kapachino

Tag: nursing

  • A Resident No More

    One year, two months, and twenty-five days ago I started my work as a “graduate nurse” at the hospital and began the residency program. For the first two weeks I did nothing but attend orientation classes, take tests and surveys, and get checked off on skills. Then I spent an intensive two months in a one-on-one preceptor relationship, which is really where I learned to do my job. Along the way I took and passed the NCLEX, becoming an RN. I began to take care of patients on my own. First three, then four, then five and, during crazy times, six. For a year I attended monthly classes centered on different topics applicable to new nurses. I got certified to give chemotherapy and have become somewhat proficient in it. I learned how to be a charge nurse. I became a preceptor myself and trained a new nurse along with a few different students. In May I went through the yearly evaluation process which included putting together a portfolio, writing an essay, demonstrating skills competency, and countless online quizzes. I got promoted and got a raise. A partner and I put together a research presentation as our final project, gave an inservice to our unit, and proudly displayed our poster at a reception.

    Today, I went to my last class. I took my final quizzes and evaluations and I was done. And this is what I have to show for it:

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    That, and a year’s worth of invaluable experience, stories, and relationships. Confidence as a true professional nurse. Memories of patients and families who I have affected for the better, and who have forever affected me. A real, honest-to-goodness mentor. A vocation, a passion, and a ministry that I’m proud of. The knowledge that I did this, that I’m doing it, and that I can keep going.

    Here I go.

  • Keeping Me Cooking

    Not all of my stories about patients are sad.

    Ms. R, only 54, came to us with thyroid cancer. She had a mass that was obstructing her airway so she had to have a trach put in. She then went through many rounds of chemo and got radiation to her neck, which is a tough place to have that treatment because it left her skin burned and the tissue inside her mouth fragile and sore. Since she came into the hospital in May she hasn’t eaten or spoken. She gets fed through a tube in her stomach, and if she wants to say something she uses a whiteboard to write it down.

    The thing is, Ms. R has been very depressed. She sleeps almost all the time and doesn’t really attempt to communicate. When she was first on our unit I wasn’t assigned to her very often. But one thing led to another and a month in I became her primary nurse. For a couple of weeks I really didn’t know what she thought of me. We had established a routine of care, she was compliant, but I had no idea if she liked me or not.

    Then one day, after one of my days off, Ms. R slept in until 2 p.m. When she finally woke up she wrote down on her board, “You leave at 3?” When I said yes, she made kind of a frowny face. I smiled and said, “You’ve been sleeping all day! It’s almost time for me to go home!” Then she wrote, “I missed you yesterday.” That was the first time I got any clue as to how she felt about me.

    I had never seen any of Ms. R’s family, so I wasn’t sure if she had any support at home. But then one day her sister came up to surprise her. Apparently her family usually comes in the evening after I’m gone. From Ms. R’s sister I learned that she used to be a great cook. When I heard that, I paused, thought, then made a decision. I took a deep breath and just started rambling. I decided that since she couldn’t open up to me, or was unwilling to, I would talk to her about my life and see what happened. I told her about how I’m a newlywed and I’m just now learning how to cook because I never did much of it before. I told her about how I always eat Lean Cuisines for lunch because I think they’re good and they’re easy. I told her about how my parents were coming over for dinner the next night and I was going to be making them enchilada casserole and I was nervous.

    Her eyes lit up. She asked me (or rather, wrote) all about the ingredients and how I was going to prepare it. I blabbed for awhile, and then at the end of our conversation she finally wrote, “I miss cooking. And eating.” And she looked up at me with her big, round, sad eyes.

    Not many days later, Ms. R’s trach got plugged up deep inside and she couldn’t breathe. I’m so, so grateful that I was there when it happened because she was practically dying in front of me from suffocation. I couldn’t get anyone to come help, and I couldn’t suction it out myself. I had to call a code on her, which flooded the room with doctors and respiratory therapists and nurses. They brought her back, but we had to transfer her to the ICU. I sat down on her bed and told her that we were going to have to move her, but that it would only be temporary. Huge tears started rolling down her cheeks. She had been to the ICU before and she didn’t want to go again. I held her hand while she was stuck with needles and given breathing treatments and her bed was prepared for transport. I escorted her down to ICU and I promised her that she would come back to me soon.

    She did. She came back the next afternoon, and ever since then she’s been improving. The amazing thing is that her cancer is gone. Gone. She’s still recovering from her chemo and radiation, but the cancer is gone. I was with her when her doctor came in and said, “This is the lady who USED to have nasopharyngeal cancer.” After three months, he had a 10-day plan to get her home.

    Ever since then, almost every day when she sees me she’ll write, “Did you cook?” Most of the time I have to say no. I try to explain to her that I’m taking it slow, that right now once a week is about all I can handle. One day last week I got tired of disappointing her and I promised her I would cook the next day. The next day came around and David and I got busy and I didn’t get to start the meal until late. David asked me, “Are you sure you want to do this tonight?” I snapped, “You don’t understand. I can’t go back to work tomorrow and see the look on my patient’s face when I tell her I didn’t cook!”

    I was off yesterday, and all this morning I was stuck in a computer class. I returned to my unit in the afternoon to help out. When I went into Ms. R’s room to give her some medicine, she SMILED. I mean a real, big smile like I’ve never seen on her face. We talked about where I had been, her plan for going home, and of course, cooking. She planned out my whole meal for me, and that’s why on Saturday we’re going to be having spaghetti and meatballs, salad, and garlic bread.

  • Just Some Stuff

    Lately I feel like there are so many things going on in my life, little and big, that it’s hard to keep straight. I just want some time to relax and read my books, but it’s hard to let myself have that time. Anyway, before I head to bed I want to share with you a few of those random things that are happening, or that I’m thinking about.

    >The triathlon that I’ve been training for is about a month and a half away. I’m pleased to report that running is going very well. As long as I don’t attempt it in the heat of the day, I have no trouble running the 5k. Swimming is another matter. After I successfully completed the entire 750m, the next couple of swims were extremely tough. I feel like I’ve backslid in that area. And as for biking, I don’t go that often because it takes so long, but I am confident that I can complete the 14 miles. I’m quite slow at all three events, but my goal is just to finish. Unfortunately, my training buddy cracked a rib this past weekend and can no longer race. I’m left to do this one on my own, which is no fun. It’s hard to stay motivated, but I’m really going to try to tough it out.

    >I’ve been enjoying listening to podcasts while I run, and also while I drive. A few of my favorites that I’ve found so far are: The Dinner Party Download, Stuff You Should Know, Filmspotting, and Radiolab.

    >We only have 8 beds (out of 28) open on my floor at work now, so there are only 2 nurses needed per shift. It’s very strange; the rest of the unit looks like it’s under some weird kind of quarantine. We will be floating to other units a lot now, and on Sunday I actually have to work the 3-11 p.m. shift. I’m kind of nervous about it, mostly because I don’t stay up that late hardly ever.

    >Yesterday I registered to be a bone marrow donor. This was one of my 101 goals. Methodist made it pretty easy, because they had a table set up right in the lobby. It only took a few minutes to fill out a form, swab my cheek, and done. I didn’t realize it, but 70% of bone marrow donations are done by pheresis, which is just like giving blood.

    >Ellen, a good college friend of mine and one of my bridesmaids, had a baby today. It blows my mind.

    Off to bed now, one of my favorite times of day!

  • When It Rains, It Pours (Or Insert Another Such Pun)

    Talk about a Monday.

    This morning I was in a patient’s room giving 9 o’clock meds when I heard the sound of running water. At first I thought it was the shower, or perhaps the sink. But there was no one else in the room. A few moments later my confusion evaporated when water began pouring from the ceiling near the door. I kid you not, within minutes the entire room was covered with an inch of water. Brown, stinky, disgusting water. Obviously chaos erupted.

    First of all, we had to get the patient and all of her belongings out of the room. That was interesting in itself considering she couldn’t walk and had to be wheeled in her bed. We found an empty room for the patient down the hall and parked her in it. At one point while I was in the leaky room packing her bags the light fixture crashed to the floor. Thankfully I was out of the way, but it sure scared me. We also soon discovered that the water leak was spreading to all of the other rooms nearby, but the one I was inside when it started by far got the worst of it. All in all we had to relocate 5-6 patients STAT.

    Once we got them out of the way we focused on containing the leak. We had already thrown down tons of blankets to keep the water from gushing into the hallway. Maintenance got there in a hurry and brought with them huge barrels to vacuum the water into. There might have been 6 inches of water in that room before they began to clean it. The hallway smelled like the big pipes that run through the bayou. I know what those smell like because I used to play in them with my brothers when I was young. We were safe and sanitary like that. They ended up shutting down the entire hall, even the rooms that weren’t affected, so that they could work. Our unit capacity was cut in half.

    So THAT was exciting. I have the day off tomorrow so I won’t have to deal with it. I’m secretly hoping that I won’t have to go in to work on Wednesday either, but that probably won’t happen.

    If the crazy work day weren’t enough, David and I came home to discover that our air conditioner isn’t working. I set it at 78 degrees before I left this morning, and when I got home it was 83. When I turned it down to cool off, hot air began blowing out, and immediately the temperature began to rise. Obviously, in Houston this is not acceptable, and that is why I am currently at my in-laws’ house (again) waiting to see if we will need a new A/C unit or not.

    Update: The compressor was locked up and needed a starter kit applied. So $440 later we’re back in our lovely home and cool as can be. I had better plans for that $440, but I just thank God it wasn’t $4400.

  • Floated!

    This morning when I got to work I found out that we were overstaffed. Usually when that happens they will call you at home and tell you not to come in, but I guess the hospital is trying to save money by not using flex staff (a group of nurses who don’t have an assigned unit, but just work wherever they’re needed) as much, because lately we are getting floated to other units a lot more often. Today, it was my turn.

    I was nervous because I had never floated before and I didn’t know what to expect. But thankfully everyone on the unit I went to was extremely nice and helpful. I don’t have a single bad thing to say about any of the people. It was just one floor below mine, but it has recently been remodeled so everything is a lot nicer and more up-to-date there. (Our unit hasn’t changed since the hospital was built in the 50’s.)

    The bad thing about that is all of the doors that lead to staff-only rooms there (like supply rooms, medication rooms, and the lounge) have badge-swipe entry, and the Pyxis machine, where 80% of the medications are stored, is accessed by fingerprint. But my badge isn’t set up for the doors, and my finger hasn’t been coded to their machine. So the entire day, whenever I wanted access to anything, I had to ask someone. It was very annoying, to me and I’m sure to them too.

    My patients were pretty much a breeze compared to what I’m used to. None of them really complained of anything, and they were mostly independent. It was a general medical floor, and I’m used to patients being a lot sicker than these were. A few hours into the day I got an admission. She was an 88-year-old lady who was extremely hard of hearing so if I wanted to talk to her I had to get RIGHT UP BY HER EAR AND TALK LIKE THIS. She was admitted due to a high fever, elevated white blood cell count, shortness of breath, and was coughing up junk. It was only after I had talked to her several times an inch away from her face, not to mention rolled her from side to side to position her, that I spoke with the doctor. He informed me that she was being put on respiratory isolation due to possible swine flu, and that I should wear a mask when I go in the room. Thanks, Doc. Thanks for being on top of that one. I hope David will still kiss me.

    Being floated also made me appreciate a lot of things about my own unit. My floor is so much more organized and well-stocked, for one thing. It also seems like the nurses there are more current on the latest research and protocols. And, I do have to say, oncology patients are so much more interesting. I think I would be bored out of my mind if I had to work with patients whose admitting diagnosis is “abdominal pain” every day, like 3 out of 4 of my patients today.

    But I got to leave on time today, and when I go back to my unit tomorrow for the dreaded Monday-after-working-the-weekend, I will be happy to be home.