Saturday, August 29, 2009

730 Days of Being A Nurse (and counting)

I've now been a nurse for a little over two years. There were times when I wanted to quit, run away, and get a cushy job (like a M-F 9 to 5 gig) but Sucked it, put my big panties on, and stuck it out. I'm glad I did. As of late, my role is much more than "just a nurse"-some of which I like, others not so much.

1. I'm a preceptor . The nurse managers and the nurse educator approached me, and said that there was a particular new grad who was really struggling with time management and attention to details. They thought that I would be the perfect preceptor for her because I'm not only efficient and organized, but I'm also calm and patient. At first I was flattered, but once I met my little "project" I really wished I wasn't so anal retentive and organized. I struggle with how disorganized and flaky she acts, but I never raise my voice. I constantly have to focus her and prompt her to prioritize patient needs. She is making small strides, but progress none the less. If nothing else, I've learned a lot about my self.

2. I was recommended by my managers to become a senior staff nurse. My application, performance improvement project, committee involvement, and inservice lesson plans are being submitted on Tuesday.

3. I advocate for my patients no matter what.
I called for a palliative care consult on a patient with lung cancer that metastasized to the bone and brain who subsequently sustained 3rd burns to 65% of her body. The resident told me that I had no night to go over the burn services authority. I pulled up the policy on WHO can make a palliative care referral and under What grounds. Guess who was right? Me. The family thanked me and the attending said on rounds, this consult was a smart idea.

4. My coworkers asked me if I would be interested in being a permanent charge nurse. Dear friends,< that would have to be a big pay raise hell no!

Life may be crazy. but I wouldn't give it up for anything.

Monday, August 17, 2009

Informed Consent

So much of the healthcare world revolves around informed consent. Hospitals consider informed consent part of their best customer service, but essentially IC is a right. Patient and their families always need to be informed. But what about their health care providers? There was so much that nursing school didn't inform me about being a nurse. Sure nursing school taught me about anatomy, physiology, pharmacology, and ethics, but there's a lot that was never brought to my attention...

That patient's will test your patience.

That being able to identify a specific bateria by it's smell isn't a skil that makes you more attractive to the opposite sex.

That just because I'm comfortable talking about bodily functions, doesn't mean that it's appropraite dinner conversation

That Id both feel and hear ribs crack when I performed CPR but have to keep going

That I'd be so tired after a thirteen hour shift the thought of walking home five blocks makes me want to cry contemplate taking a cab

That my feet and ankles would swell so much flip flops are the only comfortable shoes to wear after work

That I'd have spider veins by the time I was 25

That I'd be verbally abused my patients and their families

That I wouldn't sleep more than 3 hours inbetween my 12+ hour night shifts

That Uncle Sam would take almost half my paycheck

That money in the bank is no good when you don't have the time to enjoy it.

That I'd only get to spend one holiday with my family over a two year period

That I'd be exposed to lethal infections on a daily basis

That prophylactic antiretrolvirals following a needlestick injury would keep me in the bathroom for the better part of a month.

That doctors and nurses don't have sex in the suppy room. They have it in the on call room (kidding)

That I'd have to fight with the doctors when advocating for my patients

Looking back, if they had shoved a paper in my face and told me everything that being a nurse entails, I think I would have paused, thought about and signed anyways. Becuase even though nursing school didn't teach me any of they above, they also din't teach me...

How amzing it is to deliver a baby on the side of the FDR highway while doing a shift with the paramedics.

How gratifying it is when a patient says "Thank you for being you."

How satisfying it is to successfully run a code

How phenomenal it is to see some one survive after being burned on 90% of their body

How special it feels to be the first one a patient sees when they wake up from a coma

How nice it feels when a doctor says they are happy to have you caring for their patient

How awe inspiring it is to see a person walk on two prosthetic legs for the first time

How fulfilling it is to come home, exhausted after your shift, and know that you made a difference

Friday, August 07, 2009

a ramble

This post is going to ramble, so please bear with me. Over the last few weeks I've had several great ideas for posts; however, by the time I get home from work, my brain is mush and I choose a hot shower and my bed over my blog.

Work has been crazy lately. As the final weeks of summer approach, so many of the surgeons go into overdrive and book a million OR cases so they can go away on vacation. Makes sense, right? Wrong! What it means is that the OR's are overbooked, the PACU cannot absorb all the patients, and the ICU's end up absorbing the patients as "boarders". This past month, we have been getting a ton of ENT/Plastic patients with flaps. In the last week alone we got three of them fresh out of the OR (anywhere from 9-14 hour long surgeries). Aside from the regular tasks of recovering a patient, these patients come back on the ventilator and have q15min pulse checks It's agony. Last weekend I was in charge, had an intubated 75% burn, had an uncontrolled diabetic on an insulin gtt, and had to take a flap patient. Assignments were so horrendous I could do nothing but go home and drink wine, lots and lots of winelaugh. Okay, I drank some wine too! Later that same week, things got ugly. We only had 11 nurses for 36 patients; given that four of them needed 1:1 care and each had at least a two hour burn care/dressing change each shift, plus a pediatric ICU patient who on the verge of being intubated, we weren't in a good place for accepting these boarder patients. We got our managers involved and they talked to their managers. We were told that we can't refuse to accept a patient due to staffing. Which is funny, because we weren't refusing, but we were stating that accepting these patients is a huge safety issue. Oh well, guess they'd rather risk a lawsuit than give us an extra nurse or let us hire more nurses. Right, because that makes much more sense....

Other notable work related things-
1. Commenting to a family member of a patient with 75% burns and a 104 degree fever that "She's burning up."
Poor choice of words, and I felt like an ass.

2. Celebrating Danielle's birthday on Long Island.
After a terribly long work day, we all ventured out to Long Island for a night of drinks and celebrating. Getting chauffeured by our DD in her huge new Pathfinder, Leslie went ass of teakettle into the 3rd row seat while wearing a dress. We danced to cheesy coverband music that we proudly sang along with, we had cupcake/frosting fight in the bar, and then took shots of Jaugermeister and SoCo and Tequila. But by far, my favorite part of the night was when we returned back to the city and Alison was walking down the street yelling, "MB (aka Dr. Matt)? MB? Where do you live?" Then she and Leslie accompanied me to Paulas's apartment so we could feed her cats while she is away on her honeymoon. I think we probably freaked the cats out...three drunks girls, winded from climbing the five flights of stairs, whispering "here kitty kitty." Wonder what the security cameras thought of us that night.

Non-work related things-
My friends got married this weekend in Westchester. Of course it was an adventure getting there. I accidentally grabbed the directions to the reception, NOT the hotel where I was staying so when we got to the Country Club and tried calling the hotel for directions, we got so lost. The girl who answered the phone was quite a airhead who was clearly directionally challenged. She told us to go south the the CC Expressway and then head east on 119. However, we really needed to go north of the CC Expressway and then head west. After 2 hours of driving around Scarsdale, we finally made it to the hotel just in time to change and take the party bus BACK to the country club. Thank God it was 6 hours of open bar because my nerves were shot. Did I mention that the party bus was too wide to make one of the turns so we took out a few tree branches and then still couldn't; make the turn so we almost missed the ceremony! The dancing and DJ was awesome. So much so that I ruined my bargain silk dress with sweat and wine. Let's hope the dry cleaner can take away all my sins!

Monday, August 03, 2009

must accessorize

About a nine months ago I was in this same predicament. I have to go to a wedding in less than a week and I still have no shoes, no accessories, and no time to go shopping. Last time I needed a pair of black, peep toe pumps and green jewelry. This time I need silvery/taupe shoes and pearl jewelry. It's never a problem finding a dress, but finding the coordinating accessories on a budget kills me. I always find a great deal on a dress, but then end up spending more money than I saved trying to accessorize my bargain dress. Time's running out and if I don't get my act together I'm gonna have to go to this wedding in a moo-moo and sneakers.