Sometimes, when my friends or family hear that I have to work over the weekend, they would say, "Your schedule sucks!" Granted, at our unit, we have to work 2 weekends per month, a total of 2 Saturdays and 2 Sundays, which is an average for health care workers. Of course, scheduling doesn't always go the way we wanted. An example is my schedule for March, where I am scheduled an overtime on a Saturday, bringing a total of 3 Saturdays where I have to work. I drew the line there, I'm not doing overtime on a weekend. I'm still holding out hope that my manager can fix my crappy March schedule.
I do not mind working on the 2 weekends I'm required to quite frankly. It is a bummer that, sometimes, I cannot spend those time with my friends and family like "normal" people do, but I have accepted the sacrifices that come with this job. It sucks, but we get over it. I have come to term with the fact that, that is just a part of the job as a nurse. I work in health care, and the hospital opens 24/7. Wouldn't you want someone to work over the weekends and holidays if your loved ones are the ones in the hospital? Wouldn't you want us there, regardless of the time and date of the year, if it were your loved ones?
Another front runner question is, "You work all the time!" Um, excuse me? I work 3 days a week, with an occasional 4th day as an overtime when my unit really needs it. Just because I don't show up to an event over the weekend, doesn't mean I have been working the whole week PLUS weekend. Another benefit of 3 days/week schedule is that, on occasion, I can arrange my schedule to where I can have 4 days weekend or 5 days off for vacation without my boss rejecting it or taking away my actual vacation/sick days. That way, I can save my PTO's for longer vacation or even sell it. Heck, I can take off for a 5 days vacation once a month without my PTO's running out if i want to. How many of the regular 9-5'ers can do that?
I've come to a realization this week, that I actually don't mind weekend because I find that I get more rest from having 3 days off during the week than having a 3 day weekend. Why, you might ask?
Because I'm active in my church, so I'm always doing something church related at one point or another over the course of Friday to Sunday. Friday night is youth group, Saturday morning is church music practice, Sunday 11am is church, and that's just the routine without any additional church event we may have. So between church and other things with friends and/or family, I'm almost always on the run and weekends feel like they fly by too fast. And if I'm off over a weekend, that means I only get a day or two off during the week. Which means, I barely get time to myself.
Whereas, like this week, I was off on Sunday, worked Monday and Tuesday, was off Wednesday-Friday, then I'll come back Saturday (tomorrow). Those 3 days off mid-week haven been heaven. Even when I have errands, I can still relax without worrying I have to be somewhere at a certain time. I can go to bed as late as I please and sleep in the next morning. THAT, my friends, is my kind of weekend, one where I actually rested and enjoyed it.
Someone once told me that, as nurses, you make your own weekend. Our schedule is different than everyone else, so we make our own. We'd make our own weekend in the middle of the week, and we've come to love Memorial day as a holiday. That is the sacrifices we, health care workers, make in order to ensure your loved ones are taken care of. We are in the business of being a service to others, and we give up quite a lot of ourselves in order to do that.
So, the next time you hear me or your other health care friends who have to work over the weekend or holiday, the least you can do is to think for a moment before you utter something ignorant. While I'm honored that you'd want me or your friends to be with you on those special days, think about the sick people at the hospital who need us more, and be grateful that there are people like us, who sacrifice our time for them. You never know when it is your turn to need us to be there at the hospital to take care of you. Even on weekends on holidays.
Saturday, February 27, 2010
Wednesday, February 17, 2010
A Tale of a Night Shift from Hell.
The one where my patient flew over the cuckoo's nest, and the resident refused to order restraints, and the surgeon got upset from being waken up and hung up on me.
This is for all of you who think that night shift is easy because all your patients are asleep, and if they're not, you can just give them sleeping pill or ask the on call team for Ativan or Ambien.
I digress. Because if that was the case, I wouldn't be sitting here at home at almost 9 in the morning, eating a meal that I was supposed to eat about 9 hours ago but didn't because I was so dang busy and caught up in the mess that was Patient Cuckoo.
Mind you, some information has been somewhat altered to be vague to honor this thing called privacy. So here goes the tale:
Once upon a night shift (last night), one of Nurse Cee's (me) patients happened to have altered mental status (for you, laman audience, that's the fancy medically and politically correct term for crazy). The only good thing about the patient was that due to their diagnosis, they're not able to get out of bed to run naked in the hallway. However, arms were still flailing freely and mouth was speaking non-sense in angry and inappropriate terms.
At report, there were many a thing to be done with this patient. Ativan needed to be changed to q 4 hours (because Nurse Cee cannot live on Ativan q 8 hours alone with this patient), Foley catheter needed to be re-inserted (the previous one was pulled out by the patient), banana bag needed to be started. Then, Nurse Cee also found out that this patient was to have surgery in the morning and consent needed to be signed (we'll come back to this later in great details).
To make this hell-ish tale short, Nurse Cee managed to get the Ativan changed. However, her request to the resident on call for restraints was denied, only an order for a sitter was received. And after much verbal harassment from the patient, Nurse Cee managed to get the Ativan into the IV access.
The patient was somewhat more calm (and I use the term "calm" loosely in this story), but Nurse Cee then made a decision that it would be wise to wait until the sitter arrive at 11 pm before she would attempt any Foley insertion, as well as another IV (the current IV isn't good for running fluid). The, ehem, rationale (my nursing school instructors would be proud at the use of "rationale") is that a sitter would be there to watch the patient and can prevent them from removing any line.
In the meanwhile, Nurse Cee also had 4 other patients. 2 were alright, 1 was alright but had a series of tests to be done, and a new admission that came in at the start of the shift with orders of labs, blood cultures, urine samples, and a port-a-cath to be accessed. All of this were almost taken care of while waiting for the clock to strike 11 and for the sitter arrive to sit with the patient.
To make the story short, again, Nurse Cee managed to insert a beautiful IV while the sitter held the patient down. Then off she went to take another patient for a scan. Alas, when she got back to the floor, and just as she was about to give the next dose of Ativan to Patient Cuckoo, she received news that the patient has pulled that beautiful new IV. Her reaction was, "WTH??!!!" The charge nurse's reaction was, "What was the sitter doing?! We had a sitter so this wouldn't happen!" Apparently, instead of watching the patient, the sitter was Facebooking on the portable computer. By this point, Nurse Cee had fumes blowing out of her ears and the inability to decide whether to strangle the patient first or the sitter.
Nurse Cee then informed the resident on call of the situation and requested an order for a BUE restraints for the second time. Haldol was instead ordered, and restraints were denied. The resident's rationale was, "Well, that's "Doctor who shall remain nameless"'s patient, I don't want to restraint "Doctor who shall remain nameless"' patient."
Let me tell you that this "Doctor who shall remain nameless" is a very important and powerful figure in the hospital, who happened to be on the teaching service for a few weeks. The "Doctor who shall remain nameless" is like the resident and my boss' boss' boss' boss' boss'...and so on. Nurse Cee understood where the resident was coming from, but for crying out loud, it would make her night easier if the resident would just get over their sissy behind and order the restraints. DIDN'T YOU HEAR, O FEARFUL RESIDENT, THAT THIS PATIENT HAD PULLED OUT A FOLEY AND IV AND IS REFUSING EVERYTHING??!! What, you want to wait until Patient Cuckoo hit the sitter before you finally order the restraints?! Oh wells, Nurse Cee rest her case. At least she tried--twice. She had to settle with Haldol this time.
So then Nurse Cee had to deal with the consent for the surgery. For you who don't understand, the performing physician must talk to the patient about the procedure and risks involved, and the patient must sign the consent in order for the procedure to take place. Now, the physician is supposed to have the patient sign the consent, but nurses can obtain the signature of the patient ONLY if the nurse knows that the physician has talked to the patient.
Nurse Cee then thought, "Wait a minute, this patient is out of his mind. How can he understand what this procedure is for? Has the surgeon really talk to them? Even if the surgeon did, this patient has no clear understanding whatsoever!"
So Nurse Cee paged the surgeon, and was only in the middle of her first sentence of why she was calling, when the surgeon angrily interrupted her and said that he did not appreciate to be woken up for something that is not emergency. Then dial tone. He hung up on Nurse Cee, and Nurse Cee thought that surgeon was the biggest asshat on the planet. She hadn't even gotten a chance to inform Surgeon Asshat of the situation. But oh wells, Surgeon Asshat was going to pay for it in the morning.
To make this story short, morning came and OR called to ask if Patient Cuckoo was ready. Um, no, he was not ready because consent hasn't been signed because the patient is absolutely not in their right mind and the Surgeon Asshat hung up on Nurse Cee before she could explain the situation.
Thus began the phone calls triangle between Nurse Cee and the OR nurse and the PACU nurse, trying to figure out how to solve this. Surgeon Asshat was paged one more time and Nurse Cee volunteered to privilege of talking to Surgeon Asshat to the charge nurse. Of course, Surgeon Asshat didn't know how to proceed and tried to dump the responsibility to the OR nurse, who then called Nurse Cee again to have her basically inform Surgeon Asshat that (surgeon Asshat) needed to grow some balls and make a decision about what to do here. Afterall, it's the physician's decision of how to proceed when the patient is in this state. Nurses cannot obtain consent unless the patient understands. Nurse Cee wasn't about to jeopardize her license, period.
Nurse Cee informed the Chaplain, the charge nurse, the incoming day RN, and wrote in great details about this whole debacle on the chart. Basically, Nurse Cee covered her ass and Surgeon Asshat can kiss that ass.
This tale does not include the details of how Nurse Cee managed to draw blood and re-insert that Foley from Patient Cuckoo's struggling and flailing extremities. Let it be said that between Patient Cuckoo and the other 4 patients, Nurse Cee had no break, no meal, and no drink last night.
Nurse Cee also very much like to kick the resident who refused to order restraints and inflict more bodily harm on Surgeon Asshat. With those two and Patient Cuckoo combined, Nurse Cee wanted to crawl into a hole and cry in fetal position many many times last night.
The End.
This is for all of you who think that night shift is easy because all your patients are asleep, and if they're not, you can just give them sleeping pill or ask the on call team for Ativan or Ambien.
I digress. Because if that was the case, I wouldn't be sitting here at home at almost 9 in the morning, eating a meal that I was supposed to eat about 9 hours ago but didn't because I was so dang busy and caught up in the mess that was Patient Cuckoo.
Mind you, some information has been somewhat altered to be vague to honor this thing called privacy. So here goes the tale:
Once upon a night shift (last night), one of Nurse Cee's (me) patients happened to have altered mental status (for you, laman audience, that's the fancy medically and politically correct term for crazy). The only good thing about the patient was that due to their diagnosis, they're not able to get out of bed to run naked in the hallway. However, arms were still flailing freely and mouth was speaking non-sense in angry and inappropriate terms.
At report, there were many a thing to be done with this patient. Ativan needed to be changed to q 4 hours (because Nurse Cee cannot live on Ativan q 8 hours alone with this patient), Foley catheter needed to be re-inserted (the previous one was pulled out by the patient), banana bag needed to be started. Then, Nurse Cee also found out that this patient was to have surgery in the morning and consent needed to be signed (we'll come back to this later in great details).
To make this hell-ish tale short, Nurse Cee managed to get the Ativan changed. However, her request to the resident on call for restraints was denied, only an order for a sitter was received. And after much verbal harassment from the patient, Nurse Cee managed to get the Ativan into the IV access.
The patient was somewhat more calm (and I use the term "calm" loosely in this story), but Nurse Cee then made a decision that it would be wise to wait until the sitter arrive at 11 pm before she would attempt any Foley insertion, as well as another IV (the current IV isn't good for running fluid). The, ehem, rationale (my nursing school instructors would be proud at the use of "rationale") is that a sitter would be there to watch the patient and can prevent them from removing any line.
In the meanwhile, Nurse Cee also had 4 other patients. 2 were alright, 1 was alright but had a series of tests to be done, and a new admission that came in at the start of the shift with orders of labs, blood cultures, urine samples, and a port-a-cath to be accessed. All of this were almost taken care of while waiting for the clock to strike 11 and for the sitter arrive to sit with the patient.
To make the story short, again, Nurse Cee managed to insert a beautiful IV while the sitter held the patient down. Then off she went to take another patient for a scan. Alas, when she got back to the floor, and just as she was about to give the next dose of Ativan to Patient Cuckoo, she received news that the patient has pulled that beautiful new IV. Her reaction was, "WTH??!!!" The charge nurse's reaction was, "What was the sitter doing?! We had a sitter so this wouldn't happen!" Apparently, instead of watching the patient, the sitter was Facebooking on the portable computer. By this point, Nurse Cee had fumes blowing out of her ears and the inability to decide whether to strangle the patient first or the sitter.
Nurse Cee then informed the resident on call of the situation and requested an order for a BUE restraints for the second time. Haldol was instead ordered, and restraints were denied. The resident's rationale was, "Well, that's "Doctor who shall remain nameless"'s patient, I don't want to restraint "Doctor who shall remain nameless"' patient."
Let me tell you that this "Doctor who shall remain nameless" is a very important and powerful figure in the hospital, who happened to be on the teaching service for a few weeks. The "Doctor who shall remain nameless" is like the resident and my boss' boss' boss' boss' boss'...and so on. Nurse Cee understood where the resident was coming from, but for crying out loud, it would make her night easier if the resident would just get over their sissy behind and order the restraints. DIDN'T YOU HEAR, O FEARFUL RESIDENT, THAT THIS PATIENT HAD PULLED OUT A FOLEY AND IV AND IS REFUSING EVERYTHING??!! What, you want to wait until Patient Cuckoo hit the sitter before you finally order the restraints?! Oh wells, Nurse Cee rest her case. At least she tried--twice. She had to settle with Haldol this time.
So then Nurse Cee had to deal with the consent for the surgery. For you who don't understand, the performing physician must talk to the patient about the procedure and risks involved, and the patient must sign the consent in order for the procedure to take place. Now, the physician is supposed to have the patient sign the consent, but nurses can obtain the signature of the patient ONLY if the nurse knows that the physician has talked to the patient.
Nurse Cee then thought, "Wait a minute, this patient is out of his mind. How can he understand what this procedure is for? Has the surgeon really talk to them? Even if the surgeon did, this patient has no clear understanding whatsoever!"
So Nurse Cee paged the surgeon, and was only in the middle of her first sentence of why she was calling, when the surgeon angrily interrupted her and said that he did not appreciate to be woken up for something that is not emergency. Then dial tone. He hung up on Nurse Cee, and Nurse Cee thought that surgeon was the biggest asshat on the planet. She hadn't even gotten a chance to inform Surgeon Asshat of the situation. But oh wells, Surgeon Asshat was going to pay for it in the morning.
To make this story short, morning came and OR called to ask if Patient Cuckoo was ready. Um, no, he was not ready because consent hasn't been signed because the patient is absolutely not in their right mind and the Surgeon Asshat hung up on Nurse Cee before she could explain the situation.
Thus began the phone calls triangle between Nurse Cee and the OR nurse and the PACU nurse, trying to figure out how to solve this. Surgeon Asshat was paged one more time and Nurse Cee volunteered to privilege of talking to Surgeon Asshat to the charge nurse. Of course, Surgeon Asshat didn't know how to proceed and tried to dump the responsibility to the OR nurse, who then called Nurse Cee again to have her basically inform Surgeon Asshat that (surgeon Asshat) needed to grow some balls and make a decision about what to do here. Afterall, it's the physician's decision of how to proceed when the patient is in this state. Nurses cannot obtain consent unless the patient understands. Nurse Cee wasn't about to jeopardize her license, period.
Nurse Cee informed the Chaplain, the charge nurse, the incoming day RN, and wrote in great details about this whole debacle on the chart. Basically, Nurse Cee covered her ass and Surgeon Asshat can kiss that ass.
This tale does not include the details of how Nurse Cee managed to draw blood and re-insert that Foley from Patient Cuckoo's struggling and flailing extremities. Let it be said that between Patient Cuckoo and the other 4 patients, Nurse Cee had no break, no meal, and no drink last night.
Nurse Cee also very much like to kick the resident who refused to order restraints and inflict more bodily harm on Surgeon Asshat. With those two and Patient Cuckoo combined, Nurse Cee wanted to crawl into a hole and cry in fetal position many many times last night.
The End.
Monday, February 15, 2010
First.
There is always a first of everything. Including a first patient death.
One where I wasn't a student nurse or with a preceptor. One where I am the nurse. One where I am who the family members go to in the aftermath. One where I am person who will handle the post mortem care: completing technical hospital procedure as well as being sensitive to what the family needed in term of emotional support, which was a hard balance to find.
I don't know why I've gotten attached to the patient on the previous post. Maybe because they were so kind and so brave, in their darkest hour. Maybe because I was touched by the love and support I see between them, the desire to fight for more time to live. Maybe because what they went through was all too familiar to me--that they reminded me of Grampa and my family 1.5 years ago.
Maybe I am crazy, but as I got off my shift yesterday morning, I was hoping that if that one were to die, that one would die on my shift, on my watch. Perhaps, I needed it for closure. Perhaps, the day shift RN rubbed me the wrong way and I wanted that family to have someone who would care about them as people and not just another patient.
Sure enough, that one patient died an hour after my shift started. Time of death: 20:00.
When I came on shift, the family still--well, I wouldn't call it "cheer" in the mourning state that they were in, but let's just say they were still glad to see that I was their nurse last night, as they always have. They, too, knew that the time was coming. I knew I was not the only staff who felt attached to that patient, as one by one, I saw some of the day shift staff stopped by the patient's room to say goodbye as they were leaving. Some shed tears, some held that patient's hand for a few moment, some hugged the family members and offered any word of comfort they can think of.
Within the next 5 hours--between making and getting phone calls, readying the body for the morgue, making sure the family members are as okay as they can be, and helping them resolve issues that have surfaced, I was drained.
Fortunately, I work with an awesome group of people. A charge nurse who was so understanding that I would be tied up in post mortem care, that she did not give me an admission until I was settled. Fellow RN's who gladly volunteer information and help as to what I needed to do to complete the hospital's post mortem policy. A PCA who kindly helped me as I removed all lines and tubes from the body so that the patient would look more presentable to the family and ready to be transferred to the morgue.
It was hard in the beginning. It would be easier if I could just cry with the family instead of having to restrain myself so that I can do my job. In the end, I am just glad that it's now over.
One where I wasn't a student nurse or with a preceptor. One where I am the nurse. One where I am who the family members go to in the aftermath. One where I am person who will handle the post mortem care: completing technical hospital procedure as well as being sensitive to what the family needed in term of emotional support, which was a hard balance to find.
I don't know why I've gotten attached to the patient on the previous post. Maybe because they were so kind and so brave, in their darkest hour. Maybe because I was touched by the love and support I see between them, the desire to fight for more time to live. Maybe because what they went through was all too familiar to me--that they reminded me of Grampa and my family 1.5 years ago.
Maybe I am crazy, but as I got off my shift yesterday morning, I was hoping that if that one were to die, that one would die on my shift, on my watch. Perhaps, I needed it for closure. Perhaps, the day shift RN rubbed me the wrong way and I wanted that family to have someone who would care about them as people and not just another patient.
Sure enough, that one patient died an hour after my shift started. Time of death: 20:00.
When I came on shift, the family still--well, I wouldn't call it "cheer" in the mourning state that they were in, but let's just say they were still glad to see that I was their nurse last night, as they always have. They, too, knew that the time was coming. I knew I was not the only staff who felt attached to that patient, as one by one, I saw some of the day shift staff stopped by the patient's room to say goodbye as they were leaving. Some shed tears, some held that patient's hand for a few moment, some hugged the family members and offered any word of comfort they can think of.
Within the next 5 hours--between making and getting phone calls, readying the body for the morgue, making sure the family members are as okay as they can be, and helping them resolve issues that have surfaced, I was drained.
Fortunately, I work with an awesome group of people. A charge nurse who was so understanding that I would be tied up in post mortem care, that she did not give me an admission until I was settled. Fellow RN's who gladly volunteer information and help as to what I needed to do to complete the hospital's post mortem policy. A PCA who kindly helped me as I removed all lines and tubes from the body so that the patient would look more presentable to the family and ready to be transferred to the morgue.
It was hard in the beginning. It would be easier if I could just cry with the family instead of having to restrain myself so that I can do my job. In the end, I am just glad that it's now over.
Sunday, February 14, 2010
That one.
I don't know about other nurses or health care workers, but for me, no matter how many code blue you have seen and been a part of, no matter of many patient's death you have witnessed, it doesn't get any easier when it is actually your own patient.
One who you have taken care of over a period of time. One who and whose family you have gotten to know--well enough that you know what makes them comfortable and what doesn't, what can alleviate the pain beside the pain meds and what cannot. One whose concerns you have fought for to the doctors, pharmacy, respiratory therapist--code status, pain meds, breathing treatment, you name it. One who and whose family have cheered whenever you walked into their room and they realized you were their nurse for that night.
That one.
One who has been transferred in and out of your unit for the past several weeks. One who, everytime they had left, you thought you'd never see them again because they were going to get better. Oh, how you thought wrong, because that one kept coming back. Each time with one more tube in place, one more complication surfacing, one more step forward but two more steps back, one more of their will to live given up. From independent to total care. From having a voice to none. From full code to DNR. From lively brown eyes to two pools of despair.
You know this is coming, but you'd like to think that it would happen slowly and eventually and peacefully, giving this family to grief and come to term together. But again, you thought wrong.
It doesn't get any easier for me when I discovered certain vital signs and critical lab values nearing the end of my shift this morning and I knew what kind of serious condition has befallen him. It doesn't get any easier for me to realize that that one is dying--soon and now--from all of these complications that seem to be one upping each other.
It doesn't get any easier for me to see the family members clutching each other, crying, knowing that they might lose him sooner than they would like to. It doesn't get any easier for me to not shed my own tears when I finally got home after a long emotionally spent night and crashed on my bed.
It doesn't get any easier for me when all I can think of and hope for now, is for them to still be there when I come back tonight.
It just doesn't get any easier for me when it's a patient near and dear to me who is dying.
One who you have taken care of over a period of time. One who and whose family you have gotten to know--well enough that you know what makes them comfortable and what doesn't, what can alleviate the pain beside the pain meds and what cannot. One whose concerns you have fought for to the doctors, pharmacy, respiratory therapist--code status, pain meds, breathing treatment, you name it. One who and whose family have cheered whenever you walked into their room and they realized you were their nurse for that night.
That one.
One who has been transferred in and out of your unit for the past several weeks. One who, everytime they had left, you thought you'd never see them again because they were going to get better. Oh, how you thought wrong, because that one kept coming back. Each time with one more tube in place, one more complication surfacing, one more step forward but two more steps back, one more of their will to live given up. From independent to total care. From having a voice to none. From full code to DNR. From lively brown eyes to two pools of despair.
You know this is coming, but you'd like to think that it would happen slowly and eventually and peacefully, giving this family to grief and come to term together. But again, you thought wrong.
It doesn't get any easier for me when I discovered certain vital signs and critical lab values nearing the end of my shift this morning and I knew what kind of serious condition has befallen him. It doesn't get any easier for me to realize that that one is dying--soon and now--from all of these complications that seem to be one upping each other.
It doesn't get any easier for me to see the family members clutching each other, crying, knowing that they might lose him sooner than they would like to. It doesn't get any easier for me to not shed my own tears when I finally got home after a long emotionally spent night and crashed on my bed.
It doesn't get any easier for me when all I can think of and hope for now, is for them to still be there when I come back tonight.
It just doesn't get any easier for me when it's a patient near and dear to me who is dying.
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