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
Tuesday, May 11, 2010
Monday, May 10, 2010
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
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
Wednesday, May 5, 2010
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
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
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