Bat Lady

I went through an ADN program which included a lot of single moms and not a few who were married with kids. We all had our problems with sitters, illnesses, and everything that goes along with having kids. However, the program was such that we'd all finished our prereqs before getting in, and classes were not every day, nor were clinicals. My kids were kindergarten age and older when I started, and things just pretty much worked out for me. I did have to bring my daughter to a lecture once, but she read quietly while it went on. Others had to bring kids on occasion too, and it was tolerated so long as they were not disruptive. Community colleges, and programs like mine, are fairly understanding. We did have one classmate who had a baby the summer between first and second year. Baby came to class more than once in a Snugli and we adopted him as kind of a mascot. She said she read her textbooks out loud to him. When we had our pinning ceremony we thought he should be recognized too, but the instructors didn't really want him onstage. She did, however, dedicate her pin to him and got a huge round of applause. So that's the other side of the story.

^^^THIS^^^^ was a biggie in the area where I worked at one time. It was a smallish city with 2 hospitals. I worked in the smaller (private) now where I floated between ICU and ER. We fixed this problem. sort of, by posting a pic of the doc on duty on the front door of the ED each night. The local druggies knew which ones wouldn't "help them out" with a fresh RX and would go across town to the other hospital where they might have better luck. Eventually, I think because of communication between nurses, the other hospital's ED caught on to what we were doing and started doing the same thing. Poor druggies just didn't know WHAT to do! I guess they had to go to the little rural hospitals after that. Hopefully those EDs caught on....they had some of the same docs because we all pretty much used the same group.

Wow. I have been on so many sides of this in my career. I've had two nursing home patients in different hospitals who were intubated against their wishes, one because the EMS in that community *routinely* intubated all the "found down" patients they were called for (this was a long time ago), the other because the nursing home conveniently "couldn't find" the patient's DNR orders and she had no family to confirm them (her pastor was POA and out of town). In both cases those were two of the angriest patients I ever saw. The first had her ET tube removed once the doctor saw her paperwork and confirmed with her that she was indeed a DNR; she was pretty much in her right mind and was mad as hell. She lingered for a few days and expired peacefully on the med-surg floor. The other was kept in the ICU on the vent until her doc returned from vacation, which IMO was criminal. I had her the day he returned and she glared at everyone, especially the RT when he came in--such venomous looks! I sang to her when I was in her room, mostly hymns and spirituals, and she softened up a little for me. When the pastor finally came in that afternoon, he asked her if she really wanted to be removed from the vent and if she understood that being removed meant she would not be able to breathe on her own for long and would die. She nodded vigorously. I called the attending, he came in and wrote the orders and the RT came to remove her---and got one more nasty look for his pains, until she realized what he was doing. Once the ET was out, she relaxed for the first time all day. I sang "Steal Away" and she smiled at me and closed her eyes. She died quietly about a half hour later. When my 91 year old home health patient had what I was almost certain was an MI and refused to go to the hospital, I called her doctor and explained the situation. He wanted her to go to the ER, but she continued to refuse. I explained this to him and he said, "But she'll die!" and I said, "Dr. F, she's 91 years old, and she's tired. I don't think we can *make* her do anything." He was very quiet for a minute and then gave me some orders that made pretty good sense, comfort care, etc. The patient stayed at home and a couple of months later had "the big one" and died in her own bed where she wanted to. I found out a few weeks after the phone call that the doctor was on the list for a liver transplant (Hep C) and so was grappling with his own mortality. I had a number of his terminal patients after that and he was just great with them. When it was my 91 year old dad with pneumonia, we hospitalized him and did antibiotics and everything, but he was "Do Not Intubate". He was extremely ill but recovered and went home. However, he was very weak and not able to get around. He had dementia, and was so stubborn he wouldn't use a walker, so of course he fell and the home care aide couldn't get him up. It was at that point that we had him put back in the hospital so he could be evaluated for rehab in a SNF. He was placed, but soon refused to cooperate with rehab so we stopped it and let nature take its course and he died of CHF several weeks later. We had made him a DNR before he was place. Lessons were learned! My brother the MD said that in retrospect he didn't think we should have hospitalized him the first time. My other brother disagreed but said we probably should have sent him straight to the SNF. Lessons learned...we kept mom at home with a full-time caregiver until her death 3 years later. She was a DNR, and was on hospice for the final 6 months of her life, and when she got sick the last time (probably aspiration pneumonia) the doctor prescribed PO abx. She took a couple of doses mashed up in pudding but then refused any more PO, and died quietly in her own bed with her namesake granddaughter beside her and the music of her youth playing softly on the radio. My daughter said she was smiling.

EXACTLY. Most of the hospitals I worked in (and that's been more than several, since I did travel nursing) had a standing order sheet that the doctors used, or the doctors themselves had standing order sheets. You went by those. It was generally a standing order that you called about a tele patient with a systolic BP >160, especially if it was inconsistent with previous readings, had been checked in both arms, and the patient maybe had been admitted with something where this would be alarming (or maybe the doc had forgotten to write orders for one of his/her meds, which sometimes happened). As for why the B/P at 0200.....the patient was on tele, and maybe had meds due then rather than at midnight. Or had been admitted at 2200. There are any number of reasons. Don't jump on the nurse.

This might be one reason for a phenomenon I saw quite a bit in the 90s....the movement back and forth from ICU to home health. Many ICU nurses (not all, by any means, for reasons which I will mention a bit later) in my area took a year or two off from ICU and worked home health, or even worked occasional weekends or divided their time between the two. I was one who took time off, partly due to the stress and partly because my kids were going through high school and I needed the flexibility so I could go to soccer games, cross country meets, choir concerts, etc. In home health we really valued the assessment skills of the ICU nurses, and in turn, they appreciated the more relaxed atmosphere and the time between patients (we were in a rural area, so there was driving time which gave you time to unwind a bit) as well as the opportunity to relate to the patients more fully. There were some ICU nurses who felt that home health was somehow "beneath" them. I heard that when I went back into hospital nursing. They were afraid they'd "lose their skills" or something like that, at least that was what I heard them say. Some burned out types became agency nurses and went from ICU to ICU and hospital to hospital, but it didn't seem to help them. Others became travelers; I met quite a few during my brief travel career. That did seem to help them as a change of scenery often does, besides which there is a certain detachment that comes with traveling. You don't have to become involved in the politics of a place and you can just take care of your patients and go home, and after 13 weeks you go somewhere else.

My daughter went to a Catholic high school. When she started we bought 2 skirts, one in each style. They were also allowed to wear khaki or navy pants. They wore button-down shirts in blue, white, or yellow; we bought most of those thrift stores. The girls rolled their skirts and wore boxers underneath :) When the principal decided they were wearing their skirts too short, they all switched to pants. Boys wore khaki or navy pants, the button-down shirts, and ties. My daughter loved it because she never had to worry about what to wear. She is all for school uniforms! Her boys used to go to school in a working-class neighborhood in a fairly large city and the school had "uniform dress"...polo shirts or turtlenecks in solid colors of navy, gray, red, white, or pink, pants in khaki or navy (capris or knee length skirts for girls, knee length shorts for both sexes) or clean jeans without holes. Sweatshirts or sweaters in the colors of the shirts were also permitted in cooler weather. The kids always looked neat and clean and it didn't seem to meet with any complaints from the parents. Now they live in a different town and there is a complicated dress code. She says it's a PITA and mostly shames the girls, but whenever someone brings up the idea of "uniform dress" there's a lot of squawking about "expense" and "freedom of expression" which she never heard when she lived in a poorer neighborhood and there *was* uniform dress.

All of these comments, and more, are exactly why I left neonatal. I had to attend any birth that was considered "risky" or any C-section, and I heard a lot of these type comments from the docs. I also was back and forth from L&D with the nurses for assorted reasons and the comments were reported to me. AND I heard a few of them during my own 4 deliveries, particularly the last two, which were with 2 different doctors (I had the same doc for my first two babies, but he was off for my first delivery and someone else actually did the delivery; then we moved and I went to completely different docs for the last two.) When I was having my third boy, the doc sat at the business end of the delivery table (having insisted that not only my legs were strapped down in the stirrups, but my wrists were strapped down too!) and complained because I hadn't had a spinal so he could drag the kid out with forceps. I pushed extra hard on that one! When my son was born, his first official act, after a loud screech, was to pee all over that doc! I thought, good for you, kid! Then the next time, when I was in labor and had been for several hours on no sleep the night before, and the nurse checked me and I was only 4 cm, the doc (who was the one in the partnership that I heartily disliked and hoped *wouldn't* be on when I delivered) said, "Well, we'll just put you on a pit drip and hurry things along then." I glared at him and said, "Over my dead body and yours will you do that!" I knew my own body well enough to know that if he broke my water, things would happen very quickly and I told him so. He didn't believe me, and I told him that if he did I would have a baby at lunch time (it was then 10:30 am). He finally agreed but was MUCH rougher about it than necessary. My daughter arrived at 12:26 pm and he didn't even make it to the delivery; she was delivered by the nurse and it was the best delivery of all my four. I thought about becoming a CNM, but at the time I graduated, the only CNM programs were 200-400 miles away from my home, I had 3 kids and a husband, and the logistics just didn't make it possible. Plus which, midwives were getting absolute HELL from the OB/GYNs at the time, who hadn't figured out that they could leave all the routine deliveries to them and sail into the complicated stuff and be the big heroes they always wanted to be. So I went into peds and then into neonatal and that spell in neonatal convinced me that I really didn't like OB/GYNs and didn't want to be around them that much. I left without a backward glance, went to ICU and thence to home health, back to ICU and then cardiac stuff. And so on.....

One of my college professors was William A. Williams, and a popular TV announcer where I lived for many years was Bill (one assumes also William) Williams. When I worked neonatal, we had a baby girl come through named Chivas Aspen. Someone joked that perhaps those were the circumstances of her conception. Then there were the two daughters born to the same couple about 18 months apart, Camry Pearl and Castle Estelle.

When I worked in the nursery we had a girl baby who was given the name "Chivas Aspen". It provoked many snickers as to how/where she might have been conceived. We also had sisters born about 8 months apart who were called "Castle" and "Camry". So then I went off elsewhere and encountered folks named "Cheerful" (F), "Tiny" (M, about 6 ft. tall and 250 lbs.), "Dimple"(F), "Gidget" (F, 30-ish), and "Lady". Growing up, I knew a county judge whose name, Lord help us, and this IS the truth (you can look it up, it was Milwaukee, WI), was Christ T. Seraphim. Christ was pronounced with a short "i" though.

"Melina" (pronounced the same) is a Greek name that means "honey". If you are old enough you might remember the actress Melina Mercouri. (And incidentally, "Melissa" means "honeybee".)

I had a situation similar to yours and found it came from a co-worker who had come to the unit along with the manager and had taken a dislike to me on my first day because I was friendly with someone she hated from her last job. I tried to be nice to her but she wasn't having it, and she tattled to the manager constantly about real and imagined slights. I had to work with her two nights a week because she worked weekends and I worked a semi-weekend shift. It never got any better, but I didn't have any problems with the other people I worked with so I guess everyone else decided it was her and not me.

If you possibly can, stick it out at your job for one year. That one year always looks good on the resume. Start looking for a less stressful job because that will help you while you're earning that BSN. And another thing......I'm sure you're getting some good wound care experience in the SNF/Rehab center; at least everyone I know who worked in one of those dealt with wound care. That will look good on the resume if you want to get into wound care! Good luck to you, and study hard! You'll make it!

I was 42 when I got out of nursing school and I felt like I was just hitting my stride when I turned 50. When my late ex and I separated I was 62 and that's when I became a travel nurse. I noticed that almost all the travelers I worked with were either quite young (mostly no attachments) or on my side of the calendar. Many had retired from other situations so were over 65. Old? Heck no! After I'd been a traveler for 3 years I started feeling pretty rootless so I settled down in a good-sized metro area where I had no trouble finding a bedside job. I never encountered ageism until I moved up here (with the man of my dreams) in an area where there are 4 BSN and 2 ADN programs for the hospitals to choose from and it's more rural. I kept looking until I got sick and ended up having 5 surgeries in a period of 11 months. At that point I decided God was telling me something and maybe it was time to stop, so I did. However, I have a friend who is 76 and still working in psych home health, and I had other friends who worked well into their 70s, so if I hadn't got sick I probably would have kept looking.

Not to mention norovirus epidemics! Double UGH!!!!!

When you come in, have a code in the first 30 minutes and spend the night trying to keep that patient (who was brought in essentially dead) alive, and then have a code on a DIFFERENT patient at the end of the shift! As my brother the doctor always says, "Jesus is gonna come at shift change, and with our luck we'll be tied up in a code somewhere."