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
Thursday, April 22, 2010
Monday, April 19, 2010
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!***
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!***
Thursday, April 15, 2010
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
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
Saturday, April 10, 2010
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!
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!
Saturday, April 3, 2010
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
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...
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
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