Signs your family doesn't understand your job #457

This week, my favorite auntie asked me "Have you given up on your dream to work in an abortion clinic?"
My mind was wandering a bit, so it took a while for the question to register. "I'm pretty happy with my current job--wait do you mean "family planning," by any chance?
"Yeah, that sounds about right."

Best drug seeker video ever!

This video explains perfectly why I like working public health better than working in hospitals. No one asks for narcotics when you're vaccinating them!
(Be sure to watch all of it--the last 30 seconds are priceless.)

Overheard at work

As I've said before, there's far fewer male nurses than female nurses employed by my hospital. Occasionally, this leads to some unintentional conflict in the break room. During lunch on my most recent shift, I overheard this conversation:
Female nurse #1: "I loved breastfeeding! Especially all the skin-to-skin bonding with the baby..." (sighs dreamily.)
Female nurse #2: "I know! But after my youngest got teeth at five months and nearly bit through my nipple, I had to wean her sooner than I wanted to."
Male nurse #1 to male nurse #2, very loudly: "SO I'VE GOT THIS PATIENT ON AN INSULIN DRIP..."

Que dia es hoy?

Ever forget what day of the week it is? I've never been particularly talented when it comes to time-management, but working nights has not helped.

Perhaps it's the fact that when I leave for work, it's Wednesday, but when I come home from work, it's now Thursday. Maybe it's how magically, every single night, I have to change the date on my charting when the clock turns over from 2359 to 0000. Or even the fact that on occasion, (this is Oregon I'm talking about) I have left for work, worked twelve or thirteen hours, returned from work, and then awakened after sleeping for several hours without seeing a single ray of sunshine!

When you're doing a neurological assessment on patients, it's important to make certain they're "oriented" to person, place/situation, and time. This means that my patient who answered the orientation questions with "Paul Revere," "1956," and "Amityville, Texas" was "oriented times zero." (To be fair, "Mr. Revere" had experienced such a catastrophic stroke that we were delighted that he was talking at all, regardless of whether or not he made sense.)

I know who I am, where I'm at, and (usually) what's going on, but without Microsoft's calendar on every computer, I don't have a prayer of guessing the day correctly. Guess I'm "oriented times two."

Gender issues

Nursng is traditionally a woman's role. Of the ten students I graduted with, only one was a man.
The male nurses I've had the chance to work with have been great, but occasionally the "gender issues" make working with them slightly odd.

Usually when it's only female staff working, our break room lunch time conversations revolve around fashion, celebs and kid and husband stuff. When the male staff are working with us, it can be a bit stilted. (And we generally pass on the discussions on how great Victoria Secret's semi- annual sale is--not that I think the guys would object to that topic of conversation.) Damn fine nurses, but a bit awkward nonetheless.

Because there are so few male nurses, patients also respond to them differently than they do to "you gals." Confused patients are notorious for mistaking male nurses for doctors. And even mentally competent patients often accept what the male nurses say with more authority than they do similar statements from me.

And after spending the last shift doing 1:1 nursing on a sweet elderly lady with dementia who yanked out her IV (twice!) repeatedly pulled off her heart monitor leads, and was spectacularly paranoid about allowing the staff to clean up her bloody sheets, give her oxygen, or give her important medications while screaming "you girls are all in this together!" at the top of her lungs, I really appreciate male nurses. Especially Billy and Jim *, who were kind enough to help me out by using their masculine charms to convince her to let them put in a new IV and get a quick shot of a handy antipsychotic.

*Any and all co-workers who may be mentioned in my blog have had names, ages, (occasionally genders) and other identifying details changed. Why? Because this blog is all about me.

Bad signs

There are many "bad signs" of nursing.

"It's never a good sign when her white count is higher than her hematocrit." (For people who haven't had their brains sucked out by the nursing profession, this means that the patient is probably septic and headed for the ICU.)

"I admitted the gal in room 208, and I ran out of space on the admission form for psychiatric diagnoses!" is not something you want to hear from the admitting nurse. Ever.

"I ran out of things to give for nausea and vomiting, but he's still puking!"

And yesterday's experience:
At the very begining of my shift, I answered a random elderly lady's call light, and she said, "Excuse me, but when are they coming to get the body?"
I looked across at her roommate (who I knew from the census was going to be going home with hospice the next day) and realized that she was somewhat grayish. In spite of the lousy color, she was still breathing regularly.
I reassured the first lady that her roommate was alive, but it understandably took a bit to get her relaxed. And after a quick conversation with the charge nurse, it took less than twenty minutes to find her a new room with an alert, non-dying roommate.

Back to being nocturnal

I've started working nights again. After working days at Mills-Peninsula and contintuously having my nursing "groove" interrupted by physical therapy, family members, speech therapy, physician rounds, telephone calls from family members, questions from family members who are present, etc. I'm very happy to be back on nights. It's a bit less friendly to my own personal sleeping and waking cycle, but I'm truly enjoying working a shift where the flow of the day fits better with my personal philosphy of nursing: Keep people's pain under control and let them get enough sleep to allow the body to heal.

I'm working at a local hospital, which thank God turns out to be the only one in the five-hospital constortium that offers 12 hour shifts. "Twelves" are rough on the nights I'm working, but leaves me with a lot more free time during the week with Brian and the Mimi than eight hour shifts do.

Mimi, by the way, is teething. She's got a visible tooth coming up on her lower jaw. She was much happier than usual this morning, and then turned into a complete Screaming Mimi this evening. I interpreted this evening's fussing as "I bit my tongue! And since I have absolutely no frame of reference for this event, I think it deserves a full-out four-alarm panic! WAAAAAAA!"

Gerbil!

I had my final (thank God!) day of nursing orientation today. I realize it's very hard to make any sort of required orientation entertaining, but by the time I got off work today, I felt as though all will to do anything had been sucked out of me.

One nice thing about working the floor is that being on my feet and moving for eight hours generally rocks Shirley to sleep. Unfortunately, sitting still for six to eight hours each day this week during orientation keeps her awake. And when she's awake, she likes to kick my internal organs.

This has caused me to realize something: I have the bladder capacity of a gerbil. Between the fact that Shirley takes up a surprising amount of space in my abdomen (leaving me with the uncomfortable realization that I have enough room for her, a full stomach, or a full bladder, but certainly not all three at the same time) and her regular karate kicks to my bladder, I had to go pee every hour and a half!

Every so often I start to wonder if catheters are really as uncomfortable as the patients claim. Sometimes, I think they'd be really convenient...

Words of Wisdom

Fred, one of the nurses from the telemetry floor (for patients who aren't sick enough for the intensive care unit, but still need a continuous heart monitor) is a bit of a legend at my workplace--he can get an IV in anybody.

Now I'm a fairly new nurse, but I've started enough intravenous lines in people to know that some people have good veins, and some people do not. (One's risk for having bad veins goes up in direct proportion to one's age. Every time I have to start an IV on anyone over 65, I wince, because I know I've got a less than 25% chance of getting it in myself.) And some people--especially fair skinned women with red hair--have complete and utter crap for veins. (For some reason known only to God, red headed men have veins that make nurses and plebotomists drool.) I've learned that there's really no point in torturing these poor souls by trying (and failing) to start an IV on them when I can ask a more experienced nurse to do it.

On the last night I worked, between Tammy (the other nurse) and I, we had at least five IVs that went bad and needed to be restarted. And as Cindy's Law (If anything can go wrong, it will, and when you're short staffed and the patients and families are cranky to boot) would have it, they all had lousy veins.

So we wound up calling and asking Fred to come down a lot. He was very gracious, and had much better luck with the process than we did. When we pressed him, he was even kind enough to share some of his tips for starting IVs with us.

"I don't get frustrated when it doesn't work the first time. I keep trying until I get it right."

Now this is a wonderful tip for the rest of life as well. But I bet the fact that the majority of Fred's patients are too sick to care if he has to try four or five times before he gets an IV line started probably helps.