onetiredmomma 5,224 Views
Joined: Sep 19, '08;
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It's been an interesting couple of weeks in the old ER, rotten shifts and yet strangely awash with genuinely sick and unnervingly pleasant patients. I've had a tear in my eye more than once because a few words of kindness from patients have been thrown my way... Maybe I'm going soft in my old age. Tell me some of your stories, here are a few of mine.
I had an altercation with an ICU registrar during an emergency I responded to on one of the wards and was feeling decidedly unappreciated. Back in ER, I took over workup of a nursing home pt. in resus with some sort of compromised sepsis. I assumed he was demented /non-verbal or delirious and he had been doubly incontinent. I catheterised & collected bloods and then gave him a quick bath while chatting away to him about utter rubbish. As I was leaning across to finish buttoning his gown he whispers "You're very kind". 3 words, instant tears. Annoying really, I just wanted to be angry all day.
Unloaded patient into resus looking very ordinary - collapse / abdo pain / diarrhoea, bedside USS=Ruptured AAA. I just kept the morphine coming and called his son. Vascular surgeon blusters in after CT (without even introducing himself) saying "Okay, we need you to sign a consent form....." At this point, no one has even told the patient officially what is going on. "Um, doc, the patient isn't sure he wants go forward with the operation so you need to explain what's going on and discuss it with him". I am saying "best of luck" after getting him onto the operating table and he puts his hand on my cheek and says "what is your name?" then kisses my hand and says thankyou. Sigh.
Triaging a lady miscarrying at 13 weeks, starts sobbing at the desk so I stop asking questions and take her to a bay in acute. She keeps apologising to me for being upset- "I'm sorry but this is the 2nd time this has happened and....." so I go in for the hug, then I start to well up. We chat for a little while, I head back out to triage and a few hours afterward a man comes to the desk asking for me. He has come to say thankyou to me for looking after his wife and being so nice, that she was sorry she didn't get a chance to say so herself. What can you say to that?.
Lady patient unloaded in acute with chest pain. Her husband is grinning at me and says "You don't remember me do you?". "Well, your face is familiar". "You looked after me 4 years ago when I was having a massive heart attack". "Oh jeez...Was I nice?". "You were amazing F__N (remembered my name), everyone who works here is". Love it.
That's what I love about nursing, I sleep well at night because of patients like these.
anything BUT AC.
It was 1998, and as far as I knew, the world was perfect. I was ten years old and the reality I perceived was viewed almost exclusively through the protective eyes of my parents, who deftly maneuvered between telling me enough to allow me to grow up while simultaneously protecting me enough to allow for a safe, peaceful, beautiful childhood.
I was born curious according to Mom, asking questions as soon as I could talk, and by the time I was ten, I was starting to realize the world wasn't perhaps as safe and rosy as my parents had allowed me to believe. I was cresting the hill of childhood, rapidly moving toward adolescence, and as Dad and I strolled up the hill toward the hospital, I was about to come face to face with my future profession--and a passion that would push me through the many challenges that lay ahead.
I distinctly remember walking up the wheelchair ramp, holding the black wrought-iron rail and standing on my tiptoes to see into the window of the hospital nursery. I have always been lacking in physical stature--the shortest in most circles in my hometown being that I am not of Dutch descent--so the sensation of my Dad's hands under my arms and my feet lifting off the ground was much appreciated.
Inside, I beheld wonders I couldn't have imagined. Babies in bassinets speckled the nursery. Machines and technology I couldn't wrap my mind around taunted me from beyond the glass. And as I gazed, awestruck, a nurse who was tending one of her little charges noticed us. She smiled, wheeled the bassinet over, and held up a sleeping baby boy.
I was hooked.
It wasn't the first time I had decided I wanted to be a nurse. My Mother swears that when I was three, I told her out of the blue one day that I was going to be a nurse. Goodness knows if I really understood what I was saying, but Mom believed me, so when I came home and made the same announcement 7 years later, she was hardly surprised at the news.
A tradition was born on that chilly May afternoon. Dad and I would go to the hospital windows nearly every night to see the babies after we had eaten dinner. The nurses, incredible women that they were, took to my ten-year-old self, and within a few weeks, they were letting Dad and I into the hospital to see the babies from the large viewing window by the nurse's station. Come hot summer day or snowy Michigan blizzard, Dad and I made our trek faithfully almost every night. Our routine was unvaried and deeply precious to me: walk to the hospital, see the babies, talk with the nurses, go to the cafeteria, split a cookie, and walk home.
In addition to getting to know the nurses, I also met the doctors and much of the hospital staff from other departments who recognized Dad and I from our nightly walks. As I matured, the OB nurses began to explain to me what the machines in the nursery did, some basic physiological concepts about how those little babies' bodies functioned compared to mine, and some fundamentals of nursing practice. As I got older, we talked about grades, their importance, and college. Little did I know it, but day by day, visit by visit, those nurses became my mentors, my encouragement, and my educators until I turned 13 and moved to a nearby city.
Less than a month after we moved, terrorism forever changed the country I call home. I was thirteen when the September 11 attacks occurred, and the course of my life changed with that tragic event. Three years later, when I turned 16, I decided that I would enter the US Army. When I was eighteen, I took an EMT class, fell in love with emergency medicine and developed an intense interest in critical care. By the time I went to college, the focus of my career had drastically shifted from where it started, but I never forgot my first love in nursing. I never forgot those little babies.
Nursing school went by relatively quickly despite the bumps in the road. Those bumps included two bouts of mono, two stupid boyfriends and one uphill battle to get into the Army. But that passion that led me to the hospital every night also pushed me through the hardships and toward my goals, and in August of 2010, I graduated college and passed the NCLEX three months later.
Armed with a degree and a license, I enjoyed my few months remaining at home. January of 2011 came quickly. I had barely turned 23 when I was whisked off on orders to Fort Sam Houston in San Antonio, TX, for Basic Officer's Leader Course (BOLC). There, I learned about the Army, about my place in the AMEDD, and about the task of caring for soldiers that I was about to take on firsthand.
My first assignment was Walter Reed--the original Walter Reed, that is, before the merger with Bethesda. The looming building on Georgia Avenue in DC housed my first nursing job, and I loved every second there. I was unwillingly assigned to oncology, but despite my initial doubts, in retrospect, it was the best thing that could've happened to me.
Oncology, with its diverse disease processes, demand for a discerning, observant eye, and its high knowledge burden had me hooked within a year. I thrived, constantly learning from doctors, from my fellow nurses and from our incredible CNS. I proudly took on the title of "oncology nurse" and all that that implied. Though we were technically med-surg nurses without identifiers, we were highly respected among the doctors, valued by the ICU nurses we often encountered, and commanded respect from the interns that rotated through our ward for our specialized knowledge and trial-by-fire critical thinking skills. Oncology made me a good nurse and pushed me to be an excellent nurse for the sake of my own pride, for my preceptees, and most of all, for my patients and their families.
Our merge with Bethesda Naval changed everything about my workplace. It was slow at first, but the decline was obvious. My floor struggled through understaffing, neglect, serious medication errors and low morale associated with high patient mortality and the ever-dwindling supplies. By the time I left, every night was a fight to protect my license and my patients. My best friend and I left the hospital within a month of each other, both of us happy to have escaped unscathed.
My new assignment, while better in theory, has its own struggles. Now a first lieutenant rapidly moving toward captain, I am looking middle management squarely in the eye if I don't take a identifier-producing course and specialize, and even specializing will only delay the inevitable move from bedside to a desk. I am working a clinic with patients whom I love, but I am in constant danger of being pulled to the medical-surgical floor of my small MEDDAC that is infamous for unsafe practice and septic tank-low morale. And though the outpatient pace is interesting in its own right, I cannot help but feel empty, displaced, and a little lost.
I am far from my fiance, far from home, and far from where I want to be in my career. The disorienting effect of this combination has made my head spin. Weekends pass far too quickly and every Monday, I return to face the challenges that await me at work on a daily basis.
But despite the storm overhead and the rough seas below, all is not lost. Last year in the fall, an answer came to me not in orders or in words, but in a person. He was an answer that, at the time, I didn't have a question for. Indeed, he and I met when the seas were calm, the sun shone overhead, and all was well in my career.
Little to my knowledge, I had met the man who I will soon call my husband, and as our relationship has grown, so has my willingness to leave the service. Last month, I made my decision. Instead of taking a course or looking to prolong my military career (as I had been considering at the time I met my fiancÚ), I am ready to lay down my uniform with bittersweet emotions when the time comes in 2014. We will start a life together and I'll be a civilian--at least in title--and once more experience all the freedoms and burdens that are contained therein.
Thinking of what I wanted to do next in nursing was a daunting question. I have for over two years gone where I was told to go and done what I was told to do. How could I possibly choose an area of nursing that was going to challenge me, capture my passion, and replace the fulfillment I've known in the Army?
My answer came last weekend as my fiance and I sat watching Princess Bride over Papa John's Pizza. Inigo Montoya, propped up against his cabin drunk as a skunk in the Thieves' Forest, muttered a line that resonated. He slurs, Spanish accent strong and sword drawn in his lap, "You tol' me to go back to the beginning, so I have!" He nods assuredly. "This is where I am, and this is where I will stay. I will no' be moved!"
The beginning. It seems like ages ago, but it isn't, and neither is that ten-year-old girl who dreamed of watching over babies. In addition to that old dream, my newer love for critical care persists. In desperation, I sought a way to marry those two dreams, though I know that L&D and postpartum are not where I want to end up. I have been floated to L&D as well as postpartum since I joined the Army, and while I enjoy caring for couplets, my desire is fiercely and undeniably to tend to my first love exclusively--to the littlest ones of all.
It was in this epiphany that I realized that the NICU is calling my name. It was a realization that lit a fire inside and reignited a passion that I didn't know still existed. I am neither so young nor inexperienced to make the mistake of thinking that working in the NICU will be anything close to perfect. Every job has its drawbacks and its challenges, but I am drawn to the NICU and I know that in that passion, I will find the strength to weather the trials as I have in the past. The flames are being fanned by a dream that will--before I know it--be a possibility, and with a little patience and some preparation, a year and a half may find me where that ten-year-old girl could only have dreamed of ending up.
To the beginning. I will not be moved.
You have to eat. You have to ask for help. You must accept you cannot finish everything some days.
You have to remember that you can't do everything, especially when it happens right before shift change. You have to grit your teeth and tell the oncoming nurse that you are doing your best, but there are still things that need to be done. I think the incoming shift gets upset sometimes at little things, but they will get over it. Pts can be hard to deal with when it comes to discharges. Just take a deep breath and remember your pt identifiers like name and dob. Tell the pt you will be with them as soon as possible. Usually discharges don't take too long, especially if teaching has been done throughout the hospital stay. Just remember to breathe and do one thing at a time. It seems you are doing well especially since you had things under control until those things came up. Nursing is a 24/7 job and everyone has to do their part. There is no way you can do everything, things have to be passed on. Hope that helps. Keep your chin up.
Your note sounds a lot like my charting. You gave the information and the situation so you did fine. The other nurse needs to get over it.
I get to work early to get my ducks in a row. I do it for the same reason I get up a little earlier before work to sit and have my coffee. I like to be ready to work without a rushed chaotic feeling.
Leave the profession. Period.
In the 19 years that I was active as a volunteer EMS member of my local fire department (2 years NREMT-Basic + 17 years NREMT-Paramedic), I was often amazed at the difference between a "scene" on the day of getting a call, versus the same location a day or two later.
I'd pull up on a horrific motor vehicle crash...car into tree...partial rollover...pinned screaming pt. You work to stabilize/extricate/transport the victim of the crash. Do the paperwork, and move on. Same with a shooting....stabilize, transport, "wash down" the ground to clean away the blood.....and move on.
A day or two later, I'd be on my way home from work, and might drive by the same location. Sun shining, pretty green grass. Maybe a scrape on the bark of the tree, a little shattered glass or a discarded rubber glove on the ground, but nothing else to indicate that this is the location where a human life ended or was forever changed. Just another spot of ground...nothing more.
Now, as an ICU nurse, I sometimes experience the same dichotomy ("here" vs "not-here"). A couple days ago, I was taking care of an elderly pt with a dissecting/ruptured AAA. While in the OR, the pt received 16 units of packed red blood cells, 18 units of platelets, 8 units of FFP, 6 liters of fluid, and 4 liters of fluid from the intraoperative "cell saver".
Upon arrival to our ICU, the surgeon was very straightforward with the pt's family....the pt was not likely to survive.
Over the next couple days, the pt ended up getting multiple units of PRBC and platelets, along with liters and liters of fluid (plus pressors and hemostatic agents). The pt's family (spouse and children) hoped for the best, while the medical staff could see (from blood work) that multiple organ systems were failing.
The pt's family ended up withdrawing care....finally...after multiple "talks."
The pt's body was still in the room yesterday (awaiting transport to our hospital morgue) when I came into work. The body was eventually removed, leaving an empty room.
And the room remains....a bare, sterile room in our ICU. Ready for the next patient. The only sign of the deceased is the family contact information written on the dry-erase board.
As with scraped tree bark, the family contact information is the only (short lived) sign of yet another human having passed from this world to the next. Wipe it off with a paper towel....set up the room for the next patient.
Transient...Here vs not here.
It never fails....you're walking down the hall to check on your new patient when you hear an aide loudly attempting to persuade sweet, confused, deaf-as-a-post Ethel to get into bed "BECAUSE IT'S NIGHTTIME AND EVERYONE IS GOING TO SLEEP!"
Ethel, for her part, is equally determined that she's going outside to wait for her husband on the front porch: "My Robert is going to be home any minute. He'll be so upset if I'm not there to meet him." Insistently, she strips off her hospital gown, spies the bag containing her personal items slung over the back of the wheelchair she arrived in, and begins to dress herself again. "What time is it?" she inquires as she searches frantically for a clock and nearly topples over in her haste to put her shoes back on. "I really must go........"
Now, if you went to nursing school in the 1990s like I did, you were probably taught to try re-orienting Ethel to the current time and place. Back then, a common response to an exit-seeking patient might have been: "Oh, no, Ethel, you can't go outside, it's 9 PM and freezing out. You're in the hospital, honey. Let's put your gown back on---"
WHACK! Sweet little Ethel belts you upside the head with a tiny fist that feels like steel, then lets fly with a primal scream that could pierce the ears of a statue two blocks away. The aide activates the emergency call system and attempts to restrain the 90-pound wildcat, only to meet with a similar punch to the midsection; but within 10 seconds there are enough personnel in the room to take down an NFL offensive lineman. A co-worker produces a Posey vest and some soft restraints, and a few minutes later this elderly lady whose only 'crime' is dementia is fastened in bed, crying for her long-dead spouse with only the sitter at her side for company.
This scenario didn't have to happen. Thankfully it happens less often nowadays, but only because some nurses questioned the "conventional wisdom" and decided it was better to join the confused elderly in their reality, rather than try to yank them rudely back into ours. I look at it this way: if the life you were living back in 1952 with your husband and children was happier than the nursing-home existence you're enduring now, what's the harm in staying there if you want?
I've taken so many interesting trips and seen more distant lands with Alzheimer's patients, and other victims of dementing diseases, than I ever have in real life. I've been to Austria and Germany with one gentleman who's still fighting the Nazis in his lively memory; traveled to parts of Russia and survived a Siberian winter with the fellow who spent the final months of his life in my assisted-living facility; even patrolled the highways with the very first female deputy ever hired in the state. Now why did anyone ever think that dragging these folks back from their glory days was the right thing to do?
Take-home lesson: Arguing with dementia is like trying to teach a pig to sing---it never works, and it annoys the living daylights out of the pig.
Here are a few more nuggets of nursing wisdom for you, if you want them.
1) When a patient tells you he's going to die---even if his vital signs are stable and he looks healthier than you do---believe him.
2) People are more than just a set of diagnoses. Say it's the year 2030, and you're the admissions director of a long-term care facility. A file lands on your desk, and you're asked to evaluate a prospective resident who's got a history of alcoholism, diabetes, HTN, irritable bowel syndrome, GERD, asthma, arthritis, morbid obesity, frequent kidney stones, herpes simplex, UTIs, venous stasis, chronic low back pain, and bipolar disorder II. This is a classic example of what healthcare professionals call a 'train wreck', and you decide not to accept this patient, knowing no one could blame you for it.
Guess what? You just turned away someone you already know pretty well from visiting allnurses on a frequent basis.
3) Do what you love........and if you can't manage that, love what you do. I cannot overemphasize the necessity of having a passion for this work, because if you don't---if you do it only for the paycheck---you will more than likely become cynical and jaded. The job is simply too hard for the average nurse to keep going, year after year, decade after decade, when there are too few rewards for all the blood, sweat, and tears we put into it. There has to be a higher purpose to it (and I don't necessarily mean a religious one) for most of us to survive it with our bodies and minds intact.
So, if you don't like the job you have---or have the job you want---go out and get another one. Being satisfied with what you do for 8 or 12 hours out of the day isn't everything, but it IS a big thing.......and believe me, your patients (not to mention your friends and family) will thank you for it.
Embrace life. Embrace your profession and be proud of it. And never forget to allow the Ethels of the world to at least look out of the window, so they can see for themselves that it really is nighttime.......and know that Robert has arrived home safely.
I got the ADN first, then the BSN. I have said it here several times~ I learned far more in the ADN program than the BSN program. The ADN learns everything needed to pass NCLEX and become licensed. The older diploma programs were mostly hospital-based, and those nurses were in the hospital learning stuff every single day. The only thing different in my BSN program was that I had to take a couple more humanities classes, and a research class. It was all fluff, but nothing that enhanced my ability to be a competent RN. Today we have BSN nurses who have never even placed a foley catheter in a real, live patient, or started IV's on them, let alone anything more technical than that. The diploma nurses had to do so much more; they were right there in the hospitals daily, doing foleys, etc., until they were proficient at everything. Don't bash the diploma nurses! Many BSN and ADN nurses get out of school, then have to learn everything "on the job" because they didn't do them in school; this is why you read here how so many new grads expect (and need) six months orientation. I got 5 days!! Yes, eventually everyone will need a BSN, but if you think that will get nursing more respect, more money, etc., you are wrong; it won't. If anything, the role of RN has been "dumbed down." Today you have ancillary personnel that does a lot of what nurses used to do; when I first got out of nursing school, I had to draw my own ABG's and labs, do my own 12-lead EKG's, etc. Now all you have to do is call some other department to do it. Some places even have IV teams that do your IV's for you. Once upon a time, the RN could and would intubate patients. These are diploma and ADN nurses, by the way. A few extra fluff classes does not make you a better RN. The bottom line is that the nurse can only do what the doctor gives an order for. You might know what needs to be done, but you even have to have an MD order to give 02 nasal cannula! There is nothing wrong with being a basic bedside nurse.
One of my primary patients is shattering all predictions. He was a very sick boy, failure to thrive diagnosed with CP. Initial prognosis was poor for 'normal' cognition, ability to control trunk or head, and mom was told to not get her hopes up that he would be mobile without a wheelchair. My patient is not even 2 years old yet. But the doctors wanted to be sure mom had the worst case scenarios based upon their assessments.
Well my patient has been kicking prognosis butt. He's been acting like a 2 year old, letting us all know what he does and does not want to do He shocked my nursing supervisor when she came for a 60-day visit and he was babbling up a storm and made it clear that he did not like not being spoken to. He's making huge advances in his progress in therapies.
But yesterday was the awesomest. (if that is even a word) Mom works with him in the late evening when his siblings are in bed before its time for him to be tucked in. She mentioned it seems like he is taking steps. I know, as a mom myself, sometimes wishful thinking seems like reality.
Yesterday we were waiting for his turn at one of his many medical appointments. He was in a great, happy, silly mood. Mom was holding his hands and he took 4 steps, actually lifting his knees and awkwardly planting his foot. I could tell she wasn't shifting weight just giving him something to hold on to. Since he does (fortunately) prefer mom over me I held his hands so he could walk to mom...OMG that was the best feeling ever. I could feel him press into my fingers to support his weight to lift first his right knee and foot then his left. All with the biggest grin on his face, squeaking with his delight before he fatigued.
He hadn't been specifically working on walking motions in PT for a couple of weeks which to me is even more amazing, though I suspect the fact that his siblings are now toddling around walking may also be an incentive and example.
Of course as a mom, I was happier that the first time this happened in 'public' was with mom there as she struggles with having to miss things since she and her husband both work full time. Another family was in the waiting room and because of the nature of this particular medical office fully understood the magnitude of my patient's accomplishment and were quietly cheering him on with smiles on their faces so as to not startle him and incite a spasm.
When we finally saw the specialist he smiled and said he was not surprised that his little guy is 'messing up' the statistics and predictions. I don't think mom or patient could smile any bigger. I was just honored to be able to witness the event.
I had a preceptor once (in NICU) who told me to NEVER let a parent see me touch their baby without gloves. Now, yes, in NICU we can be a bit stringent with handwashing, contact (often wearing a gown when holding pts) and especially with out micro-preemies. But the day she told me this we had a full term, two week old (so clean/no mommy goo) who had no IV's and was getting ready to go home. Some of these babies also NEED skin to skin contact when they don't have parents that visit. So, in any case, I am very aware of what kind of handling to do with my patients with/without gloves but I don't overdo it IF it's not necessary
Universal precautions do not mean you can never touch a patient without gloves on, but you do when you expect to be exposed to blood and body fluids, so a certain amount of judgement and common sense go in to it.
Why don't you wait to see how orientation and the new job is before making any decisions.
Worst case scenario, you don't like the new job either, so then what? Better to have two options you hate but it's adding to your work history.
Best case scenario, you love the new job, you envision yourself really loving it for a long time, so then you can just cut the cord on the LTC and never look back.
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