NYC Saga: Throughout!

I don't want folks to think this blog is just about me complaining about every small detail of working. I am dedicating this post to all the COOL things I have done while here in NYC!

This was some fancy rib dish from restaurant week!

So there is this cafe near the hospital that serves alcohol to us after work in the mornings! The best times! Mimosa and a Sangria! I promise they have the strongest mimosas I have ever had in my life. Rumor has it they put shots of vodka in them especially for us! After two I am READDAAAYYYY!!!!

Lenore and Heather! Lenore building mate, building and burn extraordinaire Heather my other burn extraordinaire!  I met both of them after work at breakfast while ranting! Lets just say after meeting me in my ranting state and you still come back for more, destined to be buds

Brent and Heather

The baddest clerk in the land! And my savior for the past 3 months! Don't talk about her music and make sure you have your diets in or you will get the evil eye! LMAO! Thanks a mill kadi!!

ME on the Brooklyn Bridge! Beautiful views!

WTC at dusk, its just a big hole there....

NYC Saga: 2

Greetings folks!

Well a lot have things have transpired and changed since my last post!

A.) Renewing at the same facility but A DIFFERENT UNIT (I will explain)

B.) End of my 2nd contract

C.) Hell on earth

I have renewed my contract on a burns unit! Yep, thats right folks. What do I know about burns? Guess I will be soon to find out! But then again, I had never worked in a cardiothroasic ICU before either. What I have discovered about ICU nursing is: at its foundation, its all the same! You just have to pick up and learn on the specific details of each unit. YES, each unit! Not condition! The books say the research based treatments, then there are the right treatments, then there are unit specific treatments. One of the complexities of travel nursing. ANYWAY...

Staying in the same apartment, its not the fanciest or the most luxurious however, when I walk out of my front door its awesome! AND I think I will be on the Halloween parade route (or just off of it). Didn't want to bother with moving, I have already started accumulating my signature piles of paper....its free for me so why not?

This new contract will be through Jan 15, hopefully I will be out of town before the brutal winter starts to come full swing out here. It seems so miserable...I am a Houstonian, we don't have REAL snow. We shut it DOWN for frost! So this burn unit is 40 beds, 20 ICU and 20 step down. All of the nurses have to change into hospital provided scrubs and you have to wear hats and shoe covers during your shift. Its OR-ish except people are burned up. They say there are chances I may be floated to the step down unit, but after working that shift in cardiac step down...i don't care. Patients require less attention and you just answer call lights...

So last night was my the last night working on the current unit (well I made it my last night). It was probably one of the worst nights of my career. I was tripled with three time bombs and one after another they went off! It was complete mayhem! Not to mention I was screwed over by the charge nurse and silly manager. So at the beginning of the shift I was being pulled in the room by my confused patient who needed frequent reorienting. Then the vented patient needed attention because of the needy family member who was present. While tending to their needs the resident runs up to me asking me why my other patient's blood pressure was above the parameters. I simply replied "I have them the meds, now what do you want me to do?" I was HOT! Two of my patients were on vaso active drips which I was trying to manage along with a vent (the 3rd). So after I got the one patient's blood pressure down to the parameters (they had a dissecting aneurysm) it was time to draw blood. Then I was confronted by the charge nurse stating the person I was covering for lunch would also be tripled meaning I would have to cover 6 patients!!!! And that other nurse was not the strongest of nurses at ALL and to be truthfully honest, didn't really trust them even clicking my vitals and doing I and O's. I told her that was dangerous and instead of me risking my license I would rather not take a break and if she didn't like it she could run back and tell that to the manager...Yeah, I was pissed so the mouth piece got a little loose! LMAO! So I went in the tend to my vented patient and right before my eyes they started having a freaking seizure! Ok folks, I am a CARDIAC nurse meaning neuro really isn't my strong  point...so shit I took it back to the ABC's and 123's of basic nursing and held down their arms so they wouldn't injure themselves (or in their case EXTUBATE themselves). So I am watching this patient while they go through this episode because i knew if neuro was coming, which they later did, that I was going to be grilled on what EXACTLY happened detail by detail. Next thing I know this dizzy ass manager come up behind me "OMG THEY ARE HAVING A SEIZURE!" At this point in time my cool went out the window... I was thinking, this asshole...you are a representative of this unit clinically how in the heck are you going to sit there and panic and proclaim the obvious! Why DONT YOU JUMP ON A LEG AND HELP ME prevent this patient from being injured!? Didn't say that! But I did say "no I don't want your help, I need help from someone who is calm and has it together." YEP you need not enter my patients room if you are the following: incompetent, panicky, yelling, or disrespectful of myself or the patient. Oh you know this "manager" did not like this at ALL. They started saying something but to drive the knife and twist it...it totally ignored them. They would live to eat those words a little later in the night, but let me finish telling the story...So we stabilized the patient had them good to go and moved on. ANOTHER patient came in and the "manager" admitted them and it was so funny watching them run around panicked about just 1 patient! I don't understand nurses like that, while you are wasting energy running around looking stupid, you could be focusing your energy on getting things done and prioritizing. They were so frantic about getting another IV in this patient, so guess who was sitting there dead center, ME. And yes i had three patients and I still found time to start an IV on their patient! Just a weak nurse disguised in a white lab coat!!! In the mean time, my confused lady tries to get out of bed! It was such a hot mess and I will never ever willingly work in that place again! But here is the cherry on top: out of all of that chaos, I was able to wean one of my patients OFF of their presser and cut down nearly 50% on the other one AND the seizure patient was resting comfortably! Not to mention this was the 2nd night straight I went without a lunch! I didn't have a lunch NOT because I didn't have my stuff together! But because of lazy ass charge nurses who put people in impossible situations! I ALWAYSSSSSSS have my stuff together unless a patient has a change in condition or in case of an emergency, then YES, a lunch has to wait. On top of all this crap, I have been basically taking care of the same patient for 3 dang months! So exhausting! Trached, Pegged, SECRETIONS SECRETIONS SECRETIONS!  My message to the charge nurses and managers of that unit: No weapon formed against me shall prosper!!! No bad assignments, no bad management, no people who serve for nefarious reasons!

I'll admit it, when presented with certain situations over an extended period of time, I will start to complain or have an attitude. BUT I am human! Bull is BULL, no matter how beautifully you stack it or arrange it. What is fair is fair! This place was like working for HUSTLERS, LMAO! Phil was right from the beginning! They just had the wool drawn over my eyes! Its over now, thank goodness. On to my next adventure on burns. I can say this however, I learned about myself...my new thresholds, knowledge, and ability to take care of myself independently as a nurse. That place isn't worth mentioning again, good luck to them and their staffing.

Mom (marylin) told me there would be places like this.....Good talking to you today! You helped me grow into the nurse I am today and definitely worth mentioning in my blog!

BS RN

NYC Saga 1

I know it has been a while since I have updated but there has been lots of things going on since the last post! So here it goes!!

The unit I am working its good in the fact that they take excellent care of their patients but they treat the travelers like shit! They have done some of the most shady assignments I have had in my career. Granted in the last place was a death trap but if I was tripled at least 2 or more other nurses were tripled too! Example: I was tripled and there was another nurse with only 1 patient who wasn't classified a 1:1! Just shady business all over this unit! Not to mention that everyone is miserable and thinking of leaving the unit! I have never worked around so many selfish, miserable people! So basically at the end of this assignment I am looking to move to another unit or another facility! I know as a traveler I shouldn't be able to complain but hell im still human! I called myself trying to trust some of the staff and complain a little and they showed me none of them are to be trusted! And i don't trust any of them!! Oh but what really pushed me over was this assistant manager! SHE PISSED ME OFF!!! So I walked into the unit 7 mins late (I like to eat before I go to work because I never know when I am going to get floated!) and she makes this big deal out of it and decided to remind me of the unit practices for showing up! It took all I had to keep it professional but, this is my blog damnit and I can say whatever I want: she can kiss my ass. I understand you may have had the thought "oh he is never late so we should worry", however, I am a grown adult and if im not going to show up im professional enough to give a courtesy call! "Well people transcribe the schedule wrong all the time", this is why I do it electronically off of the MASTER schedule! You guys just don't understand how WRONG this rubbed me!!

The 1st code:

There was a patient who was circling the bottom of the toilet, I knew something was probably going to happen...some people you look at and you get a bad vibe...yeah this was that patient lol! Low and behold they coded! So of course I immediately thought of home and the code team! LMAO! Please see my previous posts about my 1st real code ever lol! So anyway I jump on the red cart and ended up charting too! PULLING double freaking duties! Any way, I was not impressed one bit by what I saw! Clearly codes come far and few between because it was an unorganized mess! One nurse thought her CPR cured the patient and started prematurely celebrating, ummm yeah. They had probably the oldest guy in the unit doing CPR for an extended period of time, hell I thought we were going to have to code his old self! LMAO! I was like um, yeah is someone going to relieve him? LOL! So I am just sitting at the cart laughing to myself at how horribly this is going, its like there is so much "experience" and no one can get it together to run this code smoothly. Needless to say, I am not impressed at ALL. Just because you work in a CT ICU doesn't mean jack snap nothing!! Well the code ended how most do....and you would think someone in charge would stay to help to chart, since I was not familiar with the code charting? YEAH RIGHT! They left their own staff member there ALONE! ALONE! They did their postmortem care alone, charted alone, and I did the code charting with a per diem nurse! I have no respect at all for them! Most travelers go find something more important to do during codes, yet I was there in the thick of it when i didn't have to be! and their thank you: LEAVE.

The Aide

This one aid makes me pray every time I have to interact with her! I have never met someone proclaim how proud of the fact they are an assistant and not a nurse YET try to ASSESS DIAGNOSE PLAN INTERVENE AND EVALUATE patient care! Everything I did with this woman, "you need to elevate their arm" "You need to wipe from left to right" "Im going to talk to the doctor" OH YESS!! It drove me crazy!! How in the hell are you going to talk to a doctor in the place of a nurse!? In addition, they would disconnect IV's, arterial lines and silence IV pumps! Oh you know I was ready to print out the nurse practice act and bring it to work!!! But the straw that broke the camel's back: during the code mentioned above this same aid kept interrupting the code for me to go check a patient's colostomy bag! Now this patient belonged in step down vitals every 4 hours minimal care-and she wanted me to STOP THE CODE, STOP CHARTING to go check a colostomy bag! AND had the nerve enough to chastise me for not attending to my patients! I was LIVID! How DARRRREEEEE you chastise me over anything not being done in an emergency situation!? ITS AN EMERGENCY! I wanted to ask her the following,"How we about we stop your life resuscitation to go check on some shit bags!?" But I didn't...or else I would be blogging from Houston at HOME! LMAO! Oh yes Ms. Thang is something else! Of course I complained to some of the staff and instead of being like "yeah I know" they were like "Well I have been dealing with it for 6 years", well THANKS!!! UGH! Its time for me to make a move!

Floated

I was floated to this cardiac step down unit recently and I was PISSED! I haven't worked on a floor since nursing school and I know my time management skills aren't built for step down...or so I thought! I go to this unit and I think the fact that it was something way different intimidated me more the actual work! Oh I was being an asshole! But the more I looked around, the more I was like: oh SHIT these nurses are SOOOO COOL! YES THESE STEP DOWN NURSES ROCKED! They had the kind of positive attitudes that I hadn't seen since leaving Texas! Two nurses started dancing, one asked me if I wanted to order food, one asked me if i needed any help. I was like, omg, have I been jaded so bad by my home ICU I actually had an attitude working with these ladies?! Oh i apologized to them and explained my current working conditions...they understood and accepted me into the fold! It was so refreshing! I just can't wait to go back! My current assignment ends October 9th, and I am looking for a different unit!

More to come!

BS RN BSN

NYC Journey: Part2 the transition

So it all started a little like this:

My phone rang about 1130 (I usually ignore calls after 0900 the morning after I work) and I answered, turns out it was my recruiter..."good news Brandon, we got a contract in NY, NY"...so of course I get excited and a little short of breath...! The details were: ICU nights. LMAO! Yes that's right folks, ICU nights and the name of the facility AND THATS IT!! So out on a leap of faith, I just signed the dang contract! I know it sounds crazy (and probably was) but I signed this contract knowing very little about the assignment accept the pay rate ;-) and the housing would be covered! That is just how intensely bad I wanted to come to NYC! God is so good to me though, come to find out I am working in one of the top cardiothorasic intensive care units in the nation...probably not as intense as back at home but something quite similar! I will have to touch on that a little later....

The transition:

So after my two weeks of hell (actually 3 including the 5 day work week) off one on one off one on two off one on three bull crap the morning after working that third night I immediately packed up Lucy and kicked back to htown on one wheel! Meantime I have several tasks to complete to become compliant with the new facility, drug test, MMR varicella titers drawn and PPD test. As a traveler all of the extra tests (Depending on your company) are out of your pocket! (However are all tax deductible, i have learned) I hemorrhaged so much money to become compliant, not to mention I completely missed my appointment for my tests because my 20 min nap turned into 4 hours because I had not slept in almost 24 hours! It was a nightmare, on top of everything else I was flying out to DC the very next day and had nothing packed nor ready! AND my family wanted to hang out, my air conditioner was broken at my apartment in Houston, the land lady wasn't able to get it fixed until after I was scheduled to be in DC! IT WAS A HELL ON EARTH! THEN, I needed to get keys made and do 7 loads of laundry in my non industrial size washer and dryer...and it was raining because of the hurricane alex. LMAO! So to make a long story short, I left Houston, AC was fixed while I was on the plane, the keys were made in NYC, blood was drawn, urine done, I came to NYC with no white laundry and I saw mama and granny right before my ride to the airport showed up. WHEW!

Vacation in DC! It was awesome food, fun friends and still trying to complete the items for compliance for NYC. I have never appreciated such great customer service as I did in DC. This one clinic tried to hustle me and my insurance for payment for ppd, well now that I think about it, probably was a better idea just to pay for the office visit and get it charged as a co pay then to pay cash...but hey...we live and we learn! Be weary of those "travel" clinics who don't accept insurance, go some where that does and they can take care of what you need for a fraction of the cost! Its all a big sham but you do what you must to be compliant, or you can sit at home unemployed!

So I don't find out my address until the Weds I am scheduled to move in! Actually I was in Maryland visiting my best friend Vicky when I found out! When I told her where i was living she literally SCREAMED with excitement! it was so funny! I had no idea what part of town I would be staying in nor what was all in the surrounding area! LMAO! If i knew then what I know now...yeah, i probably would have screamed too!

The Deets:

I am living in West Village in a studio apartment. Basically you stand in the middle of the room complete a 360 and you have seen the entire apartment, its hilarious. However for NYC standards its some pretty cool digs (pics to follow). As a new New Yorker, I have to catch three trains to work: 2 or 3 express to times square then the shuttle to grand central then the 6 to 68th street. It sounds worse than it actually is...i have it down to a science where it only takes 30 min to get to work. 30 min of walking and getting on trains is a whole heck of a lot different than sitting 30 min in traffic. Plus I manage to sit around the most insanely hilarious situations on the train...I just keep my ipod on and smile to myself. I work in a large hospital in NYC (I care not to divulge the name for privacy reason and not to burn bridges, however, if you want to know email me!) in CTICU. Its a 20 bed unit and the main diagnosis include MVR, AVR, CABG etc and yes they do VADs. I only take care of their "chronics" or basically their CCU patients, nothing fresh post op. Its nothing special...however things are done a little "different"

More to come!

BSN RN

NYC Journey: Part I

Sorry for the lack of posts but I have so busy! Finished my assignment in Temple, acquired a contract in New York City, and about to move there at the end of this week!

Conclusion of Temple:

The last couple of weeks in Temple were hell!!! My schedule consisted of the following: On one off one on one off one on two off one on three! It was a nightmare! I can't believe they screwed me over so hard my last shifts there! I didn't complain, or attempt to change it, I just rocked on and rocked it OUT! And they wonder why no one wants to freaking work there! Oh well, don't have to worry about this handsome face crossing those double doors any more!

The last shifts in Temple were horrible! I was floated frequently and hung more products in one night than I ever had in my whole nursing career. Patient 1: 4 PRBs, 4 FFP, Jumbo Platelets...Patient 2: 4 FFP (And I gave this patient factor 9!) It was probably the most bizarre two weeks of my career. Bipolar patients, patients who knew they were going to die, patients who went AMA, and patient families who had no concept of what was going on! It was freaky lmao!

AMA patient: it was a patient in their 60's with COPD (who continued to smoke) HTN, afib etc etc and who happened to have a really bad pneumonia. All he wanted was some dinner! LMAO! However, the patient was NPO because it wasn't clear whether or not they would need to be intubated. So at the beginning of the day, the patient was like screw it "INTUBATE ME, so I don't have to be aware of what's going on" and on my shift "I want dinner!". I was like, ok you wanted to be intubated and now you can't stay hungry a few hours for us to monitor your pulmonary status? Well they snatched off their bipap machine and said "I am ready to leave". OF COURSE the family was there to instigate everything, because prior to their arrival they were COOL! They were wearing their bipap mask, just relaxing/chillin in bed then the visitors showed up! Next thing I know they are pissed off, snatched off the bipap mask and demanding to leave...so of course the type of nurse I am, I explained the importance of why we were doing what we were doing and the risks involved etc etc...THEN I requested the AMA paper be printed and called the MD on call. If you want to leave, then don't let the door hit you on the ass on the way out! A hospital stabilizing you  is a RIGHT, everything else is a privilege! You sign the consent for treatment and from there on in its all a choice, so if you choose not to participate in care then hit the ROAD! I hate nothing more than a patient who tries to dictate their own care, because they are a MD, RN, or PHARMD let us do our job or get out! So it took about 20 min for me to have them out of the door, with no hard feelings...good luck and goodbye! Its nothing personal!

As the days progressed I became more and more of a smart ass. There was this dumb resident who I wouldnt let take care of my worst enemy's dog consistently dropped the ball AND worked almost every night with me until the end. I was so pissed! After a while I actually started to feel sorry for him because no one respected him including his colleagues...but naaahhhh. I took a big chunk out of that ego every opportunity I got! LMAO! Example: Patient was severely fluid overloaded who was a DNR/DNI and basically drowning right in front of my eyes. So I call the doctor, he does nothing of course..."ummmm give em a breathing treatment and increase the amount of oxygen he is on". I literally could have just crawled up in a big ball and just CRIED tears of blood/fire. I mean we can't be too aggressive with the patient, but do something! (The whole DNR/DNI patient in ICU is a special subject I will discuss on a later post)

I am tired of thinking about Temple, I am glad its over...won't ever happen again! Lets talk about NYC!!!!!!

It all actually started in March before I started my travel adventure! The 1st placed I told my recruiter I wanted to go was NYC! The reasons: I love NYC, Victoria was there, I love NYC, I love NYC.......


BS RN

9 More Shifts! Counting down....

There are nine shifts and counting until the conclusion of my very 1st travel assignment! I can't believe 10 weeks have passed already, I can literally remember moving into this apartment! To be honest, I am sooooo ready to move on and embark on a "real" travel assignment; i.e some where out of Texas! Goal: land a travel assingment some where on the island of Manhattan! I am very nervous because of the timing and just the fact who in the heck would want to leave a job in NYC in the summer time?! My recruiter told me there were various posts in Brooklyn and in the Bronx, however, I want Manhattan! This makes me very nervous but trust me I got nervous before each and very major milestone along this journey! In the back of my mind I am confident I will land a decent gig, but at the same time to sort of keep me "grounded" I think of different harsh realities...lol. Well I'm prepared to hold out as long as necessary, I still have a PRN position in my home town where the unit will be very short in the upcoming months so I will HOLD OUT! Not to mention I am paying all of my bills up through August just in case! I am as serious as some ACS when it comes to this! I have worked too hard and suffered through the purgatory which is Temple to settle!!!!

The master plan:

The last day of my current contract: July 3. Last day scheduled: June 29. Vacation in DC starts: July 1. Anticipated start date on new assignment: July 12. I will be in DC from July 1-9th...the 2nd weekend in DC should be move in day in DC...so catch the train, move in, and WORK. Well that's the ideal perfect plan! Oh yes not to mention I would go to Baltimore to visit Nick and Victoria! She is due in August so we will just sit around and eat and play words with friends sitting next to each other lmao! Love ya Vicky can't wait to see yall! Im bringin pampers! lmao!

Dumb ass charge nurse

I mean I have encountered some charge nurses who have made "choice" decisions but damn this one charge nurse (none night shift) is absolutely CLUELESS. Its freakin SCARY! Example (Just one then I need to move on lmao): Didn't report one of the patients passed away and was still in the room without passing along the word to the next charge nurse!!!! Its like the next charge nurse along with everyone else was totally oblivious of a corpse on the unit until the nurse came up, "Well they are kind of big, do we still bag em?" My freakin jaw dropped!!!!!!!!! 1st of all, how do you not know to report the patient is deceased, ESPECIALLY WHEN YOU WERE THE ONE TAKING CARE OF THE PATIENT! DANGEROUS! I mean come on, what else AREN'T you reporting!? And then have the nerve enough to give me report and tell me not to give lasix to a patient who is admitted with pulmonary hypertension with a CHF exacerbation!? Yall, I don't tell you it took all I had not to just educate this nurse...I am going to hold my mule for 9 more shifts! Anymore then they would be reporting me to the board for bullying! LMAO! I love my job I love my job I love my job!

Excellence:


This morning I was finishing up giving meds to my younger sick patient around 0600 and giving my "this is what I am giving you" speech, when I felt the patient grab my wrist...My initial reaction was like WWWTTTTFFFF!!!! LMAO! I mean do not believe in any type of physical contact at work that isn't work/patient care related! I.e no hugs, kisses, back rubs, back scratches etc....lmao. So I look at the patient and hold my breath (so I don't jerk away) and they just looked at me behind their nonrebreather mask and said "Thank you, thank you for every thing tonight". It made me feel so good! Talk about completely caught off of guard! I don't go into work expecting anything in return, because thats my duty...its what I am there for. But its nice from time to time when you know you did the right thing for the patient. This patient went into some respiratory distress and I simply told them "I am not leaving this room until you feel better"...well turns out i didn't LOL! The secretary was like "where you been!?" I just remember one of my nursing instructors saying "when your patient is in distress you stay put, press the call light and delegate". (I guess that would be ideal depending on your team work). I always try to keep my word my patients; if I say you will get pain meds every 4 hours please believe I will try my BEST to be there drawing it up in 3 hours and 50 min with time to spare! Ok, exhausted rambling taking over...

Please comments, questions, concerns!

B.S. RN BSN

Only 4 WEEKS LEFT!

I am ready to get the hell out of Temple! Its like being in purgatory! Its not small enough to be a complete nightmare but after 9pm everything freaking closes! Even the dang stop lights start to blink yellow! It pains me when I have one day off then have to return the next couple of nights because I am basically sitting there twiddling my thumbs! PLEASE HELP!!!!!

Cinco De Mayo (I don't know why I can't say May 5th...) my NY state license was finally approved!!! I think it was the quickest the NY state board has ever moved in their history! I sent off in April, so just about a month where as it usually takes 3 months! So basically I have accomplished both of my major goals on this 1st travel assignment: Travel Experience AND NY state license! I feel very accomplished!

Now to the good stuff:

Can someone please explain to me the "work horse" mentality of some of these nurses!? They don't let anyone help them, they would prefer to do everything themselves (even when everyone else is sitting down), and they seem to be the only one struggling/running around! Mama always told me to work smart and not hard! I think what irritates me the most about these nurses is when you ask them for help they REFUSE! No wait, whats absolute worse is the fact sometimes it can hinder the care of the patient. For example: This nurse will have a patient crashing, then another patient who needs to leave the unit for a STAT CT etc. This nurse will try to hang the pressor and hold up the STAT exam because they can't delegate, they end up with two HAMs and a lot of anguish and charting to do.Maybe you can have that mentality on the floor but not in ICU. Some of the most experienced and knowledgeable nurses I have experienced in my career always knew their patients...and they ALWAYS knew when to ask for help. Dear "work horses" you can't do it all, you won't be able to code your patients when they crash based on your inability to ask for help. PERIOD. Hopefully they won't have to learn the hard way...sitting in front of the board of nursing!

This past week I took care of this patient who was very sick and it just blew me away. Very sick: hx of this cancer and that cancer, I'm sure this patient had at least 4 or 5 organs effected by cancer and counting! It was to the point where their body was so edematous they had incisions hooked up to wall suction, it was crazy. What's worse this patient was under 40! They were intubated the 1st night then extubated the 2nd night...the condition this patient was in, I didn't even think they would fly without the tube!What struck me the most was how nice they were and even their condition was terminal they were still thankful to be alive! It just took be back because its like how dare I complain when this patient can't even do their own bodily functions out of normal orifices! Yes, it was bad! That's one of the reasons why I could never work on an oncology unit! Cancer patients are usually the most nice, humble/thankful people on earth! They have these terminal illnesses and are so chipper! I can't say I would be the same...who knows!

Dr. Dumbass: I must admit I have met some dumbass fellows/residents in my career but this one I met recently has to be the DUMBEST resident in the history of the medical profession! I don't even see how they passed medical school. Its so bad, I pray my patients don't have issues so I don't have to interact this this dumbass idiot. The sad thing is no one respects them. The fellow follows them around and usually we don't see the fellows unless there is some massive emergency. They are the type of person who will repeat what you just said in different words and that's their answer. So for example: "I think this patient is acidotic the pH is 7.2" their response would be "This patient's pH is 7.2 they are acidotic!" Yeah. Yall pray I don't have to interact with this person because I haven't been pulled in the office for conversations yet but I will eat this resident for lunch and pick my teeth with their pride. Some nurses are out to get residents, I need them too much to be too hateful but this one right here is an exception! LMAO!!!

I plan to start my next assignment on July 12 in NYC! I haven't started the interviewing process just yet (still too early) but im sure I will start being pimped out here in the next couple of weeks! I will def have to post on how that process works!

BS RN BSN

Follow up post: Things that made me go Hmmmm....

Ok two posts in one week! Don't get too spoiled! LMAO! Any way straight to the point

One HUGE i mean HUUUGGGEEEE thing that made me go hmmmmmmmmmm was the fact there was a patient on the unit where the nurses weren't cross trained to take. It was a patient with a vesicular drain a "brain drain". I was thinking cool...ok...im not taking it but hmmmmmmmmmmmm....the charge nurse "well heck I don''t know how to mess with the ICP drain stuff" hmmmmmmmmmmmmmmm LOL! Yeah I was freaking out on the inside! The nurse who took the patient was like "well I haven't had one of these patients in like six months, but it will be fun" hmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm!!!!!!!! LMAO! I mean I guess ignorance is bliss because there is not way in the world I would take a patient I wasn't cross-trained on! NEW NURSES: If you aren't completely competent on a device or a condition a patient has...don't take it or make it known you aren't sure about the device or the patient. When taking care of patients with devices there are certain focused assessments and "norms" you should know! For example IABP patients...you must assess the groin the balloon is in, ALL the pulses they ARE ALL important for various reasons, the wave form etc etc...also the if the patient isn't on 1:1...its probably a good idea the patient is anticoagulated...my point is: how can you know whats wrong or what orders to anticipate if you aren't familiar!!! THAT WAS SO SCARY MAN! The nurse called the rapid response nurse and the staffing nurses for help and this other nurse came from STICU...ok if you have to call resources outside your unit...maybe that patient should not be there! Whats worse I voiced my concerns with a staffing nurse there and they seem very unaffected and some what very unconcerned about this situation hmmmmmmmmmm. I am just so glad I had enough training and was exposed to experienced nurses to tell me the "no-no's" of ICU nursing. I guess execs don't think about themselves or their family members being in that hospital bed when they start making decisions like that. Oh yes! "It was decided this unit would be able to take these patients based on this criteria..." WHO DECIDED!? All the staff nurses were completely clueless to this new fact! DUDE! Very very scary! hmmmmmmmmmmmmmmm...I don't think so! I guess its good to see the good bad and the ugly...thats one thing my home facility taught me...education is key! Before any new piece of paper, machine, policy, procedure ANY thing changed or rolled out...there was extensive education! To the point of frustration! I appreciate it NOW! LOL!

It just makes me so appreciative I am on this "side" of things. I feel so sorry for the patients families who don't have a clue!

I am sooooooooo ready for New York, I am even training my mind about using the public transportation there! Yes folks, I know how to ride the subway system!!!! Just know uptown the numbers are going up, down town they are going down which is towards the financial district! The trains that run left to right are pretty self explanatory! I can't wait to go see lion king and bring Tammie to NYC! (Thats my mother!...mentioning her and all that...I would have to start another blog lmao) ahhhhhh! Can't wait!

B.S. RN

Nurses week, 8 more weeks to go!!!

Nurses this week was the weakest ever for me! I mean next to some meaningful status updates on facebook nursing week was a BUST! I got an email from my travel company...I do need to redeem my free gift ;-) Just in light of all of the failures on the end of management lately im sure free meal and a smile doesn't make up for how some nurses are being treated. Personally as a travel RN I fly above all of the crap! Its so beautiful! No politics none of these idiot decisions made by upper management effects me! I just go, do my job then go home! It still makes me mad when I hear of my coworkers getting screwed over with their pay! Especially Brenda who constantly reminds everyone of "they cut my check, so I aint......." LMAO!

Well this past week on assignment has been great. I feel like I have acclimated well with the staff...I am even organizing potlucks! LOL! Fed nurses are happy nurses...I should conduct a study and publish it...maybe someone will write it in their policy! Its crazy how many of the personalities and worth ethics remind me of each other! I mean its like every nurse I have worked with in Houston has a twin or certain aspects of them remind me of the other. There is the charge nurse who always says ok, even though the patients they are about to receive are train wrecks...there are the nurses who don't sit down and just create things to do, and make you feel lazy...there are the nurses who are nice but don't quite connect the dots...the nurses who only have their own interests in mind...etc etc. But there are a few nurses who are themselves! I must admit working with all of the different personalities does bring a certain joy to my life! I guess i just get bored so easily!!

"The nicest people on earth will die of cancer." This was said this week and it struck me because it reminded me of all the oncology patients I have experienced in my life either as a CNA or RN. I took care of this patient who was a younger diagnosed with AML (http://en.wikipedia.org/wiki/Acute_myeloid_leukemia) when through chemo treatments and then finally a stem cell transplant. http://www.mayoclinic.com/health/stem-cell-transplant/my00089 It just made me take a look at my own life and how I do take things for granted! Its like they went to get a normal blood test and BAM! they were diagnosed with AML. Cancer is just one of God's test of endurance I guess...cancer treatment is probably one of the most brutal things a person can go through...unless you live in California and you can participate in legal activities ;-) Just the thought of having to go through chemo makes me want to rethink life! Its like are you willing to suffer to live a little longer????? and after the suffering its not promised but research has shown blah? They give you numbers, figures and percentages...Then there are the emotional ups and downs...clear tests everything looks great...but you go in for a routine check up and "well there are some suspicious looking spots on your lungs and brain". Well the patient's family members were like "you are so tentative and compassionate you should work on the oncology floor". I just responded with "I can't, my heart can't take it". To all of you people who know me are thinking....whoa...yes, I do have my mojo and at work its just another slice of me...hopefully none of you will ever have to get a taste of Nurse Brandon ;-) It kills me to see good people dieing and them being so happy about it! If you ever want to meet a group of cheerful people take a walk on an oncology floor, I would have to say 80% of them are so happy! You see them with their bald heads and only able to eat bites of food...experiencing the worse pain in the world...smile. Gah! 

Well I am getting sleepy! I will have to do a follow up post to talk about things that made me go hmmmmmmmmm this past week!

BS RN

9 Weeks to go!

Well its already been a month on assignment! The thing that is killing me the most is this two job thing! I can not handle to work 5 days a week twice a month! Can't do it!! Especially since I really don't have any major financial goals...yet. I will work like a hebrew slave when its time to buy a house or something...now is not the time lmao!

I have been trying to be on my best behavior out there in Temple but I have had a couple of slips! I am only human but you get to fussin with me then Brandon has to show up and show out.

1) There is this one MD who has burned all of their bridges with the other docs so basically they have to answer their own calls...the thing is this fool doesn't answer his pager! So I paged and waited paged and waited...since its a teaching facility I decided I was going to go through the chain of command...well that wasn't working either so..."I need a MD to lay eyes on my patient...do I need to tap dance across this desk (nursing station) or start handing out sexual favors to get a response!?" The jaws hit the floor left and right! I had to really grab a hold to myself because I knew where I was headed...to the director's office the next morning sooo I whoosahed and prayed then kept going lmao. Well the patient turned out to be ok and I got some orders (the wrong ones) but hey my butt was covered! CYA!!

2) This sweet charge nurse was concerned about one of my patients O2 sats. I told them that it was fine and just let him sleep. I was in my other room when I saw them go into my patient's room and try and wake him up @ like 0200 in the morning! I kindly put the stuff I was doing on pause flung on the lights and in a true Brandon fashion: "IS THE PATIENT BLUE?!" of course he wasn't but come on people we have to treat the patients and not the monitor! Of course I felt so bad after that! The last thing I want to do out on assignment is burn bridges! They are so important! But at the same time I was tired and it was one of my nights in a series working so I was kind of pissy!

Everything is about money and budget and I hate it!!!!! You would think half of the things we do are for the benefit of the patients but trust and believe it has some financial significance to it! For example, skin documentation! JEEZ you can only document so much about some one's freakin back side ugh!!!! These institutions need to focus on where the real money savers are: THE PHYSICIANS! Some of these physicians need to grow a pair and just know when its time to let go of a patient. No I haven't been in the situation where a family member was dying in ICU but i mean you have to focus on QUALITY OF LIFE. Families should be schooled on quality of life when those chronic patients hit the door. I mean what quality of life does a 90 year old have trached and pegged in a nursing home!? Its inhuman and its a slow way of killing someone. I do believe everyone is entitled to health care but I also believe there should be a point in time where life saving measures should become comfort measures.All of this is sooo relative!!! I say this but I have difficulties bringing up code status changes to patient families. Well, I'm a lot better than I used to be.With out thinking twice I feel comfortable asking patients and their families if they want to be intubated...second nature now. I still feel strongly about physician's bringing up the conversation sooner. Some people rot weeks in ICU until infections and skin issues finally help them go see Jesus. Working in a major medical center then working in a hospital with out those "extraordinary" resources have made me appreciate code status changes! Every 80 year old crashing patient doesn't need a balloon pump or continuous renal replacement therapy! Gosh...at the same time I remember my friend Vicky telling me her grandpa is like 90 years old...had bypass surgery...fully recovered and still thrives more than some 40 year olds! UGH! The debate could rage on forever! I stand on the side where quality of life supersedes EVERYTHING! How will the out come of advanced treatments effect how this person lives!? How would this person would like to live?!!?!?!?

REAL STORY: There was this 80 year old who was very lively...probably more lively then I am! Traveled the world played tennis at least 3 or 4 times a week...felt short of breath and ended up in ICU. Later intubated, on continuous dialysis. This patient was in ICU for over 2 months developed a pneumothorax (http://en.wikipedia.org/wiki/Pneumothorax) and ended up with really bad subcutaneous emphysema (http://en.wikipedia.org/wiki/Subcutaneous_emphysema ) where basically you have air under your skin and it feels like rice crispies or Cheetos under the skin. This patient's pneumo was so terrible their head blew up like a basketball and required a chest tube. This patient literally looked like a circus side show...the spouse would come in and take pictures "close your mouth honey so we can show people how well you are doing" mind you this patient was completely out of it and mouth was opened related to their condition. Right after the insertion of the chest tube there was a document faxed stating a living will and how the patient did not want to be intubated. This is after being intubated for weeks and suffering pain the SPCA protects even animals from suffering.

With all that said: Make sure you make out your wishes in paper and get it notarized. I personally am going to make a HD moving specifying how I would like things managed in the event I become incapacitated! LMAO! Including how I want my services (minus all those horrible cliches) and a recording of myself I want to be played at my memorial LOL! 

Ready to get this NY state license on deck! I have already sent for the finger print card so I can complete the requirements for my California license also! I want to try an 8 week contract....4 weeks lol...shorter sounds so much more tantalizing now! 9 weeks and counting....

Please remember this is a safe place, tell me what you think! (But please be respectful of HIPPA, myself and of course yourself!)

BS RN

10 MORE WEEKS TO GO! Biggest fears....I had a fit!

I can't believe how quickly things are progressing time wise! In about a week and a half I would have been working on my travel assignment for an entire month! I feel very comfortable with the staff, I have already floated to a different unit, been in codes and emergency situations...I feel broken in! The greatest thing of all: IT WILL ALL CHANGE IN 10 WEEKS! YESSS! This probably could have been one of the best decisions I have ever made in my life career wise! BUT I do thank God I stayed at my home base the length of time I did because with out the experiences, I could not be as successful as I am now! No Kim, I haven't forgotten where I got my "twitty milk" from and who helped "grow" me as a RN.

This week has been an emotional, physical and mental roller coaster. In the past 10 days I have worked 8 shifts 2 of which were in a different city! Monday Tuesday night, off one, Thursday through Saturday, off one, then Monday through Weds night! I will never ever do any crap like that again in life! I refuse to pimp myself out for anything, especially work! Don't get me wrong, it is my passion and all; however peace of mind is PRICELESS!

MY BIGGEST FEARS: Sick pregnant women, taking care of critically ill patients who are around my age, and sick children.Sick pregnant women just make me nervous! I guess its the fact there are two lives hanging in the balance, the mommy and the child. The most devastating portion to me is when there has to be a choice between mother or baby...who to keep alive. Gosh it just makes my skin crawl! *PROPS TO WOMEN SERVICES RNS* Sick children make me nervous because they just never had a chance in life. OK, you have a 50 year old person in liver failure related to excessive drinking....and a child who is in liver failure because of genetic defects or mom who didn't make the best health decisions during pregnancy....enough said. Can't do it. Well recently there was a younger patient who developed a guillain barre like condition. Guillain Barre syndrome is an autoimmune disorder that effects the peripheral nervous usually brought on by some type of infection process (thanks Wikipedia). Basically imagine waking up one morning and feeling like someone knocked your elbow really hard....but having that sensation all throughout your arms and legs...AND not being able to move! Just a massive amount of pain, nerve pain, and not having it being relieved by medication. This condition is absolutely devastating! This worst part: it has the potential of spreading through out the body causing respiratory depression related to the paralyzed muscles of the diaphragm! It is scary, its almost like you be come a prisoner in your own body with out being able to move, not even blink. Any way this patient was pretty much in the early stages of it and was being treated with IVIGG and high dose of steroids which were to combat the body's inflammation process (the cause). Moving on, it just freaks me out seeing people around my age stricken with illness. I mean it could be myself or my sisters laying in that hospital bed! Just makes me count my blessings and be thankful for my health and strength every day! But any time I take care of these "youngsters" I just have to watch myself and make sure im not being over bearing! "Are you ok?" "Are you feeling short of breath??" "Are you having pain?" LOL! I just try not to get too panicky or high strung! Talk about having a poker face! If only that patient could see me on the inside: FREAKING OUT!

Real Story: I took care of this young person who suffered from marfan's syndrome, a connective tissue disorder, where they had issues with frequent dissecting aorta. (All the RNs I can see your eyes getting big) Basically they arrived in the ED and told one of the admitting RNs "I don't feel well, I am dissecting". They then left them in a room awaiting at CT scan for about 15min...after the CT scan was done...30 seconds later the cardiovascular surgeon, cardiologist, radiologist, nurses, techs, hell the house keepers were in the room prepping the patient for emergency surgery. The mother then yelled "HOLD IT, STOP EVERYTHING!!!", of course the room stopped and the surgeon looked at her like "what the hell!?" She then walked up to the surgeon and demanded, "Let me see your hands now". Of course the surgeon was about to have a fit..."Let me see your hands!" They showed her their hands..."Ok, I just want to touch the hands that are about to operate on my child" She then grasped them real tight and started praying....So the patient was rolled, no RAN into surgery. The surgery was successful the patient was recovered and per the discretion of the doctors was transferred into CCU. (Which is how I encountered the patient) The patient was very kind, energetic, and extremely intelligent. They were actually studying biology to become a cardiologist to go on to study and help patients with marfan's syndrome. It was awesome. The patient complained of not being able to sleep, so of course in the true Brandon fashion "Well the goal tonight is for you to get some sleep! I will do everything in my power to block that door to make sure that no one and i mean NO one disturbs your slumber! And if someone does, I might just loose my job because im going right off!" (LOL I keep it real with my patients! And I mean what I say!!! Its always a hoot! LMAO) Needless to say, the patient felt refreshed and rested the next morning. I returned the following night but instead of picking this patient back up, I decided to pick up the newly admitted hypothermia patient (I will discuss my thoughts and feelings of therapeutic hypothermia on a different post). So I went into the room to start my assessment and it could have been 10 seconds later I heard commotion and then the dreadful "CALL THE CODE CALL THE CODE!!!!" I couldn't think of anyone who they could be calling the code on, after all I had the most unstable patient...And it my heart dropped when I learned it was the patient I took care of the night before. Apparently the patient was feeling quite well and sitting in the chair, the nurse taking care of them asked them how they were doing that evening...they just said "I don't feel so..." then slumped over. They then they literally threw the patient in the bed and starting CPR and the ACLS protocol.... long story short one hour later and a room of sweaty nurses, docs, residents, respiratory therapists...the patient expired. Mind you this all happened at shift change, so the mother was asked to step out until after 2000. Believe it or not, she had no idea her child had expired. 2000 rolled around and the supervisors met her at the entrance of the room and they walked her to the entrance of the unit to tell her the news...seconds later you there was this scream of pure dread and sorrow. "I just left them sitting in the chair feeling good, and you mean to tell me they are dead!? BULLSHIT! I WANT TO SEE THEM NOW!!" Then she entered the room and it was all over from there...screaming crying shouting, it had to be one of the saddest moments I had in my career. But the one statement which broke down myself and all of the nurses: "My baby is gone, I just left to go downstairs, I didn't even get to say goodbye! I WISH IT WAS ME!" My god, I immediately called a "meeting" in my patients room, who happened to be sedated and paralyzed...i.e oblivious to everything, where we closed the curtain and the door and shed some tears. Shortly after the patient's spouse came onto the unit, they didn't even make it to the room before they had to be contained by the nursing supervisors...then security. It was just the saddest thing ever. The thing I will never forget and will probably take to my grave will be when the mother walked past me in the unit on her way out and told me, "Thanks for making my baby comfortable for their last night on earth, that means the world to me, thank for your all of your help, god bless you" I have her a hug and saw her out the door, then had to run to the restroom and have my little moment. I felt like such a baby! BUT HEY, I'm human 1st then a nurse!

Ok, this last story was pretty heavy so I'm going to call it a night! Please leave your comments questions! I am thinking of ways to make the blog more interactive because I would love to hear feed back! Now to enjoy 4 days off! Off to Austin!!!

LOL Oh yes the fit, I will have to make a part two! LOL!

BS RN

11 More to go! DAMN.

***ALL POSTS REFLECT MY OWN PERSONAL OPINION AND DO NOT REPRESENT ANY COMPANY INSTITUTION OR PRODUCT***

Ok I worked 5 days total this week and it was HELL. I do not know what I was thinking but hopefully when the direct deposits start rolling through all will shine! Mama always said you have to work smart and not hard, so I need to go back to living the simple life! PHILOSOPHY: Quality of life supersedes everything! Why work 6 days a week for "stuff" and not be able to enjoy it!? I would rather live reasonably; drive Lucy, live in my little apartment, lay up on the couch and chill than to try to kill myself at a job. I am currently rethinking my situation, I will probably tough it out through the end of this contract then go from there...

Everything that can and will go wrong will go wrong right @ shift change. Granted, things in ICU can change at any time but the witching hours are from 0615-0730 and 1815-1930. Even if a shift has gone "perfectly" I always get uneasy during these hours! Maybe we should change the start of shift times or something because I HATE IT! LOL! So I entered the unit found out my assignment and proceeded to look at my patients. I always make a point to look at the patients while the day nurse is still around just so I can ask questions about what is going on. I was a little irritated this day so usually when i feel that way (which is the usual at the beginning of most shifts for me) I just let the day nurse talk, nod my head, say uh-huh just so they can leave so I can read and find out whats really going on with the patient. I proceeded to do this and I noticed the patient was breathing "funny", so I was REALLY ready for this nurse to leave to I could go do a focused assessment and proceed to make some phone calls...this nurse JUST WOULD NOT LEAVE. She was fixated on the patient having an odor and needing a bath...in the back of my mind I was thinking: You have got to be kidding me, this patient is breathing like a fish on this bipap and the most you can think of is a bath!? PLEASE GET THE HELL AWAY FROM ME AND GO HOME AND TAKE A NAP. So once I ignored the nurse enough for them to leave I did my focused assessment and found the patient to be very hypoxic and having a very mottled appearance. For you non-medical and new nursing folks...mottling is a LATE sign of being deprived of oxygen! Ok, if you want to see a mottled "look" get a ice pack put it on your knee or thigh for a minute or two then look: its balmy, pale and has an appearance of "spider" looking veins/vessels come to the forefront. ANY WAY: I looked at the bipap machine and noticed that the patient's tidal volumes were between .100-.200 (inspiratory capacity; normal is about .600), oxygen saturations were in the lower 90s. JUST BECAUSE THE NUMBERS LOOK GOOD DOESNT MEAN THE PATIENT IS GOOD, TREAT THE HUMAN BEING AND NOT THE NUMBERS. So I call the physician on-call and while i was on the phone with them, they walked up and immediately called for a intubation tray and vent. I just love starting out my shift like this...The patient was intubated and because the drugs given(paralytics and sedatives) they had to be resuscitated with fluids and vassopressors. It took almost 5 hours to get this patient stable, then we had to go to CT, THEN I got another admission. Thank god they were stable because at this point I was finished! Not only is it difficult to find a patient unstable, but to walk into something like this in a strange place. The strange equipment the strange people, its terrifying! I just opened my mouth and asked for help, and everything sort of fell into place.To say the least, it was a rough night! But the patient was ok, and all involved were great! I made the physician on-call laugh because I just continued to thank them and their associates! "why do you keep thanking, its what we are supposed to to" "Well, I learned early on in my young career the more appreciative you are to folks, the faster they come when you call!" We chuckled a good while on that one! But its the truth! I also feel like I earned the respect of the doctors and the nurses on the unit because they were able to see me in "action".Its not I a different person when a patient is unstable or during a procedure, I just cut out all of the bull, pick up the pace and focus on doing what I can as the nurse to help the patient make it over their "hump". So one aspect of the night....

I do not want to go into great detail about this but, whenever you are in charge of the care of the patient...make sure to always double check with each department who is participating in the patient care. Make sure physicians are talking to the right patient, going to operate on the correct limb, draw blood on the correct patient etc. What sucks the most is if there is any breakdown in the communication it always falls back on who was the NURSE. lmao.

Why are SOME day shift nurses so up tight, mean and type A? I can't stand getting or giving report to them! They always concentrate on details which are VERY UNIMPORTANT! Yes t he kardex is important in patient care but before you give a medication you do not check the kardex you CHECK THE ORDERS IN THE CHART! So type A day nurses please get off my back about a kardex, get a life and get a pencil to update it after I leave. Thanks. If I update it, fine...if I don't ok. But I tell you one  thing, everything in the patient's room WILL be correct. My focus is and will always be patient care, I will do whats required paper work wise, but my priority is HUMAN LIFE. Yes, I am being bull headed but paper work doesn't save lives excellent prudent nurses do...however my narratives in notes always are on point! LOL!

I am so grateful for these experiences! Its a roller coaster physically mentally and spiritually! However, I couldn't imagine myself doing anything else in life! I keep checking the New York state board of nursing to see if they issued my license! This 1st experience is ok, but I WANT TO FLEE THE REPUBLIC OF TEXAS ASAP! LMAO! 11 more weeks to go!!!!!!!!! YAY!

Please leave comments questions qualms!

BS RN

***If you find any content offensive please email me and lets discus it!***

CODE TEAM/WEEK 12

Just made it back to Temple after being in Houston for a couple of shifts! It was such a sigh of relief working with my family! Great to see familiar faces, equipment and charting! But, by the end of the 2nd shift I work...I remembered why I left! LMAO! The people I work with are invaluable! They are truly like a well oiled machine; during any type of situation (code, admission, patient in distress) everyone just falls into place and starts working quickly and efficiently! Communication is excellent and all of the nurses are capable of taking any patient on the unit at any given time; everyone is well versed with all of the devices and protocols! ITS A DREAM UNIT! So why did I leave???? Well, I just needed a change! Institutional cheaper changes and an uncanny amount of responsibility jeez where do I begin!? Playing the pharmacist, lab tech, transportation...gets old (especially since I know a different system...really makes me go hmmmmmmmmmmmm.....). I do not tolerate being irritated or unhappy for long...life is too short and other opportunities exist! One of the perks of nursing, you will always be able to find a job...well EXPERIENCED nurses lol! May not be as glamorous or prestigious but a change is always good...always offer opportunities to grow and maybe even help them grow!! Shout out to night crew on 6CA!

Code team! (Kimmy and I)
I have experienced more codes/deaths in the past couple of months than I have in my short career combined! To be honest, I do stay in the "thick" of things for learning experiences...but WHEW! I'm serious, every week its been averaging about 2.3 codes/deaths LOL! It may be the water, or fears coming sprouting from impending healthcare reform law (muahahahaha) but folks have been very sick all over! Either that or the units just have been dumped on jk jk jk jk!!! I feel like I could run ACLS algorithms in my sleep! But there have been some pretty funny moments...believe it or not! I still remember the 1st "mega" code I was ever involved in back at home: Sicily 1932....(love ya GGs) There was this patient on the unit who has very bad CMP/CHF, cardiogenic shock on an off the balloon etc etc. This patient had frequent runs of V-tach...to the point where you could almost pinpoint when the ICD would fire or the patient would pace themselves out of it...So this particular night this patient was doing their usual, when someone noticed the patient wasn't shocking out of the v-tach. Myself and another nurse ran to check on them...cpr was started while I went to get the crash cart and call the code. I was so excited this was my 1st code so I did the 100 meter dash across the unit to get the red card and push it into the room....as I pushed it into the room...I heard this THUD and an "OUCH" from one of other staff nurses...yes...I did it...I ran over a nurse with the crash cart! That had to have been one of the most embarrassing moments in my career!  I looked at her, she looked at me...it took all we had not to laugh...so the patient was shocked and the room filled up with minions in the long and short lab coats lol.. In an attempt to be "helpful" while another nurse was drawing labs, I decided I would prime flushes...with adrenaline still "pumping" as I primed a flush the top flew across the room and I sprayed one of the fellows with saline..."is it raining?!"...LOL! Yes I felt like just running away. So I responded with a nervous "yes" and offered a towel...:Oh the great memories!

Week 12 starts tomorrow evening and I'm just mentally preparing myself for anything! Being floated, crashing patients, new staff members...eh. Just the name of the game I guess, but its exactly what I signed up for! 2 jobs is rough! I will have to speak on this next post, im sleepy! Please feel free to make comments, and speak freely! Good night and wish me luck!

B.S RN

WEEK ONE DOWN 12 TO GO!!!

Well I must say this has been a week for the BOOKS!!!

So the hospital orientation was one day only! We skipped the founders and culture mumbo-jumbo and went straight into taking tests and learning the computer systems! The tests consisted of general pharmacology, dysrhythmias and general nursing knowledge type test. They were extremely basic and straight to the point, you either knew it or you didn't! I did very well on the ecg test and only missed questions on the other tests related to facility specific type of questions i. e. when dressings were changed, when IV tubings were changed etc. Their charting system is very similar to my facility back home in Houston: Paper charting except for medication administration and initial screening assessment (home life, blood transfusion reactions, vaccinations etc). This was a relief because I am used to the "dual" charting methods. I think the biggest sigh of relief was learning they used the same IV pumps as my "home" facility (actually they use the upgraded version)** Overall orientation was short to the point and they expected us to be up and ready to go (There were two other travelers with me both doing 8 week contracts). After the classroom/computer training I met with the education who then blazed through a "guided" tour of the unit and the different facilities. I couldn't remember anything she said except at what time was clocked as being late and where the actual physical location of the unit. The unit 12 bed medical ICU with 2 beds reserved as "code beds". There are a few other ICUs: Cardiac ICU (CCU/CVICU) Surgical ICU, Trauma ICU etc...Any ICU nurse can be floated to any of the units and on rare occasions to the progressive care unit. Each unit does their own scheduling AND staffing. Charge nurses take patients and make assignments and decide on staffing needs. So about my 1st night on the unit....

My 1st impression of the unit was a positive one! By the end of the night I knew that I was working with a good team with great fellows, residents for back up (Mind you, all of this changes this summer...hopefully im gone by then!!). The night started out kind of slow because of all the "orienting" process...I just felt like there were so many steps in doing things, same steps as any other night but in different directions! The patient care was basically the same, I just had to adjust to all of their systems/policies/procedures! (That was until I learned the "real" way to do things ;-) I picked on that by the 3rd night trust me...) I dove straight in, we admitted the patient i drew labs, she did paper work....my preceptor was impressed. "Well usually when I orient people they just stand around"...I told her standing around doesn't accomplish anything, lets get R done! LMAO! I was on my way to get meds and this nurse who floated from CICU whispered in a very very soft voice "I need a crash cart" and of course my  eyes grew and I was like "HUH?!", then she whispered again "I need a crash cart:"...yall know it was OWN then!!! I jumped on that cart and did a 100 meter dash to that room where they were debating a pulse...so of course while they were debating, I was snatching those drawers open getting the meds ready! (If you have to debate a pulse, clearly there isn't one!) The nurse was trying to give meds and I told her "No, you go I will give meds!" As I "grew" as a nurse it was explained to me if your patient codes "we" the staff will code your patient (WAIT: that's if there is proper staffing lmao). I jumped on the meds and started pushing away. Half way threw I asked for a med, and this guy who happened to appear was standing next to the cart, so I asked for a bicarb...this fool hands me a BOX of bicarb...(Yes, a closed BOX) I had to imagine the tassels on Jesus' cloak brushing across my face not to tell him what was REALLY on my mind! You guys would be so proud of me, "I need a bicarb, opened, and assembled PLEASE". L:MAO!! BUT HOWEVER, if looks could kill...i would be in jail for murder one...! I was trying so hard not to let BRANDON shine through because after all...i need them they don't need me! No need to burn any bridges, so other words BRANDON=best behavior! So this patient ended up on all the pressors and on a pronator bed, very very sick! It really does take an emergency type situation to see how a staff works together...Overall I give them a A! They worked that code like a well oiled machine! I was sooooo impressed...not as quite as oiled as 6A (smile). I feel very blessed and fortunate to be working with this group of nurses because im sure it could be a whole lot WORSE! But I think universally night shift nurses are more efficient and work well together because: WE ARE ALL WE GOT! No managers, no attending MDs...JUST US...and the fellows, lmao!

The facilities are exceptional! I could tell the building was probably built within the past few years and the technology is pretty up to date. There is a monitor between every couple rooms to see the patients telemetry. GET THIS: nurses do not draw their blood, lab techs do! Respiratory draws the ABGs and they have unit secretaries to input all of the orders! THIS gives me a high level of anxiety because I am used to DOING EVERYTHING for my patients! My biggest fear is something not being done therefore making me look stupid or lazy...Definitely a different experience but at this point and time, I am pretty much open to anything that is not a danger to my patients. The unit is a solid ICU meaning, if you aint a ICU patient you GO OUT. There isn't any guessing or I just want my patient there one more night, oh no! ICU beds are SACRED AND VALUED! It makes me feel proud to be a ICU because the patients there are very critical i.e. vents and pressors. They move these patients fast too! If they are extubated that day, and fly through the night then they are going to be transferred that morning no questions asked. I commented on this and a doctor said bluntly "Yes they can deal with SOB on the floor, unless they need to be retubed, they can go from there". Pleasantly surprised definitely!

I am looking forward to the remaining 12 weeks! Only thing is I still have a commitment to my hospital in houston, at least 2 weeks out of every month I will be working 5 days in a week in two different facilities! So we will see how long I can tolerate this! LOL! I completely underestimated the acuity of this hospital, but I am trained to work and work hard! Just have to keep my eyes on the prize and not piss anybody off on either end LMAO! I am on my hustle mode so I can be in the area to see little Lucia when she comes into the world! Do I have any regrets?...nope! I am enjoying the change of scenery even though its hard work! Mailed off my NYC license packet yesterday, praying that every i was dotted correctly as well as the t's. My tail has been whipped! Now to rest and prepare for my drive tomorrow back to H-town!

If you have any questions or want me to touch on any specific topics just comment and I will make it happen! Next entry: Hints tips, charge nurses, experience and my greatest love of all...patients!

B.S. RN

**I will not refer to any specific brand or facility in this blog, if you would like specifics contact me personally...or until we can monetize this piece!

MOVE IN DAY!!!

OK! Let me start from the beginning:

So you decide you want to sign up with travel company X; you fill the application, submit a skills check list and give them your references...a day or two later you call them (or they call you) and you decide where you want to go. (I have explained why I'm in Temple already...travel feet-->wet, then NYC right?!) After that, you start getting calls from unit managers/directors of nursing for telephone interviews! (I will will do a hints and tips post to make things very clear and concise when exploring your travel options--if its not up within a week remind me!) They then offer the contract, you negotiate then you sign! (Hints and tips) After you sign the contract you then discuss---> HOUSING!!!!! 

*record scratch* (to my current RNs) Just like @ your home institutions you will have to be compliant and make sure all of your credentials are up to date...I will have a post specifically to you all really REALLY soon! ;-)

Basically, they offer a 1 bedroom apartment/loft/studio and furniture. The lady discussing my furniture was naming different items and I was like "PAUSE, let me make you laugh...you have just named more furniture i currently own in my apartment now"...yeah we chuckled for a couple min. After you tell them what you want, which can range from washer/dryer, pots pans, TV..(it all depends on whats offered through the place you are contracted to (and the travel company) you agree and its done. After that, you show up the Friday before your start date (you will usually start on a Monday... a day of hospital orientation then a couple "orientation shifts") and move in....Oh yes, all utilities paid (except cable and internet).

QUICK FACT: They offer 13 week contracts because its done on a quarterly system...

So I showed up to a fully furnished apartment: love seat, chair, dinning table chairs, bed, dresser, washer and dryer. Literally opened the door, brought my my ps3 and clothes and I was moved in! It was probably the easiest move-in I have ever had in my life!

Pictures do not lie! (Except they are little fuzzy r/t to the dang case on my phone!) This place is exceptional! I could not ask for a better location! In the evening I can watch the sunsets right outside of my balcony doors, its breath taking!  Just image smooth jazz playing...sipping on your favorite ______: PRICELESS!

So one of the major humps is done---HOUSING. The next hump is the facility...dun dun dun! I have heard so many horror stories about traveling about how you get dumped on and how you develop a thick skin etc....My philosophy going into this is SAFETY IS 1ST! Screw how I feel, or how you feel about me and how much im making...the PATIENTS COME 1ST !!!! Cleaning poop is a part of the job, i know this...but two confused patients getting out of bed with potential for injury...not cool. That's all I'm sayin'! I will defend and protect my license like its my child now! lmao! (For my peeps, could you imagine someone endangering a child of mine?? Yes.)

All in all, so far so great! My recruiter is excellent, really pays attention to detail and I can't wait to refer them! If you have any pressing questions please leave comments or email me directly! CHEERS!

B.S. RN

Fears and Jeers

So I am "moving" to Temple this Friday and I have mixed emotions. I love my apartment here in Houston very much, its cozy and my stuff is here! BUT some of this shit in here is so raggedy! How embarrassing is it when the A/C starts squealing like a dying squirrel when company is over?! ugh, it will def be nice to get away for a week or two! LOL! Plus judging from the pictures this new place won't be too shabby!

Def an upgrade from my current place, but granite counter tops and stainless steel appliances do not make a place! Safety, silence and savings make a place to me!!!

Well as far as working at a strange place goes, I AM SO NERVOUS! All I know is S. L!!! I only know their policies, equipment and culture. Everyone keeps telling me you develop thick skin while traveling, I just have to stay prayed up when I encounter the 1st instance of being clowned or "chewed out". LMAO! But I can handle anything for 13 weeks...as long as my patients are ok, then I'm ok. They are truly the reason why I am a nurse. Management, hospitals and staff can be such a let down, but the patients are my foundation and motivation! I'm a little nervous about being dumped on with the poopers and confused, but I have had it plenty...the difference will be it will be from strangers with no regard to who I am as a person. SAFETY SAFETY SAFETY! I don't want to walk in there with safe harbor forms...but I am so tempted lmao! (Non-nursing personnel, GOOGLE IT: Nursing, Texas, Safe Harbor)

Working at S.L was one of the joys of my life, excellent staff management ...well they were there hehehehe. Mostly the staff! It came to the point where small things were starting to irritate and get me worked up...if anyone knows me when it comes to that, its time for me to move around! You can ask any RA in Jester West 2007-2008 (spring) LMAO! I just don't like it when the paperwork becomes precedent over the actual patient care...but I am going stop right there! IF IT AINT CHARTED THEN IT AINT DONE! YOU FORGOT TO CHECK THE N/A BOX ETC ETC...And im done! Its getting closer folks!!!

B. S. RN

The Details: My 1st Assignment!

Well this is the scoop:

I am signed up with @#$$! @$#%$# travel agency (I am not going to to promote them until I setup my monetize account $$) in late February. The recruiter was referred to me by a co-worker who is still traveling today (email me for details)...basically I let them know what I wanted to do and where I wanted to go. Initially, I wanted to go balls to the wall and pick any compact state the furthest away from Texas, however per recommendation I am going to start out in Texas. With that said, I am taking my 1st assignment in Temple Texas! (Google map it) I will me working for the major trauma center out there working in their medical ICU with strong chances of being floated to their heart ICU, surgical trauma and progressive care unit. So your probably wondering, your a cardiac nurse...why not go to the cardiac icu? I am MEDICAL CARDIAC nurse and they were looking for a nurse to recover fresh hearts...so I wasn't quite comfy doing that...lol.

My apartment in Houston will be maintained as well as my job in Houston but with a decreased commitment (4 shifts per every 4 week period).They are paying for my apartment in temple, utilities included, and subsidizing my income so I can keep my apartment in H-town. Pay wise I will be making a little more traveling, working 72 than my salary as full time staff at S.L. Its a really nice deal! All money I make from working in Houston will be strictly for savings!

The 1st day of my hospital orientation is April 5th, and I move into the apartment this Friday! So the apartment is fully furnished with stainless steel appliances (I think).

More details to come! If you have ?s email me!!!

Intro!

Greetings and Salutations!

This journey in nursing started for me in 2003! It started as any typical story, at 1st I wanted to be a doctor to "help people" LOL! In high school I took this healthcare oriented class and Ms. G discussed nursing as a career to the class. Of course I ignored it because I didn't truly understand the nursing profession and damnit, I wanted to be a doctor! Well as I got closer to graduation I needed extra volunteer hours to make myself more "well rounded" on the college application, because I missed the top 10% by one dang chair! So I found myself in a brown smock (it looked like I worked at Walmart) in the emergency room @ LBJ! The nurses there were def one of a kind! I then asked the question "so where are the doctors?", they replied with sass "in the back". "So who runs this ER?", "Honey, your looking at us". Needless to say, I then learned one of the major benefits of nursing, we keep the operation going! I was UT Austin bound and here I am today!

I currently work in the med center in Houston in Cardiac ICU (medical) we do IABP, vents, CVVHD, hypothermia, peripherial thrombosis, PA catheters along with other typical ICU type of diagnosis. I have been working there since June of 2008 and I have decreased my commitment there to pursue travel nursing!

Details are coming.....