Thursday, January 29, 2009

Almost Finished

One more day of class! I have to admit it I learned quite a bit. I think it's very helpful to give us "old" nurses the textbook brush up. The new grads in this class have impressed me they are smart as a whip! They have learned a lot of things that I only learned after I started working.

I met another "older" new nurse who just moved here from Pennsylvania to be near her daughter, son in law and grandkids. She is pretty funny. We compared Labor & Delivery stories today at lunch. The memorable deliveries we helped with and a bit about our own, you know typical table talk. It could've been worse like about enemas, wait we included that; always good for a couple of centimeters. What surprised me is that it seems like most of the hospitals pick the worst doctors to be Chief. The good ones who do really nice deliveries never seem to get anywhere in the hierarchy of things. It's politics. I laughed when she told me about the arrogant doc who didn't come when she told him too and got his nice expensive suit and shoes "splashed." He never ignored her again and actually had the humility to admit that she had called him in plenty of time, instead of blessing her out.

When I started nursing school I thought it was because I wanted to be a nurse midwife. I worked 6 months in L&D. I didn't have the stomach for all that blood exposure. I also worked at that time for another Catholic hospital that did about 230 deliveries a month, mostly for poor women and people of other nationalities. Ninety percent of the patients we served didn't speak any English. I learned how to ask how many babies have you had, in 4 different languages. We were all good at gestures and hollering poooohaaa! I don't convert for hepatitis immunity and we were exposed on an almost daily basis. Not to mention that hospital deliveries, at least at that time, still looked like a war zone. Everything was so stinkin technical and fast you barely had time to write your documentation much less admire the new little one. Not for me. I hurt my shoulder and that cinched the deal. Moving along to the next nursing experience which was pediatrics.
The parents will make you crazy, they are so freaked out. Calming down freaked out parents is the number one challenge in pediatrics and it's understandable.

A very big raise at a different hospital convinced me to try adult care, neuro-ortho. That is a strange combination but it's put together commonly. Now that is hard work! Total care neuro patients, require a great deal of assessments and interventions, they are also very rewarding when they get better. Orthopedic patients have pain and mobility issues and you can really break your back lifting all the gear that goes with total knees, and broken hips, setting up traction, moving patients etc,... definitely sweat equity.

When we had a prolonged period of low census instead of lay offs they rearranged the staffing. We were asked to voluntarily go to other units to keep our full time jobs. That was how I found myself in oncology. Never did I imagine working there. My mother died when I was 26 of breast cancer that had metastasized to the rest of her body. Her pain and nausea were not managed. She had terrible care, it was the way thigs were done then. I didn't think I could handle seeing other people have the same problems my mom had. Imagine my surprise when I found out that not only did my personal experience make me a better oncology nurse, but my patients appreciated when I shared with them. I have a very strong commitment to manage pain and suffering. My mothers experience fueled my energy and determination to do everything in my power and on my shift to solve problems. I did go the extra mile, give the extra touch. The best aspect of oncology nursing was the use of humor. These patients NEED to laugh. Many are in the hospital for long periods of time and we get to know the whole family. Being able to joke and "cut up" are life savers for these people. Staying serious and upset will bury people. Levity also deeply reassures critically ill people that this day is a good day, this day is a day of life. These patients are the most appreciative of any that a nurse can ever encounter. It was natural to spend some time at hospice too. Like I said before I'm a professional job hopper. Actually each of these moves were a minimum of one year to a maximum of 5.

Which brings us to the present day, orientation for a new job in medical/surgical ICU. It's a bit scary. The ventilators don't worry me. What worries me may seem strange. I worry about how I will handle seeing hospice appropriate patients in the ICU, it happens all the time. I'm skilled at bringing up the subject of death and dying with families. I'm not there to decrease how many patients we have in our beds, but I always want to do the RIGHT thing for the patient. I'm sorry but it's never right to code people in their 80's, it's barbaric. On the other hand life is sweet when it's your own and everybody deserves a chance.

The other thing I worry about is living on the technical end of nursing. What kind of relationships do ICU nurses develop? What if I'm not smart enough? Sometimes my mind won't fetch and retrieve words I'm looking for, what if I start stammering all over myself, and get the fumble fingers? I've always thought that critical care nurses have nerves of steel.

I know if it doesn't work out that I can change areas and go back to floor nursing, but it is really hard for me now. The truth is I am getting older and running those halls beats me up. I do pee when I need too, but no one ever gets enough to drink and it's not infequent to miss lunch break.
Especially in oncology where you are always hanging blood, platelets, chemo, and giving pain and nausea meds. You might be attempting to take a lunch break but when your call lights go off you get up, unless some one helps you out. Lunch is 10 minutes to eat. Charting is a break ( not really), to sit down and try to get your mind together. People don't realize what all goes on in a shift.

One evening I was having a very busy "group" of patients. One woman with metastasized breast cancer was taking a severe turn for the worse. I saw the signs of imminent death and notified her doctor, who notified her husband to come, and we changed her to be a "do not resuscitate." Considering how bad the cancer was, it had even surfaced to the outside of her chest and was visible, coding her would have been a terrible cruelty. It was not really expected though. Often patients take a good bit of time to go through the process of dying, it can be months. She went from answering my questions to leaving us in one shift, it happens but it's not usual. There was no real difference in medications , nothing out of the ordinary. Within the hour of my getting her status changed she died. I was very busy with her family preparing them, helping them, and making sure my patient didn't suffer. There is a whole lot that has to happen after a death, very time consuming, above all else the family must be supported.

While all of this was going on, one of my patients had used his call light to ask for assistance. No one had answered his light and when I went into his room he was really mad. I apologized and asked him what I could do for him. He wanted his nightstand moved so it would be more convenient for him to reach his things. That was fine, I moved it, but he continued to rave about the poor response time to his request. Finally I couldn't help myself I said, " I'm sorry sir but I had a patient die." He quit complaining, he didn't know anything about the person specifically to protect privacy, and he got a little much needed reality check. The hospital is not a hotel. We still have to prioritize, it's why the person at the desk asks if the nurse can bring something with her when she comes to your room, it's why we try to find out the need when the call light goes off. Nausea, vomiting, pain, bleeding, falls, dying, are all rapid response, hopefully help to the bathroom is in there too. I know everybody has a story about the terrible care they got in a hospital, but it's a tough job, somebody has to do it. It is important to remember the somebody is a human in a sea of suffering. There is no excuse for laziness but we all need to bear with each other in trying circumstances, for everybody's sake.


Anonymous said...

Nursing and teaching are not my thing. I have great respect for those in both of those fields.

There seems to be one not so great nurse per hospital stay. She/He may not be such a bad nurse its just the others just outshined her/him!!!
Thats my opinion and I'm sticking to it.
Keep up the great work.

Flea said...

Oh wow. I got nuthin' else. Just oh wow.

Chesapeake Bay Woman said...

I have to say I am speechless too, except for one thing, and that is that I never would have known that (aside from obvious situations like skin cancer, etc.) that Cancer could make itself so insidious that it would appear on someone's chest on the outside.

What you juggle on a daily basis makes most problems absolutely trivial.

Laura ~Peach~ said...

have been on both sides of this... as a nurse ready to rip my own hair out thanks to the typical insanity times 2 of work and as a patient who finally gave up on the nursing staff and begged the surgon to please send me home I could get better help from my kids... I stayed on PCA pump less than 24 hours post op went home at 60 hours post op with 152 staples in my abd... 3 Jp drains and tylenol for pain.... my kids had a crash course in being nursing aids and did wonderfully.

Unknown said...

I always thought nurses had one of the hardest jobs in the world. I can not even imagine all the things you have to go thru! Oh my. I am praying for you as you undertake this new endeavor.

Debbie in CA : ) said...

Anyone that confuses a hopsital with a hotel has a screw loose!! I've been in hospitals more than my share. I birthed my five babies with a bag packed and ready to leave as soon as I got a green light. (Lydia was my record ~~ home within 4 hours of delivery.)

The nurses work the hardest and receive the most flack. I have spent many a day/night ministering to nurses while sitting by Andrew's ICU bedside. I always told him we were missionaries to the staff and other patients. We always were.

Thank you for doing what you do!

Love you!

Becky said...

Wow. I can really appreciate this post having just come home from a hospital stay. I'm sure you do great in oncology and your patients are surely blessed.

My mom was an RN for years and so I do have somewhat of an insiders view of what you deal with. You are brave souls, I couldn't do it. I would probably do better at the hotel thing.

God Bless!

Flea said...

I'm tagging you in the morning.

Anonymous said...

Those are great stories. My husband always remembers this one patient while he was a resident and she was coding. Right in the middle of it she came out of it, told him a funny joke then instasntly died. He has never forgotten her and she died laughing and smiling. What a way to go.

Karen Deborah said...

NP that is cool!

Michelle said...

Whew....I found all of that so overwhelming. Nursing sounds like it takes such an emotional toll on a person.

Chris H said...

I do have a story about bad nursing care in a hospital! But I am sure each and every hospital/ward is different! You are one in a million cos I know you do care.

Heidi said...

I have missed you SO SO SO MUCH!!! What a great post my dear friend! I dont think that I have ever mentioned that my granny is an RN and all of the strange table conversation that we get into... Enema's, circumsition, bloody stool - you name it and its on the table!!! LOL I hope this works out for you just the way you want it to! LOVE YOU!!!