am asked if I can come in early/stay late/come in at all for any amount of time.
I still have a job, thankfully. And one would think that with the number of people let go from detox that they’d send me back up there. But no, I’ve been banished to stepdown for reasons unknown. I’m not sure who to ask…I’m not sure if I even want to ask, you know? And it could be worse: I could be in the high-functioning unit or the kids’ unit.
Oh well, what can I do? I just go in, smile and do my job. The techs wonder why I don’t complain about it. I tell them that it wouldn’t do any good because I was hired to float, and that ******** about it would just make my mood darker. Instead, I can accept and make the best of it, and get some joy out of the day.
Now that I seem to have taken care of the household emergencies, it’s time to turn a lot of my paycheck towards my credit card and my retirement fund.
I transferred my balance to a card via a 0% APR offer (and with no transfer fees, how rare is that?!?). The offer only lasts until May, but I figure I could make a pretty decent dent in it if I give up about 300-500 per paycheck towards it. Then come May, I’ll transfer it back to my original card–they’re constantly giving me balance transfer offers so no worries there–and keep chipping at it. My goal is to get it paid off by this time next year…I think I’ll do it far earlier than that, but I’m leaving myself some wiggle room just in case.
I have two IRAs. One is a 403b that I got from my last job pre-nursing school. The 403b is just like a 401k except it’s for non-profit and educational institutions…and since I’m not at a school nor am I getting benefits at my current job, I can’t do anything with it except watch it grow and shrink. Then there’s my Roth IRA, which I send 50-100 a month to. I’ve got a good mix of mutual funds and stocks in there and while it’s miniscule (it’d last me about a month should I need it today), at least I’m contributing something.
The stock portfolio is also small. That did well because in 2001, I bought Apple at 12 a share. It’s now trading at 180. I wished I had sucked it up and bought Google at 85 a share when it launched, but I was in nursing school and couldn’t afford to do it. Now that’s still trading in the 500s. I do own part of a share though, so I made like 30 dollars on it. But I’m trying to purchase about 50 dollars’ or so worth of stock each month in solid stable companies like Coca-Cola, Pfizer, Avon, etc. I read somewhere (the Motley Fool?) that the best stock picks were based around common, everyday things, since they’re not likely to be going anywhere anytime soon.
I am trying to put money in the savings account…easier said than done. This last month has been a rather costly one for us with household stuff; also, I will admit that I’ve become a bit of a splurger lately. Once I sat down and did the bills for the month I realized that though we are now a two-income family who until now had gotten along on one income rather OK, that is no excuse for me to spend my income carelessly.
I was up two pounds at weigh-in today. I know why: I’m forgetting to eat at work again. | | Assault and battery by Gatorade | | I knew it was bound to happen sooner or later: a patient threw something at me.
I was back on stepdown the other night. The report said that the patient was involuntary, psychotic, delusional, a pussycat in the AM but once it got dark out, she would get all worked up. True to form, she did. She started slamming doors, spitting in the hallway, and getting into it with her roommate who was otherwise peaceful all day but told me in no uncertain terms that if this patient got in her face again that she’d “fuck her up”.
So we separated the two, thinking that having a private room would help the agitated patient calm down. But now it’s the safety checks that were getting her agitated, and she started complaining, throwing things, getting into it with other patients, and slamming doors even more. She was reprimanded several times, and even reminded that this behavior is not going to work in her favor at her court hearing, but she disregarded it.
I’m peacefully in the med room doing my med pass when she got me with the Gatorade. I yelled, “Hey!” and it took all my willpower to keep my mouth shut after that.
I went to my charge nurse, who thank God is on the ball. She arranged for an immediate transfer for the patient to the intensive care unit. Then she tells me to see if she has any PRNs that I can give the patient. Sure enough, she does: Ativan PO or IM.
“Should I offer it PO?” I ask.
“Do you think she’ll take it PO?” says the charge nurse. Both of us know how this is going to end.
I point to my wet head and shirt. “Probably not.”
“Draw it up.”
“It would be my pleasure.”
So I prepped the needle, and though we had one male tech on the floor, we called for another tech to come help me give it. Thank God they found me the biggest one on duty.
Charge nurse sends our two techs in, and tells the patient that we’ve got medicine for her, and would she lie down. She keeps saying, “I’ll be quiet, I’ll behave,” but when she sees me and then the needle, she starts glaring daggers. I stare back with no expression (I’m still fighting to keep my tongue holstered and succeeding). They asked her if she wanted it in her arm or her thigh. She didn’t answer, so I said she’ll get it in her arm. She didn’t fight it–the two techs weren’t going to let her.
God help me for saying it, but giving her that IM injection felt so damn good.
In the five minutes between that and her transfer, she kept walking the hall and muttering threats at me. I didn’t flinch and I damn well didn’t take my eyes off of her as she passed. She kept telling the techs that she’d behave now but they told her “you had your chances, we offered to help you, you need to go.” So now she’s over in the intensive care unit, where they take no crap from any patient.
Afterwards, I took a few minutes in the lounge to breathe, curse her out (to the amusement of the techs), and then write the incident up. The techs were impressed and said I handled it all very well, better than they would have. The charge nurse understood how I felt when I gave that IM–such things have happened more than once on this floor.
Unfortunately, because of all of this, I had forgotten to give one patient all of her meds–I was in the process of doing that when the Gatorade attack happened. She refused the remaining two meds, so I had to square that away with the night nurse, and I might be written up for a med error. Maybe I got lucky and the night nurse was able to persuade her to take them.
Can’t win them all. |
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