October 30, 2009

I now understand why so many at-home moms drink

I'm not being facetious.  

My being under house arrest due to illness means the preschooler is also under house arrest because I'm not supposed to leave the house to take him to school or anywhere.  For the past three days he's been hounding me like the plague...I can't get a moment's peace to relax or do my reading for class.  What's worse is that  he's developing the 4-going-on-40 attitude and everything is "I want!" or "No!" or "Mommy, do this!"  He deliberately disobeys me when I tell him to do/not do something, and when he does something wrong he gives me that laugh, that laugh that says to me "I know I'm ignoring you and I don't care!"

I've tried everything from being nice to being a bitch.  Nothing works.

Add to this the fact that I'm feeling much better (ah, Theraflu, how I love thee) and would love to be out and about right now--hell, I'd even like to be at work if I could!  But I can't because I'm still contagious...nor can I go visit friends.  So I'm trapped in the house with a demanding preschooler.  What's worse is that tomorrow my better half will be gone until Sunday, so it's not as though I have someone in the house that I can hand him off to for a while as I go and hide.

It's all I can do to grab a bottle of wine and up-end it in my mouth.   But the Theraflu is keeping me from doing that.

I don't spank either--I had it done to me as a child and I don't approve of it.  But I'm beginning to understand that "why" feeling too.

Oh well.  This too shall pass...I hope.

Oh yeah, I'm officially a BSN student now.  Pre-BSN student, actually...it's kind of confusing how the program is all set up.  But I'm taking a 6-week online class that so far is a throwback to my Fundamentals and Management classes.   I'm one of two RNs in it--the rest are all brand-new nursing students.  I better not let myself get too cocky about it.

October 29, 2009


I was complimented the other day. I'm back on detox; one of the clinical instructors was showing her students around the unit, pointed to me and told her students "that nurse explains detox really well."


I've been mastering the basics but I didn't think I was "really well" at the topic. I was flattered. That compliment makes me want to learn even more about detox so I can really be thorough in explaining it to patients and students.

I'm a firm believer in consistency, meaning that if you're going to enforce a policy, you should do it for everyone regardless. Like every other hospital around here, alternate weekends are a must. One of the policies in my place is that if you call out sick over a weekend you're scheduled to work, you may be asked to produce a doctor's note as well as have to work the next "off" weekend you have. Apparently too many people have abused taking weekends off, so they started cracking down.

Now while I don't mind at all being asked to fax my doctor's note (I am indeed sick: I had to call out this weekend because my doctor wants me home recovering until Monday) because I approve of the consistency on their part, part of me couldn't help but feel a tiny bit peeved as I work EVERY weekend. I don't have a "off" weekend coming off--I'm in for at least one, usually two shifts every single weekend since the day I was hired. And it's not as though I'm abusing the weekends: this will be the first one I am off, and only because I am highly contagious.

Go fig.

So yeah, I'm on an enforced vacation from work. I'd like to say I'm home relaxing...but I can barely keep my head up. I'm chugging Theraflu q4 just so I can breathe, and I'm buried under down comforters while it's 70-something degrees outside.

October 26, 2009

Money money money

I've been on stepdown for so long lately I'm not sure if I should call it my new home. 

There have been staffing cuts all throughout the hospital, and a lot of good people (including nurses) were let go.  This means we're now even more short-staffed.  The official reason is "budget cuts" and "our census is low".  I don't know about the budget, but I know that we don't have a lot of empty beds...in fact, I get admissions trying to admit people to the unit even though I've told them we have no free beds.

I really don't know why I stress over not getting enough hours.  Nearly every day I am asked if I can come in early/stay late/come in at all for any amount of time.

I still have a job, thankfully.  And one would think that with the number of people let go from detox that they'd send me back up there.  But no, I've been banished to stepdown for reasons unknown.  I'm not sure who to ask...I'm not sure if I even want to ask, you know?  And it could be worse:  I could be in the high-functioning unit or the kids' unit.

Oh well, what can I do?  I just go in, smile and do my job.  The techs wonder why I don't complain about it.  I tell them that it wouldn't do any good because I was hired to float, and that bitching about it would just make my mood darker.  Instead, I can accept and make the best of it, and get some joy out of the day.

Now that I seem to have taken care of the household emergencies, it's time to turn a lot of my paycheck towards my credit card and my retirement fund. 

I transferred my balance to a card via a 0% APR offer (and with no transfer fees, how rare is that?!?).  The offer only lasts until May, but I figure I could make a pretty decent dent in it if I give up about 300-500 per paycheck towards it.  Then come May, I'll transfer it back to my original card--they're constantly giving me balance transfer offers so no worries there--and keep chipping at it.  My goal is to get it paid off by this time next year...I think I'll do it  far earlier than that, but I'm leaving myself some wiggle room just in case.

I have two IRAs.  One is a 403b that I got from my last job pre-nursing school.  The 403b is just like a 401k except it's for non-profit and educational institutions...and since I'm not at a school nor am I getting benefits at my current job, I can't do anything with it except watch it grow and shrink.  Then there's my Roth IRA, which I send 50-100 a month to.  I've got a good mix of mutual funds and stocks in there and while it's miniscule (it'd last me about a month should I need it today), at least I'm contributing something. 

The stock portfolio is also small.  That did well because in 2001, I bought Apple at 12 a share.  It's now trading at 180.  I wished I had sucked it up and bought Google at 85 a share when it launched, but I was in nursing school and couldn't afford to do it.  Now that's still trading in the 500s.  I do own part of a share though, so I made like 30 dollars on it.  But I'm trying to purchase about 50 dollars' or so worth of stock each month in solid stable companies like Coca-Cola, Pfizer, Avon, etc.  I read somewhere (the Motley Fool?) that the best stock picks were based around common, everyday things, since they're not likely to be going anywhere anytime soon.

I am trying to put money in the savings account...easier said than done.   This last month has been a rather costly one for us with household stuff; also, I will admit that I've become a bit of a splurger lately.   Once I sat down and did the bills for the month I realized that though we are now a two-income family who until now had gotten along on one income rather OK, that is no excuse for me to spend my income carelessly.

I was up two pounds at weigh-in today.  I know why:  I'm forgetting to eat at work again.

October 24, 2009

Assault and battery by Gatorade

I knew it was bound to happen sooner or later:  a patient threw something at me.

I was back on stepdown the other night.  The report said that the patient was involuntary, psychotic, delusional, a pussycat in the AM but once it got dark out, she would get all worked up.  True to form, she did.  She started slamming doors, spitting in the hallway, and getting into it with her roommate who was otherwise peaceful all day but told me in no uncertain terms that if this patient got in her face again that she'd "fuck her up". 

So we separated the two, thinking that having a private room would help the agitated patient calm down.  But now it's the safety checks that were getting her agitated, and she started complaining, throwing things, getting into it with other patients, and slamming doors even more.  She was reprimanded several times, and even reminded that this behavior is not going to work in her favor at her court hearing, but she disregarded it.

I'm peacefully in the med room doing my med pass when she got me with the Gatorade.  I yelled, "Hey!" and it took all my willpower to keep my mouth shut after that. 

I went to my charge nurse, who thank God is on the ball.  She arranged for an immediate transfer for the patient to the intensive care unit.  Then she tells me to see if she has any PRNs that I can give the patient.  Sure enough, she does:  Ativan PO or IM.

"Should I offer it PO?" I ask.

"Do you think she'll take it PO?" says the charge nurse.   Both of us know how this is going to end.

I point to my wet head and shirt.  "Probably not."

"Draw it up."

"It would be my pleasure."

So I prepped the needle, and though we had one male tech on the floor, we called for another tech to come help me give it.  Thank God they found me the biggest one on duty.

Charge nurse sends our two techs in, and tells the patient that we've got medicine for her, and would she lie down.  She keeps saying, "I'll be quiet, I'll behave," but when she sees me and then the needle, she starts glaring daggers.  I stare back with no expression (I'm still fighting to keep my tongue holstered and succeeding).  They asked her if she wanted it in her arm or her thigh.  She didn't answer, so I said she'll get it in her arm.  She didn't fight it--the two techs weren't going to let her.

God help me for saying it, but giving her that IM injection felt so damn good.

In the five minutes between that and her transfer, she kept walking the hall and muttering threats at me.  I didn't flinch and I damn well didn't take my eyes off of her as she passed.  She kept telling the techs that she'd behave now but they told her "you had your chances, we offered to help you, you need to go."  So now she's over in the intensive care unit, where they take no crap from any patient.

Afterwards, I took a few minutes in the lounge to breathe, curse her out (to the amusement of the techs), and then write the incident up.  The techs were impressed and said I handled it all very well, better than they would have.  The charge nurse understood how I felt when I gave that IM--such things have happened more than once on this floor.

Unfortunately, because of all of this, I had forgotten to give one patient all of her meds--I was in the process of doing that when the Gatorade attack happened.  She refused the remaining two meds, so I had to square that away with the night nurse, and I might be written up for a med error.   Maybe I got lucky and the night nurse was able to persuade her to take them. 

Can't win them all.

October 23, 2009


In psych nursing, most of the codes called are not code "blues" (i.e., the patient physiologically crashing).  Most of the codes are for out-of-control patients.  Which means that my ACLS and soon-to-be PALS certifications don't get much of a workout, but my "standing there looking incredibly tough and ready to take to you the floor if I have to" skills do.

Codes aren't all too common as a whole.  All of us are well-trained in heading off patient problems before they happen, so I can work for a week and not hear a single code called while I'm there.  Then again, I can also hear four codes called in one day. 

Most of the out-0f-control codes are called for the kids' unit.  The peak time is right after school vacations, just before or on the same day that school starts.  The rest are on the intensive care unit.

Generally, when you hear a code, available staff from whatever unit comes running.  If it's a medical code, then you'll see more nurses than anything else.  For out-of-control codes, you'll see everyone from administration to medical staff to maintenance...and yes, that includes those big burly guys that were there backing me up when I had to give those court-ordered IMs to the uncooperative patient a while ago.

The last time I was at work (a few days ago), they didn't have me on my usual unit.  I had been there for the past week, and I think some of the other PRNs whose home unit is there complained about being floated elsewhere, so they floated me to stepdown...whichwhile it is in an intensive unit, compared to all the work I have to do if I'm on detox, going was like giving me the day off with pay:  a lot less paperwork, a lot less meds, and less needy patients.  Though I felt bad for the two nurses who ended up on detox:  when I went to the floor on an errand, I saw the two nurses swamped off their feet with no supporting staff.

Floating was also a nice change of pace, both in patient population and coworkers.  They asked me if I'd like to transfer my home down to stepdown, but they've hired so many nurses for that unit I'm not sure how easy it would be for me to get hours if I was in that pool with them.  Plus, even though it's a hell of a lot of work, I'm learning a lot about the detox process and I'm really starting to find my groove there. 

Though in the end, it really doesn't matter where my home unit is because I'm hired to float--I can get sent off anywhere.  Which is fine by me because I do appreciate the change from time to time.

October 20, 2009

Handling med errors

The nurse that I'm relieving asks me if I gave this patient his medication the day before.  I tell her I did. 

Well, she tells me she wrote the order incorrectly on the MAR.   He should have received a higher dose.

Oh, I said. 

I was the one who double-checked it, so I went to look at the original order.  Yes, the MAR was written wrong...but in checking, I missed the error and OK-ed the entry.

I went back and told her that.  Meanwhile, she's editing the MAR to reflect the correct order...which anyone in a Nursing Fundamentals will tell you is a big NO-NO. 

So I went to my charge nurse and asked for an incident report, and then took the matter to the supervisor.  I did sign off on an incorrect order and take full responsibility for that, so I had myself written up.  But I wanted it on record that not only did she transcribe it wrong, she edited the MAR after the medication was given.  I'll fully own up to any mistake I make, but I'll be damned if I'm made to look the fool by an edited MAR.  Fortunately for me, said nurse had told the charge nurse she wrote the change in on the MAR, so it's not a "my word against hers" thing; also, the night nurse who first discovered the error also knows what the MAR originally read.  Last, the supervisor told me that said nurse has been making a lot of med errors lately.

I don't know what came of all this yet, as I've had a few days off.

The supervisor told me that should I encounter an incorrectly written order during a double-check, I should rewrite it and then file an incident report about it.  To be honest, if I had come across the incorrect order while double-checking, I probably would just correct then sign off on it, then leave a note for her instead of writing her up.  I think to tell her about what she did wrong would be just as effective as filing a report...at least, if it was the first time I came across it.  If I had corrected 5 prior orders from her already and this was #6, I may get the form first.  But I'll be damned if I let her get away with changing the MAR so it looks like I'm the only one in the soup on this when she started it.

It was also a reminder to me to be more vigilant about transcribing and checking orders.  As I said before, I'm culpable in this too, and if I had noticed the error when signing off on the order all this could have been avoided.

Fortunately and most importantly:  no harm/no foul to the patient from this.

October 16, 2009

Ups and downs

It's amazing how I can go from feeling like I've got a handle on things to feeling like a nursing student on her first clinical and then back...several times in the same shift.  I was on the ball when it came to dealing with two patients going through bad withdrawal, but then when we had a patient fall, I did everything except probably one of the important things:  get her vitals. 

I went to my first code.  I was cool, calm, I was collected, I got the code cart, I didn't know how to work the oxygen.  I also couldn't find a rebreather but in my defense, that wasn't my fault--there wasn't one there.  Patient is still alive AFAIK.

I taped report:  I did much better on the patient reports themselves but forgot room numbers.  And after going to check census twice because I wasn't sure, I still got it wrong during the taping.

Such is the first year.

On the brighter side, no staff tried to split me today (and I was on my guard much more for it).  And one patient thought he was being cute by doing a magic trick with his Trazadone because he wanted to take it later.  I told him I was impressed with the act, it did look like he swallowed it, but please take it out of his pocket and take it now or give it back and get it later.  It was in his left pocket.

Learned some more about facility politics too.  I'm doing my best to stay out of it.  And as far as work goes, I've told them I'm just trying to cover all my bases as I'm a new grad so yes, my charting's longer than average and I do tend to stick to the P&P and how I learned to do things in school, instead of "how it's usually done" but I'm not going to be going around ratting people out because they do "the usual way"--as long as patient safety isn't compromised, that is.

I'm not as stressed about all the new nurses anymore.  Like I said, I can't put in for hours I can't work, and I'm sure they'll try to find what work they can for me--it's pretty much out of my control.   There's plenty of units I can float to so it's not as though I'm only competing for hours in one spot.  In fact, they asked me twice if I could put in extra time:  they wanted me to stay late yesterday (I had to decline), and they wanted me to come in early on Sunday (in a lapse of sanity I accepted).   I'm not sure where I will be, but it doesn't matter.  As I tell everyone:  I just show up for work, I go to whatever unit I'm told to, I do whatever I'm assigned to, and I'm cool with it.

Though lately, floating is something I have not been doing:  they have apparently taken a liking to me in detox.  Which is fine with me, because I do like working there a lot.

I need to read up on Librium today.

October 15, 2009

First year bumps

I learned the hard way about staff-splitting yesterday...I didn't recognize it until after the fact.  Oh well.  There wasn't any harm done and my manager took me into the office to explain a few things about it to me.  Again, I didn't take it personally which still puzzles some of them.  Though I will admit that after I left work, I did feel a little stung because I made a mistake...but I reminded myself that I am in the "first year" and this is a time of experience and learning.  I'm probably brooding over it far more than everyone else is.  And mistakes happen:  everyone makes them.  As far as mistakes go, this one was rather minor--it had the potential to be major though, so I need to be more careful about how patients behave.   I think I was getting a bit too comfortable and letting my guard down...I need to tighten up my performance.

The facility hired more nurses:  most are PRN, though a couple were permanent.  Every time they do that I worry for a day or so if I'll be able to get enough hours each week.  Being PRN, I'm not guaranteed any hours period.  Then I remind myself that most of this is not under my control:  I give scheduling a list of what hours I can work and if they find the shifts for me then that's all well and good.  After all, I can't put in for hours I can't work.  And if they can't find work for me for the hours I do put in, they just can't and it's not worth stressing over.  Financially, we're all right if I don't work full-time, and if we did need extra cash I could pick up PRN work somewhere else. 

What is in my control:  my work performance--I'll just keep doing the best that I can so when they look at me they'll keep in mind my performance and that I'm a hard worker, and hopefully use me more.  Also, once my better half's own work schedule improves, I can start putting in for more of the odd hour shifts.

Actually, considering how often they ask me if I could work extra shifts, as well as the turnover rates here--many people just stay for their year's experience and then move on--I don't think there'll be any problem with me getting at least some hours every week.  So I'll finish stressing over it today, then let it go until the next batch of hires comes through.

October 13, 2009

Puttering along

Two days off in a row is nice.  OK, I am the first to admit that my current schedule is 97% my doing, and if there's anyone to blame for not getting two consecutive days off, it's myself.  But a shift swap at my director's request has resulted in the last two days being free, so I've been catching up on sleep (well, trying to), reading some non-nursing books and cleaning a bit here and there.

I'm not usually a fan of "chick lit", but for some reason I've been inspired to read them lately.  The nice thing about them is that they're fast reads:  for example, I went through Confessions of a Shopaholic in about three hours, and I'll probably read The Devil Wears Prada and At The King's Summons at the same rate.  I'm also on an Amish tear, so I've been reading a few factual books about their society.  Don't ask me why or how I get into certain subjects that I feel compelled to read up as much as I can on them.  I'm not sure how it works myself.

I've been on the detox unit for a few straight days, which is helpful as I get to be able to put faces to names as well as to their conditions, and I can see the progress or lack thereof over time.   Mind you, the variety of going to other units is nice too, especially since detox can be such a hectic place--with the exception of the intensive care unit, the other units generally tend to run less intense as far as meds and paperwork goes.  On the up side, the atmosphere is a bit more smooth on detox, at least I think it is.  They're all walkie-talkies, there's minimal psychosis, and the days are far more structured.  It has its moments, true...so do all of them.

So the new fridge is great--it actually keeps food cold.  Next paycheck will go towards new towels and sheets.  We've decided that whatever is left over from my check after all bills and expenses are covered should go towards doing things around or getting things for the house.  You know, the stuff that we keep saying we'll do but never get around to doing because of time and/or cost, such as window screens, getting rid of ratty towels, fixing the AC, etc.

The endocrinologist drew blood for more specific thyroid tests.  I should know something in a week...at least I've started losing some more weight though.  I'm down nearly 6 lbs since starting Weight Watchers.  The only problem:  I forget to eat while at work...which is actually not a good thing.

October 9, 2009

Tolerance and help

It amazes me what the human body can tolerate, and how much tolerance that the body can build towards something.   I admitted two patients who if going by the numbers, should have been comatose at the least, if not dead.  But both were walkie-talkies and in decent condition given what drugs they were on.  Both were also cooperative, though assessing them was a test of my patience.

They threw me up as charge nurse the other night, with only partial help with the medications.  I think I rose to the challenge well--I stayed calm, did everything the best I could, and I did the most important thing:  I called for help when I needed it.  And boy, I did need help during that last hour with the admissions.  I know I missed a few things on one of them, but the following nurse was going to go over the chart, and I told her I'd come in tomorrow to make sure everything was all squared away.

I feel no shame in asking my coworkers for help.  I'm not WonderNurse; I'm a new graduate nurse who's on a steep learning curve.  This is the "first year" and I am developing.   I would rather ask for the help, do the job right and let them think what they will of me for asking...than to say "I'll do it myself," refuse to ask for help and muck things up, because they'll think a lot worse of me if I do that.  They may be impressed when I have the good day and nothing goes wrong, but when the bad day happens--and it will happen...

I also have no problem asking for and receiving feedback from my coworkers, and I tell them to please tell me what I'm doing wrong--I won't take it personally.  I don't think they're used to that attitude because one of them looks at me like I'm crazy when I say that.  I don't think she believes me...oh well, she'll get used to me :)

It's been nice getting paid.  Our fridge went on life-support yesterday and it was my salary that got us a new one immediately instead of having to wait until his next payday.  It'll be here tomorrow and I can't wait--until then, I have to cram as much as I can into the mini-fridge and pray that doesn't give out.

October 6, 2009

Fun day

They put me on the intensive care unit.  Let's see...

  • We had the delusional patient who spent the day walking up and down the hallways giving oratories.  Some were really good speeches, especially when the nursing students were on the floor and he had an audience.  Others, not so good--apparently we're all not qualified staff in his opinion and he wanted a court hearing to discuss his rights.  This was before he got into a 30-minute long heated argument with the security camera.

  • There's the one that was refusing their meds PO...but they were legally mandated, so had to get them IM.  He was not happy about it--in fact he was verbally abusive and his agitation was escalating, so along with the charge nurse, they called in 5 male staff to help me give it.   Talk about a show of force:  they managed to pull up the burliest staff we have for this.  After a lot of cursing, swearing, and threats to come after us if anything happens because of this--much of this directed at me as I was the one with the needles--he got his shots and within an hour was sleeping.  It was all I could do to keep my knees from knocking the entire time. 

  • The other mandatory IM was rather cooperative.  I also outweighed him by 100 lbs (seriously, he was skin and bones).  I still brought a male counselor because I had to...but after that first experience, this was easy.

  • Bad news:  my first needle stick.  Good news:  it was a sterile needle--it happened as I was drawing up the meds for the preceeding patients.  I know why it happened--I was nervous about having to give the first patient described the shots.  After taking a minute to refocus, I started over with a new syringe.

  • One patient went south on his new meds, and I had to play track down the doctor while we scrounged for more male staff to help him in the bathroom.

  • Several patients were seeing and/or hearing things that weren't there.   Fortunately, most took the haloperidol I offered.   One didn't want it, but that was because the voices were only playing music and he was down with it.

  • And it must have been national No-Shower day. 

Overall, I think I met the challenges pretty well.  I definitely can't say it was a dull day....I hope I don't have another day like it for a while.  And FYI to the nursing students who may read this:  if, when taking vital signs, you get abnormal results...retake them.  Then if they are still abnormal, tell a staff member about them.  Don't let us find out a couple of hours later from the vital sign sheet that someone's Stage 2 HTN but who shouldn't be.

In other news,  week 1 of Weight Watchers is complete, and I lost 5lb.  I'm still following up with the endocrinologist though because of the abnormal labs.

October 5, 2009

It's official, I'm an employee now

I did pretty well overall with orientation:  plenty of good feedback about my performance, lots of tips for improving myself, one med error d/t my not understanding a part of the MAR, and he only got half of his antibiotic dose.   It'll be kind of frightening flying on my own--really on my own this time, without the "orientee" safety net under me.  But I'm sure I'll be OK.  Just keep to the P&P, remember the 7 rights of medication administration, and yell for help before a crisis occurs and not during/after.

I need to work on creating a medication nurse cheat sheet, since that's what I'll probably be doing a lot of in the near future.  Then I'll make one for charge nursing.

I also got exposed to the office politics.  In my defense, the two nurses talking were sitting on either side of me at the station, so it's not as though I was creeping around corners and listening at closed doors.  But anyhow, I learned a few things about the place and some people, some good and some not so...of course, anything I heard I've taken with liberal doses of salt, as I prefer to find out more facts myself and make up my own mind about matters, instead of just going along with whatever I hear in passing.

I'm also intending to stay out of the politics as much as possible.  I'm really just there to be a nurse.