F/U Appt

Just following up on my previous post about moral distress and ethical issues since, well, I've been doing a lot of thinking about it these past few days.

What are some ways you guys deal with the stresses and emotional tolls of nursing?

I've been considering getting another job lately, especially after recovering from a musculoskeletal injury this past spring.  Maybe if I can't leave my work at work, then I'm not cut out for ICU nursing? My husband says I have changed since I've become an ICU nurse and when I ask him how, he can't really put his finger on it. While that frustrates me, I have noticed a change in myself as well that I can't quite put a finger on. I guess I just haven't wanted to admit it to myself.

I don't know about any of you other Critical Care nurses out there, but there's a certain cynicism I've gained since ICU. Maybe it's just seeing things for how they truly are now and not being afraid to say it. I don't know what it is.. but has anybody else had a similar experience?

Nurse Shotgun

Moral Distress?

Yup. So I'm now discovering the joys of ethical/moral distress in nursing. Not that I haven't had nursing experiences in other areas of work that pushed me morally.. but this past week of work has been especially trying.

My last few shifts have really started to weigh on me heavily. To the point where I have come home crying and upset with family for no reason. So what is moral distress? The American Association of Critical-Care Nursing (AACN) says moral distress happens when:

• You know the ethically appropriate action to take, but you are unable to act upon it.
• You act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity.

Certainly, I encountered patients and situations in my years on the Medical floor that I had moral and ethical issues with. Doctors and nurses withholding pain medication from palliative patients, confused patients being restrained in Geriatric chairs in the hallway, etc. You know, stuff we have all came across in some form or another during our nursing careers. But since starting my job in ICU, my eyes have been forced open. Wide.

A patient who has been sedated on a short term sedative infusion for almost 2 weeks longer than what is recommended by best practice guidelines.. and now starting to show signs of long term neurological effects from this. A patient whose significant other is being kept in the dark by physicians, since they don't want to admit they've screwed up on several things during their stay with us. Physicians who, after doing your job and advocating for your patient, ignore your concerns to spare their egos... not caring that the patient is suffering because of their arrogance. Not caring that this patient may never experience a quality life off of a ventilator because of their neglect and ignorance to concerns. It really speaks to our tendencies as human beings to cover our tracks to spare ourselves.

My other patient, an elderly patient who has made it clear they did not want to be intubated, now finds them-self restrained to a bed with a ETT down their throat. With only PRN Benzos for sedation... when presented with the option of intubation, was never given an honest picture of what this would mean for them for the rest of their days. That the ventilator will be what they will now depend on to help them breathe. That they will probably never leave the hospital and go back to their home...

Something that really bothers me is when we allow family members to make decisions for perfectly competent patients. Some days I even wonder why I bothered with all of those stupid Ethics courses in University. I mean seriously, they mean nothing in the real world of the workplace it seems. I know in my heart that what is happening to these patients is cruel and nothing short of a crime.. yet, no matter what, somebody needs to look after those patients and provide quality nursing care. The physicians at our facility have the gonads the size of peanuts when it comes to having honest conversations with patients and families about risks and major decisions about their care. Is it some kind of secret that discussing these things with patients and families is a crazy hard thing to do? Or that it will constitute a large part of your time as an ICU physician?

I found the article linked about from the AACN very helpful in helping me sort through my moral distress. Please give it a read and share your thoughts on the subject if you have any!

Keep it real. Until next time,
Nurse Shotgun

PS - Voila! The newest addition to my collection - my Browning BPS!!

Critical Care. Yikes.

So, since I have fallen off the face of the earth for like the past 7 months, I will give a brief synopsis of my life. I totally left that dirt-squirrels ass as I posted before and I haven't looked back since. About 2 months later, a co-worker set me up with her sister's husband's brother on a group outing and well, the rest is history.

As far as the rest of my life, I went on a vacation to the Middle East this fall and started a new job in the Intensive Care Unit a few months back. Remember that post about ambitions? Well, I can now scratch "Be a critical care nurse" off that list! It's very... different... from Med/Surg floor nursing of course. I went from overseeing the care of 10-12 patients to 1 vented patient or 2 non-vented patients. I still remember how overwhelmed I was on my first day and thinking "what the hell have I gotten myself into?".. and boy, getting that first really sick patient with 9 different drips and infusions who was being tubed and lined... and just standing there looking like a lost goat. Good times, good times. Having to present your patient in rounds with the dumb-ass residents talking to you like you're a kindergartener.. It'll take some time to get used to and to develop an even thicker skin than I already have.

So sorry for the lack of posts. I know, my following is SO huge. But these past few months, I've been treading water and trying not to drown. Good thing I kept some of my textbooks from nursing school cause I've been studying them more than I did for my licensing exam.

Well, keep it real. Back to work tomorrow - I'm sure I'll have some interesting tales to regale you with this week. I sure hope it's a good doctor on for the week - if not, I could have some REALLY interesting stories.

Tchau,
Nurse Shotgun

Progress Note

Well...


Yeah, it's been a long time, I know it. Not that I have a large following who are sitting at their computers all day anticipating my posts... But I digress.


So, in the past few months, life has taken a few turns and made a few changes. This guy I was seeing, turned out to be somewhat of, well, what the French call a "douchebag". He's a nice guy, but because I don't get shitface-drunk every weekend... and the fact that my life doesn't revolve around acting like a teenager who hasn't taken their daily dose of Ritalin with my "buddies", it wasn't going to work. Whatever.


So at work lately, they have been assigning me to the charge nurse role on most night shifts. This is a pretty big assignment for somebody who has only had their nursing licence for a little over 12 months... and our unit is the biggest in the hospital. Yes, I had taken the odd shift as charge since Christmas time, but this is a big step. Yes, it'll look good on a resume.. but the crap we have to deal with is not worth the extra $0.65 an hour. Btw, after taxes, is enough for me to buy a Quarter Pounder with Cheese when I get my pay check. Fabulous.


I have been thinking of looking for a job in Critical Care. Med/Surg nursing just isn't cutting it for me anymore. Yes, I still learn new things every shift, and there is a lot more to learn.. But I have now conquered the basics and am ready to specialize within the next year or so. The options are not plentiful in this small corner of the world, but I will see what turns up.


The work load at work these past few months has been overwhelming to say the least - not to mention unsafe for both the nurses and patients. It being summer and all, staffing is always an issue. Of the past 12 shifts, we have worked 10 of them short staffed (down at least 2-3 nurses/aids each of those shifts) But being the only RN on a floor of 25 patients is a bit much. Running between the Heparin gtts, Lasix infusions, telemetry, drains to be flushed, various IV meds, assessing and caring for the unstable patients.. even dealing with verbally abusive family members (which once was an uncommon occurance) is becoming more and more frequent.


Oh the life of a nurse. Can somebody remind me why I CHOSE to do this?

Frig.

Okay, so this is my fourth attempt posting this. This fricken app is a piece of shit and it keeps erasing on me. Yeah, sorry for the lack of posts lately. This is related to two things: #1) Let it be known that I now have a LIFE! I have been dating this fella for about a month now- and it has potential! We've been seeing each other a LOT. He gives me butterflies! ... Okay, enough of that shit. I ain't getting all mushy on ya. #2) Work is totally kicking my ass. Seriously. I won't even start the rant about our management and their complete lack of concern for their employees safety - and more importantly, the patients! We are so fricken short staffed and they don't give a flying shit cause they haven't had a set of scrubs on since nursing school in the 70s. They'd never survive a shift on the floor. And the patient population we have in currently are ridiculous. I put one woman on the bedpan 13 times in a 12 hour shift... And if I didn't get there within like 45 seconds of her ringing, she would just piss the bed full just to be spiteful. And of course, she was covered in bedsores, so all of those dressings would get saturated and I'd need to change like 3 dressings. It's great cause 60% of the shift I was on my own for 12 patients. Eff. Can somebody tell me why I still work there? And I won't even tell you about the workload issue we had a few weeks back... An effing disaster. I dont know what it's going to take to make the managers wake up to what is going on. Yes, I know it's the same everywhere in our lovely, socialist healthcare utopia: there's no money. But is it going to take somebody getting seriously hurt or killed for them to wake the hell up? Who else has this issue? Eff. This job makes me bitter and jaded. What happened to that optimistic outlook I once had as a brand new nurse? ... and how do I get it back? Over and out, y'all. PS- I totally have my eyes on a few shotguns on the Cabelas website. I am looking for a shotgun made for a woman, but preferably not pink.. Any suggestions?

Oh, What A "Crappy" Night

Yeah, so I apparently need to spend more time on the computer- sorry for the lack of posts this past month.

What's new and exciting for me? I'm glad you asked. This past month at work, we have been moved all around. A few of us who us who used to work on the cardiac/telemetry part of the unit are now working on the stroke unit. I have no shame in admitting that this is not enjoyable for me. At all. God bless the poor patients there, but the amount of people on that unit who think they are at the Four Seasons hotel is starting to piss me off.
The best is when a patient rang their call bell (one of the 4 'Nurse' call bell buttons built into the bed) to tell me that they can't find their manual call bell... Honestly.
Or another gem from my last night shift: a patient rang their bell and asked for some Tylenol as he was experiencing some back pain. So I went and got him the Tylenol plain 975mg po he was ordered q6h prn, he says "thank you... And oh by the way, I shit myself"......... And boy, did he ever. Fully independent, lucid and continent on the past 3 shifts I had him as a patient... But I will tell you right now, the bed was full. When I asked him what happened, he said he was too lazy to get up to the bathroom and thought it'd be better if he just went in the bed and that way he could just lay there and we could clean him up... I marched him right to the bathroom where I had to coax him to clean himself. Heavens above, if I ever become that way, please remind me of that story.
To add to the delights of the night, there was also a hateful elderly lady in a room with a young lady in her thirties... Who decided to shit herself, play in it, then wipe her hands on her roommate's bed while the poor thing was asleep! There were 2 black, tarry handprints on this poor girls bed. When I asked her why she would do such a thing she said "well what did you think? That I was going to walk around with shit all over MY hands?"... Yup. Okay.
Continuing on with the theme of the night was a lady who was incontinent of a BM when we were going around doing our end of shift checks. After my partner and I got her cleaned up, new clothes, full bed change, and tucked back into bed with a warm blanket, we turned around to leave. Then she asks for the bedpan and ends up overflowing that all over everything. Another bed bath, new clothes, new bed and warm blanket later, we leave the room.
Then, the biggest jewel in my "crap crown" for the night.. As I was finishing my end of shift checks, I walk into this gentleman's room to check on him when I see him standing up at the side of his bed in a semi-squatting position. As I go to turn on the light, he stands up and when the light comes on, there he stands with his arm outstretched. And in that hand, was a big handful of crap and he says "this is for you". Why thank you.

And I thought night shifts were supposed to be boring?

I Am, In Fact, Still Alive.

I have successfully returned from the tropics and am safely back on Canadian soil. Now, why do they not need nurses on Caribbean beaches? I mean, I'm sure there must be some need for RNs in some of those luxury results... Right? With all that rich food and people on "romantic vacations", it's a breeding ground for cardiac events. Hmm. Maybe I'd have to "settle" for cruise ship nursing? Being back to work is a slap in the face. I need another job. I will begin the job search tomorrow. I've had enough of Medical. Any suggestions for exciting jobs?

The Big Picture

     While most days, I absolutely hate my job, there are days that I try to look at the bright side of my job: forming trusting, therapeutic relationships with my patients.
     I find it hard not to have compassion for my patients. Most of the people that I work with, be it RNs, LPNs, CCAs or physicians, seem to have little to no compassion for their patients. For example, there is a gentleman with a chronic illness that is well known to the unit. In my year on the unit, he has had multiple lengthy admissions. As a result of this, I have gotten to know him and his wife well. He is a very well educated gentleman who is now in the end stages of his illness and beginning to suffer great pain. This is a man who took great pride in his independence- even though he was slow at his ADLs, he could accomplish them on his own. Now, he requires assistance with standing, bathing, toileting and ambulating to his bedside chair. Even the simplest of tasks are now becoming a chore for him. He is deeply apologetic for "wasting our time" because he "knows that we are busy". Is that what patients think? That they are wasting our time when they genuinely require assistance? Is this what nursing care has become? When the gentleman with the chronic illness rings for assistance, most of the staff rolls their eyes and mutter some form of "they need to get him out of here" under their breaths. One even said  "his wife just needs to take him home to die." He is a 2 person assist and I just find it so disrespectful that when we are in there helping him, when the other person is standing there with their hands on their hips or sighing or rambling on endlessly about their stupid weekend partying plans like I actually care. And you know what REALLY makes me mad? When staff are texting or looking at their cell phones at patient's bedsides!
     I understand that yes, we are all tired. It's been a long shift, it's been insanely busy on the unit this past few weeks and we are all run off our feet- and yes, most of us are burned out and a little snippy at times. But that does not give us the excuse to disrespect our patients or act unprofessionally.
    I am now off on vacation for 2 weeks (hello Turks and Caicos!) and I can't help but worry about this man. His condition is declining and I even wonder if he will be alive when I return. 
     Now while this gentleman only rings when he really needs something and is genuinely thankful, there is a gentleman who has been on the unit since the summer, fully continent, who is content just to lie in his own piss until we change him. He will just urinate or take a dump in his pad, then ring for us to come clean him. No attempt (or desire) to get up to the bathroom, a commode or even a bedpan. Now that is upsetting. And he needs to be the one that should be trying to go home. He is content being waited on hand and foot and he has now come to expect it.
     I guess when it comes down to it, I am just frustrated with work. Frustrated with the management not taking our concerns into consideration - and the health and care of the patients is being affected. Patients are having falls because there are not enough bed alarms for confused patients (or enough staff to look after these patients/bells), staff morale is the lowest of anywhere I have ever worked, and a lot of people are burned out.
     At the end of the day, I try to look at the positive things, like the care I have provided for my patients. While I don't always have the time to spend as much time with patients as I would like to, I do try to chat with my patients every shift. You know, just talk. Some of the staff I work with seem to get a little pissy about that, but you know what? Too bad. I am the one who has to answer for the care I provide. And when it comes down to it, I am happy with the basic care I give to my patients. While sometimes I feel guilty that I couldn't be there to stop that confused patient from falling out of bed, or just spend a bit more time with that dying patient's family, I try to look at the bright side. In all the darkness, there is a bright side.

Frustration.

     I write this the day after two of the busiest shifts I have worked in my 8+ months in the nursing field. Nothing is more frustrating. 
     Not only did we have five discharges on my first day shift, we also had three admissions from Emerge- within an hour and a half of each other and of course, within two hours of the end of shift. It is unbelievably frustrating to feel like you can't get all of your work done, to rush through it and not do a good job- just having the goal of "getting it done." Like, it is now 1600h and while you're trying to get charts done from 0800h, you are "interrupted"* constantly answering phones, talking to family members, outrageously high blood glucose readings, IV meds, answering call bells to get patients off of commodes... it makes it impossible to get your work done. I'm sure other nurses sympathize with my frustration- as doing these things is part of our role in providing care, but you know what I mean. I can probably count on both hands the times I have gotten out of work "on time" since I have worked there. It is not uncommon for me to bank a half hour+ of overtime after shift change and OT for missed meal breaks each shift.
     In our Canadian health care system, there is too much paperwork. After hearing from my American nurse friends, it appears that your "paper-trails" are even longer (although you guys are using technology we could only long for.. we don't even have Unit Dose in our hospital district or any form of electronic charting.) I mean, the amount of charting in a shift is foolish- charting the same thing in 50 different places.
    The unit I work on is constantly battling sick-calls.. burned out and overworked nurses. Being understaffed and working short is not uncommon in a shift. For day shifts: 26 patients- we have 2 RNs, 3 LPNs and 1 CCA to look after them. Then an IMCU- where we have 1 RN for 4 acutely ill patients (mostly cardiac in nature). The work load is impossible and management who while hearing our concerns, refuse to change the way things are done. While bringing up all of the overtime that is worked, they refuse to hire more nurses- stating "it's not in the budget" (but neither is all of the overtime they are forced to pay out!)
    How can we change this? They were always telling us in school "you can be the change!" but I don't see how this is possible. What do you guys think? Has anyone had a similar experience and found something that has worked?


* - Not that discussing care with family members is an "interruption" or an inconvenience, but you catch my drift.

Daily Deduction # 1

My deduction of the day/shift: if you, the patient, can wash your face and hands or feed yourself, you can wash your critter. I am not washing it for you. K? Thanks.

Growing Up Sucks.

      I have now completed 3 sets of shifts on my own… I’m not sure what I think of it yet. When I sit down and think of what I do in the run of a day and what my role is, I don’t even know if I could tell you. I don’t feel like I have a clue what I am doing. I just try to get by. It scares me when a LPN comes to me and asks “what do I do?”. I’m usually the one going to them and asking then what I do.
     Since I last posted, I found my first patient who was “down” and called my first Code Blue. Got him back, but they ended up passing away in the ICU at the end of shift- thankfully after the family arrived. Have dealt with old men peeing on me, acquiring injuries from morbidly obese abdominal folds, been swung at by a demented patient. No wonder they don’t tell you what the real world of nursing is like while you’re in school, cause you’d probably drop out and take your money with you. Anyways, I’m sticking in there… barely. I don’t want to be there, but I show up and suck it up. Missing home and all the comforts that accompany it. Growing up sucks.

Radioactive Man

It’s a typical night shift on the Medical floor. Sitting down to do charts after midnight when a man wanders onto the unit with a coffee in his hand…

Man with coffee: ”Ma’am, are you pregnant?*”
Nurse: ”.. Umm, no?”
Man with coffee: ”Good because I’m radioactive. I can abort a fetus 6-8 feet away. I had some cancer treatments down below a few weeks ago and I’m radioactive. Are you a nurse?”
Nurse: ”Yes, I am. Can I help you?**”
Man with coffee: “My pee is pink when I start to pee. Is that normal? Why is it pink?”
Nurse: ”Well, you did have something up there reaming out your urinary tract.. that can cause some irritation and some discoloration is normal.. but if it’s been a while, maybe it wouldn’t hurt to follow up with your doctor.”
Man with coffee in hand: “Yeah.. so whatcha got good to eat in here?”

* - Hello? Why the heck would you ever ask a woman that in the first place?
** - This is not a good thing to ask

Orientation Week

Yikes.


Orientation week is finally over. Spent the week in classrooms meeting the different disciplines that we would be working with, doing a small tour of the hospital, brushing up on some knowledge and skills. It was a long week  but I think in the long run, it'll prove very useful.


My first set of shifts start on Friday - 2 days, 2 nights then 5 off. Of course, my shifts start on a weekend! Oh well, it's not like I do anything on the weekends anyways. I'll just be thrilled to receive that first pay cheque.


Glad to be home for a visit for a few days. I like my new place and new job, but there's nothing like home.


Peace and love!

The CRNE... The Devil's Incarnate in Paper Form.

Well, after writing the CRNE yesterday, the extreme thunderstorm we had last night didn't scare me nearly as much. Talk about putting things into perspective.. Gosh, I hope the two events weren't correlated.


The CRNE sure lived up to its reputation and those who disagree, you'd better check your pulse! All that aside, I am glad to be done. All courses and schooling done.. All clinical done.. Graduation done.. Exam done. Now, to start my new job on a floor I absolutely detest and to move away to a new place. Everything is happening so fast and well, I'm just not ready for it.


But that's life, eh? Life doesn't stop just because I am not ready for it. I mean, it never ceases to amaze me how I can think I am ready to move on and forget things.. or somebody, when you see them again, everything changes. It's been many years; I have convinced myself that life has lead two of us in different directions and that ties have been cut.. but I see them again in a passing glance.. smiling.. and that just all goes out the window.


Well, in a few days I will start my new journey and chapter in life.. I will keep posting. Don't hang on edge for too long.

Twas the Night Before Pediatrics Clinical...

Well, it's the most wonderful time of the year.


The evening before my first day of Pediatrics clinical rotation. Not the most encouraging of words have been spoken of this rotation- classmates and others just tell me to "grin and bear it". Gah. Let's hope my preceptor will be stellar- I'm sure they will be! Though I must admit that I'm kind of excited to try something new. I will fill you in on the events of the day tomorrow- like how many times I get thrown up on, pooped on, etc. Or maybe I'll have an irate, rogue mother who throws a bedpan at me. I'm not known for my good luck, nor am I known for having the perfect words at all times. Should be a doozie!

The Inaugural Post

Well, here it goes - my first post.

This blog will basically be filled with the ups and downs (...there will be a lot of downs- don't say I didn't warn you) of the busy, messed up life of a 4th year nursing student... maybe even some funny situations from the clinical area. 

I'm hoping blogging about my experiences, frustrations and joys will help me enjoy my final leg of my nursing-school life journey... here's to hoping.

I'm working on some graphics in Photoshop and will hopefully have things looking snazzy soon.

-- toodle-doo!