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."

Those who are studying for a degree in Healthcare Administration should be REQUIRED, as part of their degree, to spend a year doing clinicals under the guidance of CNAs and nurses. Only then will they fully understand what it is that we do. They would, in my vision, have to shadow and, as we did as students, actually work alongside the nurses, the CNAs, the dietary staff, the radiology techs, and even housekeeping, to see what makes the hospital run. THEN they will know that it takes people to make it go, and that the hospital can't make a profit without us.

Oh bull pucky! This has been going on for way longer than Obama has been president. When they started hiring these young know-it-alls with degrees in "health care administration" straight out of school is when it all started, and that was in the late 1980s-early 1990s. (You want to talk about who was president then?) They are all bean counters with NO knowledge of patient care whatsoever and their only interest is in the *bottom line*. They listen only to the the ANA (nursing lobby) for their recommendations, and that's where the whole BSN thing came from. Now take your hate politics and sit on them, please.

^^^^^^^THIS^^^^^^^^^^^^

Seems to me that when I started out in nursing 30 years ago there were not quite so many utterly humongous patients out there as there are now. I'm talking about the 400 lb.+ ones that I encountered in my later career. I spent most of the latter years of my career in critical care and step-down and there were way too many of them, and a lot of them DID NOT MOVE by themselves. In the years when I did travel nursing, I worked in one hospital that had pretty darn good lifting policies, with a lot of mechanical lifting and other patient moving equipment, and another that actually had a turn team, although they went home at 11 pm and left us night folks to do the best we could. Other than that, it was same old, same old. ICUs in a lot of hospitals, at least, are going to the beds that have built-in lift/scales, which are pretty great. Unfortunately, on step-down, it's same old, same old. And then you encounter the occasional one-upper. In my last permanent job I worked with a nurse (female) who was a body-builder. Now I am a small person and reasonably strong for my size, but I am not shy about asking for help moving a patient if I think I need it; it's why I still have a back at all! She, however, never asked for help so didn't think I should either, and if I did, she would either not show up or take her time about it and then do the exasperated sigh thing, which was guaranteed to make me wish I hadn't asked her at all. Nobody else I worked with on that unit was ever like that.

I had only been an outpatient or an L&D patient before I was a nurse, so my 5 hospitalizations several years ago were a real eye-opener to me. The first was for an emergency appendectomy at the hospital I had just left 6 months previously; we were in town because The Man was attending a seminar when I suddenly got sick. It was pretty funny because I knew everyone in the ED and could pick my own surgeon, and when I was taken to my room on the floor where I'd previously worked (not on the same unit, but on the short-stay next door) it was like the progress of a princess, with everyone saying hi, and I was so drugged up I wasn't in pain any more so I was smiling and saying hi back. I got wonderful treatment from everyone there right across the board. Then several months later I got really sick with something else and landed in a hospital where I was a total stranger. I had four surgeries in the course of 9 months, 3 major and one fairly minor, and was on the same unit each time. The nurses there came to know that I was a nurse although I didn't broadcast it. I probably mentioned it on admission because the admitting nurse and I discussed Meditech, which we both hated. Anyway, the nurses were all wonderful and I was treated wonderfully. Well, there *was* one....I thought maybe she was having a bad day, but another nurse just sighed and said, yeah, she's like that. On that particular day I was 3 or 4 days post-op and my colostomy sprung a leak. I asked her to change it for me and she said, "Who's going to do this for you at home?" in a rather nasty tone. I said, "I am, but I still need to watch how it's done." I got a big exasperated sigh but at least she did it. She wasn't real nice about helping me to the bathroom either, but I still felt sick and weak. After that day I didn't have her any more. The rest of the nurses were great. When I had a drug reaction, and when I had a transfusion reaction, they were amazing. And I had one who was an LPN-to-RN student at the local community college who kept coming in just to chat and pick my brain; once I was feeling better I enjoyed that.

This is lovely, until you spend your entire working life in right-to-work (or as my late husband was fond of calling it, "right-to-slave") states. When I applied for my first job, I was told flat out that there were no unions, and that if I was caught trying to organize or in any way promote union activity, I would be fired (this was in the 1980s). Union organizing or activity was similarly frowned on, though not so explicitly forbidden, at all other hospitals and agencies where I worked during my career. When I worked as a traveler, I once had an assignment at a hospital in a state where unions were a routine thing. This hospital had a nurses' union, and I could see where it definitely benefited the staff. Of course it did nothing for us travelers.

That's why mine was pink for many years!

When I worked neonatal, FLKs were usually described by one of our nurses as having "some kind of syndrome" and that passed on to the rest of us, so it became SKS. I didn't stay there so here are some others. FFH syndrome: Family from Hell syndrome PTA bath: should be self-explanatory. First heard from a little old lady when I was in home health! A cursory wash-up of the important parts so you don't stink too badly. D/C (or turfed) to the Eternal Care Unit: died POF: Pillow on Face. What you want to do to some patients Jesus bus is parked outside the door, Jesus bus is waiting, etc.: Patient is actively dying Guest of the state (or county): patient is a prisoner Frequent flyer: frequent admit Crock: patient with constant, usually imagined, complaints; might be really sick, but you never know Serum porcelain level: patient is a crock, but how sick is s/he really? Asked by a fellow RN when a doc was ordering blood work on a patient that was a frequent flyer--she asked with a perfectly straight face, "Dr. S, do you want a serum porcelain with that?" He answered, "Nah, she'd break the machine!"

I've rarely gotten stopped for anything, once for a "rolling stop" and he did let me off with a warning when he saw my hospital parking tag hanging from my rear view mirror. The funniest thing though was that I almost always worked New Year's Eve 3-11 or 11-11, so I'd invariably get caught in the roadblocks they set up to catch drunk drivers. One year I got waved through as soon as he saw my parking tag. Another year I did get stopped and asked for my license, but the officer saw my scrubs and asked me if I was coming from work and when I said, "Yes sir," he said, "Well, you haven't had time to party yet, go on," and waved me through.

Once I started working, I did take the flu shot yearly whether it was mandated or not. Most years it didn't bother me. We gave it to each other on the unit (or in the office, when I worked in home health). I got the flu once, the year they grossly miscalculated and some kind came in under the radar; I came down with it at work and finished my shift, but I was about as sick as I'd ever been in my life. Also, the last year I was a traveler, I had my one and only reaction to the shot, and it was awful--headache, body aches, and sore throat that lasted 24 hours and made me wish I had never taken the shot. Now that I'm retired and in a "vulnerable" population, I still generally take the shot if I think of it, but I really don't feel all that confident in it. A couple of years ago I didn't because I got pneumonia and it took me so long to recover that it was late in the winter before I felt well enough to get it, and by that time it was too late.