Tuesday, September 12, 2017

Improvement

So remember that time I was orienting back up in the trauma area, and was feeling super bummed because I felt like I had forgotten a lot of old skills and was generally being a shitty nurse?

I finished my orientation, got a couple of solo shifts done, and I'm happy to report that it's coming back. There haven't been any really hectic dumpster fires yet, but so far so good. I signed up to take a critical care refresher course in a couple of weeks as well, so that's good too.

Thanks to you guys for the support and encouragement from a few posts back. It's a good feeling to know that I don't, as initially feared, fail as a nurse.

Wednesday, August 16, 2017

Announcements

Last night I walked into the docs area to let him know that the gyn exam was all set up. Instead of being a normal human being and saying, "hey doc, the gyn exam is all set up," I just walked in and bellowed "ARE. YOU. READY...TO PELLLLLVVVVVIIICCCCCC???????" and walked back out. 

I don't know what's wrong with me.

Thursday, August 3, 2017

Beans, beans

YOU GUYS. I did a hilariously bad thing and got away with it. Just before getting into the elevator to take a patient and family upstairs, I farted. It was unavoidable; I had to let it out. Honestly I thought it was going to be a little poof of air and nothing more, because that's what my toots had been all day. Naturally, I was spectacularly wrong.

Don't you judge me. I know you've all had those same farts, the ones where you let out a little squeaker and somehow the stench of death and shame follows you across the house. A constant reminder of the evil you've loosed upon the world. Don't even play like you're better than that.

Anyway, I let it out while we were walking down the hallway towards the elevator. I thought the speed of my transport pace and the fact the family was up just ahead of the stretcher would save me. The doors opened and we all got in. As soon as the door closed, I realized that the aforementioned stench of shame and death was somehow clinging to my scrubs and slowly filling the elevator. Of course we were headed to the 7th floor, so it was going to be a bit before anyone could escape.

And then...miracle of miracles! THE PATIENT APOLOGIZED! For a fart that wasn't his! It was a true case of you smelt it you dealt it, because he sure did go "oh man sorry guys, I guess I let one go when I shouldn't have!" I was saved by his admission, and can only wonder if he genuinely thought he ripped one or if he knew it was me and was covering.

I'll be eternally grateful, and my shame and I will survive another day.

Thursday, July 6, 2017

Relearning

I loved travel nursing. So, so much. It was everything I always wanted - fun, adventure, shiny new places, mountains and lakes and friends and road trips and sunshine and spontaneity. The single downside to that job was the lack of working trauma - in the smaller non-designation hospitals, we of course saw some walk in stuff; in the larger ones I was inevitably assigned to the non-trauma sections due to being temporary staff.

As such, I've lost a good amount of trauma skill.

Or to be more precise, I've lost a good amount of confidence in my trauma skills.

Recently I started orienting back into the trauma section of my current hospital, and it's been a rough start. I know what to do, I know how to do it, but it seems like the ability to adapt to the new protocols and new ways of doing things is a steeper curve than I expected and it's been a huge drag on my outward confidence.

I started my career in an absolutely fabulous trauma hospital. I was regularly assigned to the most critical of critical-care rooms, because I was great at it. I honestly don't mean to sound self absorbed, but I was truly good at managing those type of patients.

And now that I've been out of that constant trauma game for five (!) years, it's a different beast. The specific protocols, the phone numbers to call blood bank with, the organization of crucial trays and supplies within the cabinets...it's all different. I'm having trouble letting go of the old ways - why is it that I can remember the phone number to the CT read room of my home hospital, but can't retain the number to the page operator? Why can I remember the location of O2 Christmas trees and the precip tray and the luer locks in the supply room of a hospital I last worked in four years ago, but can't find things in the stock pyxis without using the lookup function? Why do I still recall the phone number of the local ambulance company but can't remember the damn zip code of my own current hospital? Why could I handle the grumpy surgeons at home hospital, but still feel on edge with the ones here? If I were dropped back into patient care at my old place I'd be running the show in five minutes flat, just like before I left.

I know how to take care of a trauma. It's all that routine, hospital-specific stuff that is killing me. And I inevitably feel like I'm a shitty critical care nurse when I can't quickly locate things or numbers or policies, and thus my confidence in the patient care side of it falters.

It's frustrating as hell.

I think I'm being harder on myself than I need to be, but I'm used to being the best and it's disheartening to not be that right now.

Wednesday, July 5, 2017

Eye can't handle this...

Forewarning: don't read this if you're grossed out by eyes. Or blood. Or blood clots. Eegh.

***

After very little thought, I've decided that this new thing I've seen has taken the top spot in the list of GROSSEST STUFF EVER.

I've seriously never been this squeamish before, not even holding traction on crunchy bones or dealing with avulsed fingernails.

The offending thing? Canthotomy. Or more specifically, a lateral canthotomy and cantholysis with both superior and inferior canthal tendons cut for emergency decompression after a retrobulbar hemorrhage during anaesthesia.

Let me put that into basic words, for any non-medical people out there: during the numbing of the nerves behind the eye for cataract surgery, something starts bleeding. That sudden influx of large amounts of blood behind the eye builds up and tries to squeeze the eyeball out of its socket, but pesky anatomy like eyelids and tendons are keeping it in place. The pressure inside the eyeball shoots up to 90 mmHg (normal is 10-21), so an emergency procedure called a canthotomy is done. This procedure consists of cutting the lower eyelid enough to see the tendon holding the eyeball in place, and THEN CUTTING THAT TENDON. If all that doesn't fix the pressure in the eyeball, then you cut the upper lid and tendon too.

Obviously this whole process is a bad outcome for supposedly minor eye surgery but as if that's not enough the patient will uncontrollably bleed because they're on blood thinners too, so they come on in to my ER. Where the doctor will have me take down the dressing to see what's up and I will gently remove said dressing until I reach the eyelid, in which case I'll have to stop because I'm not sure if what's attached to the dressing is clot or eyelid or eyeball and oh god it was so gross I'm getting squeamish just writing this.

I made the doc take over because NOPE. And also because I don't want to be responsible for accidentally pulling someones eye out of their skull. When she got all the dressing and clot out of the way, all you could see was tendon ends, floppy lid, and what theoretically was still an eyeball but pretty much just looked like a handful of red mush.

I'll be fine if I never see (heh) that again, thanks. Once was enough to place this very solidly in the top spot of grossest stuff ever.

Tuesday, June 20, 2017

911

Me, to the doc who just saw my 45 year old patient presenting for two days of constipation: "Hey man, you want me to go ahead and call the fire department, or would you like to?"

Doc: "Uh, why exactly would we call for the FD?"

Me: Oh, well, you ordered an enema. I figured his butthole must be on fire, and I wanted to make sure that was taken care of by the appropriate people.

Doc: "Not funny."

Me: "Incorrect. That is hilarious. But the sentiment stands; I'm not doing a soap suds enema on this patient. You can change it to literally anything else, but unless I see flames I'm not going anywhere near him with that SSE."

***
I told the doc later that while I was in fact trying to be funny, I didn't want them to think I was blatantly ignoring their orders for the sake of being rude. I did, however, want them to recognize that ordering an enema as a first line constipation treatment on a completely healthy patient was ridiculous.

Seriously though, dude hadn't even taken a colace before coming in. He sure did get discharged with a bottle of mag citrate though, and NO ENEMA.

Monday, June 19, 2017

Gravity always wins

My feeling when, two minutes before my orientee and I get to clock out, our fall risk score of zero patient decides to faceplant off the end of the bed and I realize we now have another full hour of care/documentation to do:
Credit

*for the record, he was totally fine

Thursday, June 15, 2017

Mistakes

It's easy to write about the times I felt good as a nurse, or did things easily, or was smart and caught some little detail that helped me better care for a patient. It's much more difficult to write about my failures.

This wasn't even a big mistake, just an offhanded comment that I've been ruminating over for weeks now.

Recently I had a kiddo with appendicitis who was being transferred to the pediatric hospital down the road. It was a ridiculously straightforward case: kid with zero medical history had no appetite for a day and then started with nausea and classic RLQ pain, parents brought him in for a workup, CT showed an appy and we started antibiotics and the transfer process. He was a typical young kid - old enough to know what was happening, but young enough to be terrified by it. About twenty minutes before transfer, he started to cry a bit.

What I should have done was sat down next to the kid and told him it was okay to be scared, that it was okay to cry. I should have validated his feelings and told him that yes, surgery is scary and doctors in masks can be scary and that this whole thing is scary - even me, trying to be comforting, can be scary.

I didn't.

Instead, I told him that it's okay, he doesn't need to be scared, that we're going to take great care of him and everything would be fine.

I can't make that promise - what if everything is not fine? I'll take care of him to the best of my ability, but he might still hurt. I'm not scared by hospitals, but he damn sure was. I told him the classic caregiver lie - with the best intentions and hopefully true, but not at all what a nine year old needs to hear.

I messed up.

Monday, June 12, 2017

Vitals

I went in to discharge a patient last night, and since she had been there a little over two hours I needed to check a set of discharge vitals. I opened a new cuff and p-ox and let them run while I was going over the paperwork, then wrote down the vitals and waved her off to the exit. Back at my computer to chart all the discharge paperwork, I noticed that the blood pressure and heart rate I had just taken were the exact same as the triage set. Does anyone else ever get that weird feeling when this happens that if your chart gets audited, whoever is reading over it will scoff and be like "chyeah, obviously they didn't check discharge vitals! No one has a repeat BP of 143/68 and HR of 71! I'm definitely going to call them in for a meeting."

I then had a moment of questioning if I should change it by just a single number, to 142/68 or something, just enough to make it different and clearly a new set of vitals. Or even to chart the correct identical BP/HR, but free text a note that yes, they are in fact a new set. Which then led to me feeling horribly guilty for even thinking about falsifying data, but also wondering if I'm just a crazy person simply for having this series of thoughts.

Paranoia over chart auditing is such a weird thing.

And then I remembered that everyone, everywhere, always charts 16 as the RR (edit: in the stable, non-respiratory or neuro patients. I'm not that shitty of a nurse; geeze, guys!) and then I felt better about myself.

photo credit

Wednesday, June 7, 2017

Personal Best

So guys I hit my personal all time-best record of AMA discharges yesterday. I had, count em', one two three FOUR against medical advice discharges! Four! And two of those came literally at the same time, with adjacent rooms both signing out (no, they weren't there together). I did my part in legitimately trying to get the one guy who needed to stay refrain from signing out, but no dice. The other three I practically tripped over myself to get the paperwork ready so I could hold the door open for them.

I very nearly had a fifth AMA, but the admit doctor swooped in at the last second and convinced her to stay. Le sigh. Coulda had the championship thumb ring, but at least tonight is another chance!

Thursday, May 25, 2017

Precepting

So the bosses at work, in all their infinite wisdom, apparently decided that I'd be a good fit for training a new grad into the ER. I guess that means I haven't screwed up too badly there yet? Adapting to a new hospital is always hard, and that makes the feeling of "am I actually good at this, or just good at faking?" a little harder to shake. Even after eight years of nursing and multiple rounds of precepting (mostly travelers and other experienced nurses, but a couple of new grads too), there's always a little voice in the back of my mind telling me that I've still got a long ways to go before I don't suck at nursing.

I went through a pretty intense year or two of impostor syndrome back when I was a relatively new nurse. Most days I came home and felt that any good thing I had done at work was owed to the abilities of my charge nurses, coworkers, or just good luck. Gradually, I felt more comfortable with most things but that little nagging feeling has never completely gone away. People tell me that it's a good feeling to have, because it means that I still care about the profession and that I'm not allowing myself to become complacent. I can understand that, but I wonder if other people still feel this way even after so long?

So tell me, do any of you feel this way too?


Tuesday, May 23, 2017

Me-owch (I'm pretty pleased with this blog post title)

One of my favorite doctors at work is apparently very naive when it comes to standard vagina-slang. Case in point:

After the doctor and I saw a patient presenting with vaginal burning and urinary frequency, I asked if he wanted me to put in for a veterinarian consult. I was met with a confused look from him with immediate snickering from the other docs and scribes around.

Doc: "Uhhhhhhh..."

Me: "You know, for her kitty cat problems?"

Swear to you guys, this patient referred to her vagina as her "kitty cat" at least three times during the doc's exam. It seems that in all his years of doctoring he's somehow never heard this term, which I'm totally okay with because it makes for these little moments of hilarity. And let's be real, it's these moments which make working in the flaming dumpster fire that is today's healthcare system even a bit tolerable.

Tuesday, May 16, 2017

Give me sugar...in water...

Last night, I came the closest I've ever been to peeing my pants at work. I didn't even have to pee, either - it was 100% scare related. Let me explain.

As I was giving report off to a coworker just before I danced out the door at 0300, she very insistently leans over and says, "pick your feet up."

You know that tone of voice where someone goes from jovial to deadly serious in a nanosecond, but is also trying to keep it together so as not to panic someone? That same tone of voice when you spot a loose puppy trying to run out in traffic but you don't want to yell at them to come back because it will just freak them out? Yeah, that's the one. You understand.

Anyway, coworker gets a look on her face with that voice tone and even though we had just been laughing about something stupid I instantly knew she wasn't messing around and picked my feet up. Of course, I then look down to see why.

THE BIGGEST COCKROACH I'VE EVER SEEN WAS ABOUT TO CRAWL UP MY LEG.

I let out the most embarrassing sound, tried to push my rolling chair away from the desk and simultaneously stomp the bejeesus out of that monster while not touching it. Fortunately, the cockroach scurried away in the same direction as my chair, I leapt out and smushed it into a million bits.

I'm very certain that if it had crawled up my pant leg, I would have screamed and cried and peed my pants. And wouldn't that be a blog story to tell...


thanks for the gif!

Tuesday, April 11, 2017

Miracles do happen

I witnessed a glorious miracle last night at work.

Backstory: A 28 year old woman takes the cabulance in to the hospital for multiple minor complaints, some of which she's had for years. It's 10:42 pm when she rolls through the doors, on a Monday night. Miracle part 1 is that this patient is waved off to triage - too often, a patient gets a bed here just because they come via ambulance when too many little pawpaws are patiently waiting out front with real complaints.

I see her in Express Care, because she's 28 with minor complaints and that's how shit goes. Her xrays are back an hour later, but because I've got 15 other patients too out there it takes a bit to get her discharged. Finally, around 12:30 am she's ready to go. I've got her dc papers, her 800 mg motrin, and her ace wrap ready to go. "How am I gonna get home?" she asks. I shrug and continue the discharge because FFS, you're an adult so you figure it out.

She asks to speak with social work for a cab voucher. I tell her no. She demands. I call social work, who says no. I relay that to the patient, who then demands to speak to the charge nurse. I die a little inside, but let her sit there for 20 minutes and then go get charge. On our way back out to talk with this little shit of a patient I learn that the yelling and "Fuck you, I want a sandwich*" I heard earlier in the night was, in fact, from this very patient.

Charge nurse flat out refuses the bus pass, cab voucher, and even the demands to speak with the house supervisor, all through a very Oscar-worthy attempt at tears, sob story, and putting multiple family/friends on speaker phone to plead the case/yell/curse/cry on behalf of the patient.

MIRACLE TIME: After another 15 minutes of near-continuous bitching, a ride magically shows up at the front door to pick her up.

Imagine that.


*not even exaggerating this demand

Sunday, April 2, 2017

Brains are scary sometimes...

So I had an incredibly horrifying yet weirdly educational and interesting experience happen to me today. To set the scene a bit, I've been busy this weekend so haven't gotten much sleep over the past few days, and have been slightly more stressed than usual over life/work/all the normal things. When I woke up this morning it was raining outside - a deafening thunderstorm with constant downpour of rain. I honestly love thunderstorms because they sound so calming, but they're not easy to sleep through. Today's was a doozie of one, hence the early wake up.

All of these things must have melded together in my brain today because upon becoming aware, I experienced something for the first time ever - sleep paralysis.

Anyone else ever had that? It's FUCKING TERRIFYING, fyi.

I woke up, and my first thought was "joy! A thunderstorm! I like them." I then attempted to roll over to get a better view of the rain and realized that I couldn't move. Obviously that immediately sent me into panic mode because I also realized I wanted to breathe deeply and couldn't which made me feel like the thunderstorm was drowning me. I kept trying to move and also felt a strange buzzing throughout my body, almost like I was touching a low voltage wire or something.

This lasted for a good ten or fifteen seconds, which were intensely terrifying. The interesting part comes in when, and I have no idea how, I realized exactly what was happening to me. At some point I realized that I was still waking up and had probably disrupted REM sleep. I tried again to move or breathe but couldn't, yet recognized that this is a thing which happens to people - it was just a neurological phenomenon, albeit a scary one. I realized that I was lucky and wasn't hallucinating any shadow figures or noises, which helped calm me back down. After that mini pep-talk, I figured I'd just wait it out. Sure enough, another few seconds later I was fully awake and able to move again.

Not that I ever want to experience this again, but it was kind of cool after the fact to have recognized exactly what was happening while it was still happening.