girl in greenwood

It's a new year. I have a new(ish) job. I have a new appreciation for how excellent my life is. I mean, I've had that appreciation for a while, pretty much since I got interested in nursing. But either my life is way more awesome recently, or my new job has sharpened my focus, or maybe both.

Labels: anxiety, hospice, nursing

I'm all about the lists lately.

Things that have recently made me happy:
-My amazing coworkers and their enthusiastic hugs, support, assistance at work, and ongoing admiration for the extra work I'm doing.
-My husband's love, support, and general holding-down of the home front.
-A message from a friend inviting me to come spend time with him and his adorable baby.
-The positive reaction I get from patients and families when I attempt to speak my terrible Spanish with them.
-Learning the polite way to invite my Ethiopian friends to eat with me, and better yet, trying it out on my coworkers and watching them look surprised.
-Waking up at 6:30 on Saturday and still making it to work on time!
-Paychecks from staffing agency work.
-Anticipation of my friend E's return visit to Seattle
this week.
-My house.
-My garden even though it still needs a lot of work.
-Weird flavors of Lucerne light yogurt - Bartlett Pear Mangosteen?

Things that have recently made me sad:
-Glioblastoma.
-War. The entire concept and the individual loss of life.
-Reading all the recent studies about how getting more sleep makes one's life 1,000 times better and being unable to control the fact that if I spend 14 hours on work & transit time, that doesn't leave enough for shower/dinner/quality time with husband/winding down enough to sleep/getting the recommended 9 hours of sleep. Clearly we need 30 hour days.
-Lupus with severe, life-threatening complications in a patient younger than me.
-Lice, scabies, bedbugs, and all their little friends.
-Seizures.
-The IRS
-Colostomies and corn - two things that do NOT go great together.
-Losing my fancy Bluetooth headset like a dumbass.
-Giant pancreatic pseudocyst.

Labels: dread diseases, nursing

Conditions I've witnessed and am glad I don't have:

Calciphylaxis in end-stage kidney disease.

A colostomy resulting from a rectal foreign body and subsequent intestinal perforation.

A collection of problems that were all making each other worse: congestive heart failure, acute renal failure, necrotizing pneumonia, and protein deficiency due to lack of interest in eating. Also, did you know that when part of your lung tissue dies, you pretty much have to cough out the dead stuff to clear your lungs?! Gross.

Labels: dread diseases, nursing

# posted by girl_in_greenwood @ 6:14 PM 1 comments

Today was a difficult day.

My patient was 20.
He'd had a drug overdose.
His family had made the difficult decision to put him on comfort care.
Today was the first day I'd cared for him.
Today was the day he died.

Normally this kind of thing doesn't get to me that much.
But he was so, so young, and the family was so, so heartbroken.
It was tough to watch.
I cried.
More than once.

But you know what?
I did a f*cking outstanding job as their nurse.

The patient died peacefully without signs of pain.
The family was all gathered at the bedside singing and praying.
I reassured the family that the patient's signs & symptoms were normal, that he was very near the end, that their feelings of guilt/anxiety/relief were all nomral, that they didn't need to worry about any logistics, that they were doing the right thing by holding the patient's hands and touching him.
My excellent coworkers took over care for my other patients for a while so I could devote my time to this family.
I got the chaplain, the palliative care doc, and the medicine attending doc to stop by before the patient died.
I did postmortem care to get the body ready for friends and family to see.
I paged a couple other doctors who had cared for the patient so they could visit the family.

The nightshift nurse who had asked for me to be assigned to the patient came in at the end of my shift and we hugged and told each other what a terrific nurse the other was.

I called another of my coworkers on my way home to give her some positive feedback the family had shared with me.

Now I am drinking a large alcoholic beverage.
And wishing there was some way to tell people not to use heroin and aprazolam together.

Labels: nursing

One year ago I was a brand-new nurse scared out of my mind about starting work.

Today I precepted a brand-new nurse (a graduate from the same school I attended) who was scared out of her mind about starting work.

One year ago I could barely handle taking care of two patients.

Today I had a total of six patients with admits and discharges.

One year ago I had successfully drawn blood once.

Today I helped my preceptee try to draw blood for the second time. She didn't succeed. I stuck the patient once and while I had to dig around a bit for the vein, I got the blood sample.

One year ago I had no idea how to put a tele monitor on a patient, much less how to read an EKG.

Today I admitted a tele patient, stuck on the monitor and assessed his rhythm, then called the doctor to report on the weirdness I was seeing without breaking a sweat.

One year ago I was nervous every time I went into a patient's room because I felt awkward and incompetent.

Today I breezed into a patient's room and was greeted by the patient's daughter, who informed me that I was her mom's favorite nurse.

One year ago I was not sure how I would like working in a hospital with lots of people I didn't know.

Today I got hugs and kisses from most of my coworkers, including a doctor.

This job has worked out brilliantly.

Labels: nursing

More conditions my patients have had that I'm glad I don't:

Huntington's disease. And a big honkin' meningioma as a "bonus".

Multiple enterocutaneous fistulas secondary to surgeries to treat colon cancer.

Diffuse large B-cell lymphoma - this was actually a patient who had undergone chemo in the past, and when it was discovered that the cancer was back, she declined further treatment and went on comfort care. She died on my shift.

Labels: dread diseases, nursing

# posted by girl_in_greenwood @ 11:42 AM 3 comments

In nursing school, we spent a great deal of time discussing therapeutic communication. We were taught to validate feelings, express respect for the other person, and try to steer the conversation in a productive direction.

Yesterday I heard the following interaction while out with a group of coworkers:

Nurse 1: "You know that guy G*** with the possible mad cow disease, and how he's totally crazy?"

Nurse 2: "Sure, yeah, he calls everyone "f*cking b*tch," right?"

Nurse 1: "Yeah, that guy. The other day I gave him his meds and then asked him if there was anything else I could do for him, and he looked me straight in the eye and said, "Yes. You can suck my dick."

Nurse 2: "HAHAHAHA! What did you say - "It sounds like you're feeling horny right now. Would you like to discuss those feelings?" "

Nurse 1: "No, I just covered my mouth and ran out of the room because I couldn't stop laughing!"


I love my coworkers.

Labels: nursing, nursing school

Recent diseases that my patients have had lately that I am glad I don't have myself:

-Full blown AIDS with Kaposi's sarcoma and C.diff diarrhea as a bonus.
-TTP and resultant amputations of both hands & both feet
-completely out-of-touch with any kind of reality schizophrenia (and a foot infection)
-Median arcuate ligament syndrome. (No, I'd never heard of it before, either.)
-spontaneous pulmonary embolism for no apparent reason.

I think this may become a recurring topic on my blog, since I find new conditions that I really don't want to have on a regular basis.

Labels: dread diseases, nursing

Okay, okay, I've been promising this post forever. Consider it a cautionary tale. (If you don't like gross stories, don't read this one, ok?)

I took care of a patient a while ago who was a young woman who had decided to leave her boring suburban life and plans for college to hang out with the wrong crowd. She was using heroin and while her claim was that the massive necrotizing infection in her face started when she just picked at a scab on her forehead... it seems more likely to me that she had either injected or dripped a solution of heroin into her eye. That's right, her eye was the center of the infection. And man was it gross. The eye was swollen shut and continually oozed bloody drainage... when we cleaned it, it drained more, so that it looked like she was was weeping blood. Amazingly, she didn't lose the eye, although she is blind on that side now.

The good news is that she stopped using heroin and got into a methadone maintenance program. The bad news is that she came back to us a couple monthes later with abcesses in her thighs... apparently she decided to change things up by injecting cocaine into her femorals. I didn't ask her this, but I wanted to ask why she would risk infection by injecting when she had a perfectly good cocaine nozzle right on the front of her face... I suppose that would be a less-than-therapeutic message?

So, the takeaway lessons here are:
1. If you use heroin, keep it the hell away from your face and eyes.
2. If you want to use cocaine instead, I really can't recommend injecting it.
3. Srsly, college is not that bad. At least give it a try before you turn to drugs & whoring yourself out. Kthx.

And finally, heroin factoid of the day: dealers apparently cut black tar heroin with many things including fecal matter. Yes, poop. Which then users inject. And get nasty infected abcesses, big surprise. Could it get any grosser?

Labels: nursing

I started this entry back in October... but it's still relevant to me so I'm posting it anyway.

****************************
You know what's funny? I precepted a newer-than-me nurse this weekend. And it went really well. I think that was partly because the new nurse is EXCELLENT. She was a nurse tech at Big County Hospital for the last year, so she is already very familiar with the work environment. Partly it was because I am so recently finished with orientation that I remember it keenly, and have lots of opinions about what makes for good vs. bad experiences. At the end of the first day together, she thanked me for helping her have a good day... which made me feel great.

Otherwise, I'm doing all right. I've been in kind of a funk at work lately - I think I'm reaching the point where I need to shake up my expectations for myself. Right now, I feel like I do a decent job with basic nursing care like making sure that my patients get their meds, have good pain control, get fed appropriately, get blood sugar checks if necessary, get their braces cleaned and adjusted if they have 'em (we have quite a few patients in spinal braces of various shapes & sizes)... which is all good. I'm pleased with that. But! Remember how I was talking about how I feel like there is so much more I could be doing? I have quantified some of that for myself. (I apologize that this is going to be boring for non-nurses, but I've got to get this stuff in writing before it gets away from me!)

In a perfect day, I would go into each patient's room and do the following:
-introduce myself
-update the whiteboard (we use these to write the nurse's name, the patient's name, the date, and any other assorted information like questions or goals)
-check vitals, assess for pain
-listen to lungs/heart/abdomen
-ask the silly orientation questions (do you know who/where/when/why you are?)
-check their name band
-if they're someone who needs to be turned every two hours, go ahead & turn them unless the night nurse told me they were just turned.

It doesn't sound that hard. But I don't think I EVER actually get all of that done in one visit.

Later on in a perfect day, all my patients would get:
-a bath
-teeth brushed or oral care; frequent oral care for unconscious or trached patients
-lotion applied to dry skin, especially feet
-room tidied & organized
-turned/repositioned every two hours like clockwork
-education packets on pertinent health conditions
-a chart review that included not just med checks, but tracking down details like the location of their belongings and starting discharge paperwork
-new IVs if the old one(s) was due to expire
-their freaking disgusting nails trimmed (if applicable)
-whatever sort of wound care they may need
-an offer to help fill out their menu requests (if applicable)

I'm sure there is more that will come to mind over time.

Labels: nursing

Spotted on the fridge in the break room at work. My coworkers are sooooo mature.

Labels: nursing

This year has really flown by. My workmate E* recently pointed out that we've been employed at Big County Hospital for 6 months, which is astonishing. It's turning out better than I could have hoped - I work with a fantastic bunch of people.

I'm somehow surprised to find R* & I still in our rental house - intellectually I know that we planned to spend about two years here, but it's already been an entire year? Wow. This little house has been treating us well - it is completely free of poo in the bathtub and the furnace is working like a dream. Not to mention the guest quarters for anyone who needs to stay with us and the garage storage for bikes and such. We're still contemplating our next move - R* believes the housing market will continue to fall for some time, so the longer we wait, the better deal we'll get & the bigger our down payment will be.

I started this entry wanting to write about work, but I still struggle with knowing what to say about it. Here, I'll give my readers a choice of patient stories, and I'll write first about the one you vote for.

*my comfort care patient who died on my shift (this is the first time a patient of mine has died under my care)

*the reappearance of Eyeball Girl

*the flasher guy who wouldn't go home

Vote in the comments, please!

Labels: nursing

There has been a great deal of outrage at work based on this series in the Seattle Times:

Culture of Resistance

I work at the Big County Hospital prominently featured in the articles. I can tell you that our MRSA infection rate for last month (October) was the lowest that it has been in the last 10 years. This is due to aggressive detection & isolation practices as well as strict hygiene and cleaning measures. The casual statements made in the article about how the hospital doesn't screen or isolate patients is WRONG. All ICU patients are screened at admission and routinely thereafter. MRSA patients are very rarely roomed with non-MRSA patients - and when this happens, it's because the county hospital cannot just close its doors because it's too full. We have to continue to provide care. In these rare instances, the MRSA patient is paired with a low-risk roommate, someone who doesn't have open wounds or a compromised immune system, to try to avoid communicating the infection.

I am appalled at some of the "facts" people are spouting - both in this series and in the comments. For example:

Hospitals don't thoroughly clean rooms between patients.
That would be wrong. Not only do rooms get cleaned in between patients, when the patient has been isolated due to infection, a "terminal clean" is done, which takes about an hour and is very thorough. Every bed is disinfected between occupants.

MRSA, C. diff, and other superbugs are viruses.
No no no. They are bacteria. This means, unlike viruses, they can be treated with antibiotics. This distinction is really important!

Patients with MRSA acquired it in the hospital.
There was a time when this was likely to be true - but these days LOTS of people are carrying MRSA out in the community. So they bring it in to the hospital in their noses or on their skin, then it may flare up into a full-blown infection after trauma, surgery, or some other insult to the immune system. Yes, these carriers need to be isolated, but it's certainly not a given that the hospital made them sick.

What it boils down to is that everyone needs to participate in preventing infections. This means hospital employees, patients, visitors, everyone. So patients, quit refusing your baths. Visitors, wash your damn hands, and don't let your kids sit on the floor. Doctors, take off your white coats and put on the gowns when you go in an isolation room. Everyone, clean your stethescopes between patients.

Now, I would be interested in getting a nasal swab for MRSA because I'm sure it would come back positive!

Labels: nursing

I learned a random fascinating fact today: Byetta (a drug used to help treat type II diabetes) was derived from the saliva of the Gila monster. The coworker & I who were looking up the drug agreed that we couldn't make this stuff up!

I also did a good thing for a patient today - the patient had a painful wound that needed to be cleaned and have the dressing changed twice a day. The night nurse told me that it was so painful the patient was literally crying loudly... so before I did his wound care, I paged the doc and asked for an order for topical lidocaine. Which he stopped by and wrote for me almost immediately. So I was able to blast a bunch of numbing medication into this guy's wound - and it made a huge difference in his comfort level for the rest of my shift. That felt really, really good.

Of course, I also forgot to label a syringe of Reglan that subsequently got thrown away, and forgot to hang an antibiotic in a timely manner. This is why I will not be getting too big for my britches anytime soon.

Labels: nursing

I noticed this week that I'm feeling like I'm getting the hang of being a nurse. I go to work, I get my assignment, I go about my day, and I generally don't freak out about any of the regular stuff that occurs in my shift. I still leave the hospital each day thinking that I could have done better/more/in depth/smarter... but I suppose that's always the case.

I continue to get good feedback from my patients, which is pretty reassuring. And I am really growing to like my coworkers. I already knew I liked the 4 others I went to school with, but I like the ones I didn't know in advance, too.

I did post-mortem care for the first time this past week. The patient wasn't assigned to me, but the nurse who was assigned to him was busy with a semi-emergency and the deceased patient was, well, deceased. So I helped. And I was surprisingly okay with it. I suppose it helped that the patient was elderly and had a do-not-resuscitate order and died peacefully.

On a personal note, I'm finally getting some time off. I didn't work last weekend, but my in-laws were here so I didn't exactly have down time. This weekend, however, I have been lazy as hell, and I have two more days off before I go back to work. Sometimes working 12 hour shifts is so worth it!

Two of the best patient quotes this week:

(little old lady to male nurse) "Don't you touch me, or I will KICK YOU IN THE BALLS!"

(head-injured young patient to the same nurse, on the same day) "Dude, do you think you could get me some weed?"

Labels: nursing

Things feel like they're falling into place. I'm getting used to my job, although I still wonder who on earth thinks it's a good idea to allow me to take care of patients all by myself - can't they see I don't know anything? But mostly I'm doing all right as a new nurse. I wish I could figure out how to be more on top of everything that needs to be done... I feel like I'm barely getting all the basics accomplished during my shift, which is frustrating to a perfectionist like myself.

I'm also doing better in terms of taking care of my health. I'm down 22 pounds since NCLEX, we're consistently eating better and getting more exercise and activity. I still haven't figured out how to keep the house from becoming a disaster, but I imagine that will come together at some point.

I find myself wanting to talk about some of the things I see at work, but I'm not sure how to approach them. My impulse is to describe some of the crazy, gory, astonishing physical problems I encounter on a daily basis, but that's only part of the picture. I also have to balance a thousand details, make & receive a thousand phone calls, keep track of a thousand medications and associated assessments (how much insulin does my patient need? gotta check the blood sugar!), and answer a thousand questions. It's no wonder that I come home exhausted.

By the way - don't squirt a solution of heroin into your eyeball. Kthx.

Labels: nursing

I woke up late today. Really late. The clock said 6:22. My carpool buddy was supposed to pick me up 2 blocks away at 6:25. I threw on my scrubs, grabbed my keys & my badge, and literally ran the whole way. We made it to work on time.

Where I had 5 patients in the course of my shift, one of whom spoke only Spanish. And was going home. And needed teaching about his new colostomy. My Spanish is really not up to the task.

Then my night-shift coworkers didn't come get report from me until 15 minutes after I was supposed to be gone.

Now I'm going to sleep the sleep of the dead. And luxuriate in my four days off.

Labels: nursing

Today was my first day on the floor where I was actually hired to work. I had just finished 3 shifts on the unit where I was training... I had such a good experience there that I thought I would be sad to move on. But I had a surprisingly good day, and I feel surprisingly happy about being in this new place. After just one day I already have ideas about how to make things run more smoothly. And best of all, I did not feel like the "new kid". I knew 2 of the nurses on the floor with me, both of the unit secretaries, and one of the aides. And then my classmates E* and O* showed up at shift change and it was truly lovely to see them both. E* and I are sharing a locker in the staff room now, where we will keep a stash of cinnamon Altoids which my husband hates. I don't know if E*'s wife likes them or not.

I also learned today what happens when we call for a show of force from the security department: a whole lot of people RUN onto the unit and scare the crap out of whoever is causing trouble. That was awesome. (Incidentally, the trouble-causers were the friends(?) and family of the patient. The patient himself was way too out of it to be troublesome.)

At least so far, I'm feeling like my preceptorship on the trauma unit prepared me extremely well, and I am going to be just fine. That is a good feeling.

Now I am about to enjoy two days off, followed by a couple of short shifts, and then a weekend with my parents. Life is good.

Labels: nursing

I've been working and not blogging. But I appreciate the visits & comments from readers! So here are my replies to some of you, because I have been a terrible e-mailer lately.

UnsinkableMB -
Thanks for the thoughts on shoes, orthotics, and achey hips. I've been trying out different shoes in my closet and haven't found the perfect thing yet - but I'll keep looking. And I think I'll investigate orthotics, especially if my insurance will pay for them!

ThirdDegreeNurse - it's so nice to hear from you! I hope you're doing well in your nurse career, too. I'd love to get an update from you if you feel so inspired.

Emilie - Yes, nurses have to eat either in starving bear mode or in fluttering bird mode. One shovels without perceptible chewing or swallowing, the other zooms through the breakroom and swoops up a few bites of whatever potluck dishes are still left and repeats this move several times throughout the day.

Also thanks for the nice words about my "good" things. I am having trouble remembering the good things when I have a hard day.

Heather - Sorry for the shivers. I will keep posting my helpful tips as they occur to me, but I'll try to keep them tasteful enough for non-nurse reading. :)

Kim - Thanks for my move to the big leagues! And I love the idea that I was giving birth to a career. Hee.

Anonymous Shoreline RN program applier - You absolutely DO need to make sure that your transcript gets to the nursing department, but it doesn't have to be an official copy. Stop by the front office in the nursing building - the secretary for the nursing dept can help you make sure your paperwork is in order. And, at 115 points you should be a shoo-in to get accepted! I've heard that the required number of points is back down near 100 points now. Good luck!

Caroline - Thanks for the compliment! And hey, I know I haven't been commenting on your blog, but it sounds like you are rocking the house. Good for you!

CyNurse - Thanks! And the weight loss continues but slowly. I am down 18 pounds at this point, but I still can't fit into my favorite jeans. Not quite.

GeekRN - Hi there compadre! Nice to hear from a fellow Shoreline grad. Especially since you're still working as a nurse, which means that in several more months I will most likely still be functioning, also. :) So you're Mr. Meow Note?? When I started the program in spring 2006 the management students were passing out CDs of them to everyone. By the time I graduated, that practice had pretty much fallen out of favor. I don't think it was because of the administration, though - I think it had more to do with the fact that the curriculum has changed over time and the notes didn't match up to the lectures as well anymore.


So. I have just a few more days of orientation. And my first day on the new unit is Monday. In a cheery note, I already know that I will be giving report Monday evening to my classmate E*, who is well on the way to being my new work-spouse, after being my clinical boyfriend during last quarter. Yes, I'm being a little facetious, just to annoy my husband.

I'm surprised to find that I'm starting to feel ready to be on my own at work. I'm sure I will still need help, and that I won't be all that happy with my performance on a regular basis, but I seem to have gotten past the pants-wetting terror of my first few weeks at the hospital.

Labels: nursing

Good things that have happened at work:

I noticed when one of my patients had early signs of bleeding internally (increased heart rate, low blood pressure...) and got my preceptor involved right away and we ended up calling a rapid response, which culminated with the attending physician coming into the room, taking one look at the patient, and saying something to the effect of "I'll see you in the operating room in 15 minutes". My preceptor congratulated me aftewards, saying I made a good catch.

I freely confess that the only reason I knew what was going on and that I needed to react quickly was because a former coworker told me about a nurse who got fired because they missed the early signs of a patient bleeding internally after surgery, and the patient died. When I heard the story, I promised myself that would not happen when I was a nurse. I had lunch with my former coworker last week and told her about my "good catch" and she was so proud of me. :)

I've been handling three patients relatively independently for a couple of weeks.

Yesterday, a patient who used to be a nurse told me that she appreciated having me as her nurse because every time I came in the room, she and her family felt calmer and more in control. That was super nice to hear, especially considering that she used to be on the other side of the bed, as it were.

I'm down 15.5 pounds since NCLEX. I credit long days of work in addition to dieting.

Bad things that have happened at work:

I've gotten to the end of my shift with little charting done and have had to stay late on more than one occasion.

I cared for a new paraplegic who was so positive and so in denial and he told me "I'm going to work hard and walk again!" and I actually started to tear up, it was so sad. Ouch.

I just worked 4 days in a row and I am tuckered out.

Weird things that have happened at work:

I took care of a person who was in the trouble with the law and was guarded by a series of police officers. One of whom tried to hit on me. That hasn't happened before.

Head-injured patient who is very confused and yells all the time saying to me "I HOPE YOU DON'T THINK I'M A F***ING PUSSY!" after asking me for pain meds. Heh. No, buddy. You've got broken bones, not a lack of courage.



So there you go. Little snapshot of what I've been doing. I'm still orienting through the 3rd week of August, then I will apparently be joining up with my future colleagues on the new unit.

Labels: nursing

# posted by girl_in_greenwood @ 8:15 PM 5 comments