Saturday, December 30, 2006
T minus 1 day
I start Stepdown ICU on Monday.
I'm excited, I'm nervous. I'm profoundly ready for a change.
It's what I hope nursing can be. It's the cream of the crop at my hospital, a place where all the nurses seem to be happy. It's what I hope will be a level of professionalism that I myself shoot for. I'm sure my expectations will get adjusted, but I'm also hoping they won't get adjusted as dramatically as they were in rehab.
So my coming posts will hopefully be full of fun adventures in my journey into critical care. Yay!
/jo
I'm excited, I'm nervous. I'm profoundly ready for a change.
It's what I hope nursing can be. It's the cream of the crop at my hospital, a place where all the nurses seem to be happy. It's what I hope will be a level of professionalism that I myself shoot for. I'm sure my expectations will get adjusted, but I'm also hoping they won't get adjusted as dramatically as they were in rehab.
So my coming posts will hopefully be full of fun adventures in my journey into critical care. Yay!
/jo
Sunday, December 24, 2006
Nursing != kumbaya
I hate cute.
I was always a kid with a dark streak. I was reading Alfred Hitchcock books when I was 11. I loved Nancy Drew, hated Barbie. My mom didn't get a girl who loved pink and lavendar, my mother was clawing at her face and moaning, "Could you PLEASE wear ANOTHER COLOR BESIDES BLACK?!?!"
I taught myself to program as a proto-teenager. Later, I chopped my blonde locks into something spiky my parents hated. Later, I went to college in a large city, studied art, smoked heavily and occasionally did illegal substances. I drank a lot of coffee. I made very large and disturbing oil paintings. Later, I translated those self-taught programming skills into my own business, and worked as a nerd for many years. I can code in 5 languages and can understand at least twice that number.
I don't smoke anymore. I stopped the drugs many years ago after an (deserved) incident with strychnine.
I became a nurse because I was at my dying grandfather's bedside. I wanted then, and still want, to ultimately be a hospice nurse. I'm more comfortable with death than with birth. The teenage dark streak was actually not rebellion, I really am creepy. But I want to do it not because I'm creepy, but because I get that dark is scary and I am not afraid to be present with somebody and provide comfort and good clinical care while they're afraid.
My point of telling you this is to say that nowhere in my life did I learn kumbaya. At no time did I ever gravitate to cute. Gender roles are not something I get.
The nursing I learned from my professors is one of clinical assessment, nursing judgement, pathophysiology and pharmacology. One of chemistry medmath and sound skills of listening and feedback grounded in clinical psych.
There are days I think I learned nursing from Betelgeuse. I don't know where that nursing is.
Too much of nursing is cute. Several people have blogged lately and railed against SpongeBob scrubs. I am in accord. I do wear patterns, Chinese coins, African masks, and Art Deco butterflies (which could be construed = cute), southwest Navajo motifs...in reds and dark purples and blues and greens. My excuse for not wearing solids is the art background. This might be a lame excuse.
I went to the Nurse Practice Council meeting for the first time last week. The love at that meeting made me feel like I was choking in a sea of cotton candy. "I want to thank SoNSo for their contribution and for..." "I want to thank you all for being here today...." "You all have done such a wonderful job with..."
We were all so busy thanking and congratulating each other, that nothing got accomplished.
I've had geek meetings that nothing gets accomplished, too. But it's "There's this problem with the code..." "This module keeps breaking...." "The customer wants this..." It may not translate to actionable items, but there's a lot less smiling sweetly and nodding and CLAPPING
...GOD...they CLAPPED that I had come to the meeting cos I said I was curious about NPC and what they're working on and wanted to see what I could do.
At a geek meeting, I'd've been saddled with the chunk of code that was written by Aramaic-speaking monkeys tripping on acid for that kind of volunteerism.
The trouble with kumbaya is that it isn't professionalism. So much huggy feely isn't discussion of how the latest clinical study could be communicated to, and implemented into the units. If we all need to be in consensus and accord, it flattens out the need for a person to drive hard up a clinical ladder for more responsibility, more autonomy, better pay, more respect.
If I, Joe Nobody, get the same vote weight at the table as the CNO...I think that's a problem. Really, I do. That woman defended her doctoral dissertation this week...who the f#ck am I next to her? If my vote and voice counts the same, doesn't that change a little bit my drive to go BE her in 10 years? Sure, I want a voice. But I'm okay with hierarchy, because my voice is still inexperienced and it's appropriate for more experience and better education to be at the steering wheel.
****
Just helped another nurse with a patient who was incontinent. "Let me help you clean up the pee-pee," she said.
...What's the solution? Wait until all the Granny Sunshines retire? What?!? Help me out here! How will we ever get intelligent professionals who WANT to be nurses when they "help clean up the pee-pee" and hug and kumbaya corn syrup all over each other...
!!
#!/bin/msh
#
read @vars /bin/rant.dat
foreach $vars
do
echo "And THIS is ANOTHER thing that makes me crazy:" $_
loop
exit 0
******
splat.... bang .....
/jo
I was always a kid with a dark streak. I was reading Alfred Hitchcock books when I was 11. I loved Nancy Drew, hated Barbie. My mom didn't get a girl who loved pink and lavendar, my mother was clawing at her face and moaning, "Could you PLEASE wear ANOTHER COLOR BESIDES BLACK?!?!"
I taught myself to program as a proto-teenager. Later, I chopped my blonde locks into something spiky my parents hated. Later, I went to college in a large city, studied art, smoked heavily and occasionally did illegal substances. I drank a lot of coffee. I made very large and disturbing oil paintings. Later, I translated those self-taught programming skills into my own business, and worked as a nerd for many years. I can code in 5 languages and can understand at least twice that number.
I don't smoke anymore. I stopped the drugs many years ago after an (deserved) incident with strychnine.
I became a nurse because I was at my dying grandfather's bedside. I wanted then, and still want, to ultimately be a hospice nurse. I'm more comfortable with death than with birth. The teenage dark streak was actually not rebellion, I really am creepy. But I want to do it not because I'm creepy, but because I get that dark is scary and I am not afraid to be present with somebody and provide comfort and good clinical care while they're afraid.
My point of telling you this is to say that nowhere in my life did I learn kumbaya. At no time did I ever gravitate to cute. Gender roles are not something I get.
The nursing I learned from my professors is one of clinical assessment, nursing judgement, pathophysiology and pharmacology. One of chemistry medmath and sound skills of listening and feedback grounded in clinical psych.
There are days I think I learned nursing from Betelgeuse. I don't know where that nursing is.
Too much of nursing is cute. Several people have blogged lately and railed against SpongeBob scrubs. I am in accord. I do wear patterns, Chinese coins, African masks, and Art Deco butterflies (which could be construed = cute), southwest Navajo motifs...in reds and dark purples and blues and greens. My excuse for not wearing solids is the art background. This might be a lame excuse.
I went to the Nurse Practice Council meeting for the first time last week. The love at that meeting made me feel like I was choking in a sea of cotton candy. "I want to thank SoNSo for their contribution and for..." "I want to thank you all for being here today...." "You all have done such a wonderful job with..."
We were all so busy thanking and congratulating each other, that nothing got accomplished.
I've had geek meetings that nothing gets accomplished, too. But it's "There's this problem with the code..." "This module keeps breaking...." "The customer wants this..." It may not translate to actionable items, but there's a lot less smiling sweetly and nodding and CLAPPING
...GOD...they CLAPPED that I had come to the meeting cos I said I was curious about NPC and what they're working on and wanted to see what I could do.
At a geek meeting, I'd've been saddled with the chunk of code that was written by Aramaic-speaking monkeys tripping on acid for that kind of volunteerism.
The trouble with kumbaya is that it isn't professionalism. So much huggy feely isn't discussion of how the latest clinical study could be communicated to, and implemented into the units. If we all need to be in consensus and accord, it flattens out the need for a person to drive hard up a clinical ladder for more responsibility, more autonomy, better pay, more respect.
If I, Joe Nobody, get the same vote weight at the table as the CNO...I think that's a problem. Really, I do. That woman defended her doctoral dissertation this week...who the f#ck am I next to her? If my vote and voice counts the same, doesn't that change a little bit my drive to go BE her in 10 years? Sure, I want a voice. But I'm okay with hierarchy, because my voice is still inexperienced and it's appropriate for more experience and better education to be at the steering wheel.
****
Just helped another nurse with a patient who was incontinent. "Let me help you clean up the pee-pee," she said.
...What's the solution? Wait until all the Granny Sunshines retire? What?!? Help me out here! How will we ever get intelligent professionals who WANT to be nurses when they "help clean up the pee-pee" and hug and kumbaya corn syrup all over each other...
!!
#!/bin/msh
#
read @vars /bin/rant.dat
foreach $vars
do
echo "And THIS is ANOTHER thing that makes me crazy:" $_
loop
exit 0
******
splat.... bang .....
/jo
Oh, rehab...
This is a cranky and critical post.
But I'm SO ready to be off rehab.
These are retirement nurses. And their concerns (or lack thereof) make me nuts.
The new guy I'm orienting again Monday is nice. He went to nursing school 10 years ago, flunked the NCLEX, worked in retail management 10 years, studied for the NCLEX out of a book, took it and passed it. Bam! He's a nurse and he's orienting on my unit.
He didn't know he needed to have a stethoscope. Or a drug book/PDA pharm reference. He did show up wearing scrubs, though.
You, too, can be a licensed RN by studying books, I guess.
The New Guy has no practical skills. He hasn't touched a patient except for clinicals 10 years ago. He doesn't know how to take vital signs. He stands behind the patient s/p L5-S2 fusion to talk to him. It doesn't occur to him that the vomiting patient who cannot speak wants to brush her teeth after we get her cleaned up. He doesn't have the lingo....'LRE' is not how you note right lower extremity. He doesn't know where on the back to listen to lungs (I had to tell him to listen to the back), how to describe the sound ("I heard gurgling"), much less what it might mean in the total picture of the pt's dx, comorbidities, funky bicarbonate and elevated temp.
He can learn. However, I can't teach him med-surg in four shifts, much less rehab. Trouble is that in my hospital, people regard rehab = TCU. GOOD rehab is med-surg knowledge PLUS physical medicine and speech/cognitive therapy. Sadly here, people are content to have rehab being the nursing pasture.
Except that the patient acuity is changing and and it is not okay to have this the nurses' retirement home anymore. We all know patients are sicker everywhere now. Medicare is making that dramatically so in rehab, because it's pushing patients out of the hospitals and into the SNiFs unless they have complex comorbidities, or are among 13 diagnoses...most of which are neuro. We are not ortho TCU anymore.
And no matter what the Head of Education says, this is NOT an ideal place at ALL for a new nurse to start. No support at NOC, Old Guard nurses who are just NOT interested in handling this acuity, patients that can and increasingly do turn on a dime.
Don't you want your new grad with a few other nurses who know what to do in a crisis? Not an LPN of 30 years who hasn't listened to a lung sound in the past 10 of those years? You know, the LPN who infused NS c 20mEq of KCl at 755mL/hr this year? ...Cos the "pumps are tricky"...the one whose head is planted in a pillow 6 feet away from me right now.
Yeah, I want the new guy as the RN with her on a night like that. *boggle*
It's not that the guy can't learn, of course he can. He is not ready to have the training wheels ripped off in 6 weeks.
Not much I can do but pass on what I think to our manager (who is not a nurse), and go trotting off to stepdown. I guess this is how it goes.
/jo
But I'm SO ready to be off rehab.
These are retirement nurses. And their concerns (or lack thereof) make me nuts.
The new guy I'm orienting again Monday is nice. He went to nursing school 10 years ago, flunked the NCLEX, worked in retail management 10 years, studied for the NCLEX out of a book, took it and passed it. Bam! He's a nurse and he's orienting on my unit.
He didn't know he needed to have a stethoscope. Or a drug book/PDA pharm reference. He did show up wearing scrubs, though.
You, too, can be a licensed RN by studying books, I guess.
The New Guy has no practical skills. He hasn't touched a patient except for clinicals 10 years ago. He doesn't know how to take vital signs. He stands behind the patient s/p L5-S2 fusion to talk to him. It doesn't occur to him that the vomiting patient who cannot speak wants to brush her teeth after we get her cleaned up. He doesn't have the lingo....'LRE' is not how you note right lower extremity. He doesn't know where on the back to listen to lungs (I had to tell him to listen to the back), how to describe the sound ("I heard gurgling"), much less what it might mean in the total picture of the pt's dx, comorbidities, funky bicarbonate and elevated temp.
He can learn. However, I can't teach him med-surg in four shifts, much less rehab. Trouble is that in my hospital, people regard rehab = TCU. GOOD rehab is med-surg knowledge PLUS physical medicine and speech/cognitive therapy. Sadly here, people are content to have rehab being the nursing pasture.
Except that the patient acuity is changing and and it is not okay to have this the nurses' retirement home anymore. We all know patients are sicker everywhere now. Medicare is making that dramatically so in rehab, because it's pushing patients out of the hospitals and into the SNiFs unless they have complex comorbidities, or are among 13 diagnoses...most of which are neuro. We are not ortho TCU anymore.
And no matter what the Head of Education says, this is NOT an ideal place at ALL for a new nurse to start. No support at NOC, Old Guard nurses who are just NOT interested in handling this acuity, patients that can and increasingly do turn on a dime.
Don't you want your new grad with a few other nurses who know what to do in a crisis? Not an LPN of 30 years who hasn't listened to a lung sound in the past 10 of those years? You know, the LPN who infused NS c 20mEq of KCl at 755mL/hr this year? ...Cos the "pumps are tricky"...the one whose head is planted in a pillow 6 feet away from me right now.
Yeah, I want the new guy as the RN with her on a night like that. *boggle*
It's not that the guy can't learn, of course he can. He is not ready to have the training wheels ripped off in 6 weeks.
Not much I can do but pass on what I think to our manager (who is not a nurse), and go trotting off to stepdown. I guess this is how it goes.
/jo
Friday, December 15, 2006
Change of Shift is up!
Over at Protect the Airway....
(And it looks really good this week...arg! that I can't dive in until Monday or so...)
/jo
(And it looks really good this week...arg! that I can't dive in until Monday or so...)
/jo
Dear Santa,
I want to write to you about what a good nurse I've been this year.
For example, let me tell you what a good job I did with a patient I discharged yesterday. He is an alcoholic, and he was under the influence and an doing extreme sport in our beloved Rocky Mountains. Now you may know that the Rocky Mountains are full of rocks, some of which are made of granite. My patient fell down and now he has a hard time remembering who's president.
But I did a good job with him. I kept him safe and didn't let him fall even when he was threatening to hit me if I didn't get out of his way. I gave him medications to keep him from having seizures and to keep his blood pressure in a good range so the injury didn't grow worse.
And when his caregiver, whose judgement the courts deem sound, wanted to take my patient home yesterday. But the caregiver believes the patient will be driving again in two weeks. The doctors, the nurses and all the therapists think another 2 - 3 weeks inpatient is ideal, and when the word 'driving' is floated, it is met by widened eyes. However, the MD discharged the patient and I helped get him ready. I prepared discharge paperwork and I sat with the patient and the caregiver and reviewed everything.
Now I know my patient likes to drink. And there's a medicine my patient takes that can cause him to keel over dead if he drinks while taking this medicine. I used a big fat highlighter to explain this to the patient and the caregiver. I was REALLY ADAMANT about how important this was. And when the caregiver said, "Well, what I want him to do and what he does are two different things", I did not turn into a howling banshee and hit anybody.
I documented the heck out of my teaching to the patient and caregiver like a good nurse.
So you see, Santa, I was a good nurse. What I would like most for Christmas this year is a hovercraft.
Love and homemade cookies,
/justcallmejo
For example, let me tell you what a good job I did with a patient I discharged yesterday. He is an alcoholic, and he was under the influence and an doing extreme sport in our beloved Rocky Mountains. Now you may know that the Rocky Mountains are full of rocks, some of which are made of granite. My patient fell down and now he has a hard time remembering who's president.
But I did a good job with him. I kept him safe and didn't let him fall even when he was threatening to hit me if I didn't get out of his way. I gave him medications to keep him from having seizures and to keep his blood pressure in a good range so the injury didn't grow worse.
And when his caregiver, whose judgement the courts deem sound, wanted to take my patient home yesterday. But the caregiver believes the patient will be driving again in two weeks. The doctors, the nurses and all the therapists think another 2 - 3 weeks inpatient is ideal, and when the word 'driving' is floated, it is met by widened eyes. However, the MD discharged the patient and I helped get him ready. I prepared discharge paperwork and I sat with the patient and the caregiver and reviewed everything.
Now I know my patient likes to drink. And there's a medicine my patient takes that can cause him to keel over dead if he drinks while taking this medicine. I used a big fat highlighter to explain this to the patient and the caregiver. I was REALLY ADAMANT about how important this was. And when the caregiver said, "Well, what I want him to do and what he does are two different things", I did not turn into a howling banshee and hit anybody.
I documented the heck out of my teaching to the patient and caregiver like a good nurse.
So you see, Santa, I was a good nurse. What I would like most for Christmas this year is a hovercraft.
Love and homemade cookies,
/justcallmejo
How weird is it and A little about restraints
...when your CNO leaves a book in your little inbox called, "Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference"...?
A book, mind you. Not a bookLET, a 280 page softcover book.
By the way, I've been busy with holidays and ...okay, that's a lie. I've been busily taking Sudafed, eating soup and quilting. Okay, SOME of the things I've been doing is shopping and wrapping presents. I want to have been busily writing cards, but I haven't.
I wanted to post a followup to what I said last time in "Babel Fish". I don't want anyone to think that I'm laughing at people with TBI. Ever. I hope it didn't sound that way. I wanted to write about restraints, actually. Another blog I pop over to, Death Maiden's place, was talking about that a few weeks ago. Some fleeting brain dump on the subject:
The patient with the Great Escape plan did just that today: he went AMA. (Against medical advice.) I hear he's "better", but if he's leaving AMA, clearly physical or occupational therapy thought there was room for hospital-based improvement, and not just outpatient.
But I have a new brain injured patient tonight. He has a posey bed (Vail bed), and I don't have it zipped up so he's not actually restrained at the moment. He's sleeping and refusing all oral medications. Fortunately a 97/63 bp means I wasn't gonna give the bp meds anyway. But there's some antipsychotics NOT floating around in his body that should be and I'm waiting for the crazy any minute.
I spent an hour tonight with his sweet wife, who tearfully tells me "He's not like this, he's a NICE PERSON." Nobody said he wasn't, regardless of how he's called each of us several expletives today. I believe her. It's part of the pathophysiology. She's 100 lbs soaking wet and saying, "If I just took him home and got him to clear from the meds, he'd be okay, right?"
No, my dear, we all want that to be true but it is not. Right now, your beloved husband is not himself and he could hurt you. He could hurt himself. What happens when he says, "Honey, I'm going to work", gets behind the wheel of a car, seizes, and kills himself and the family of 4 in the minivan he crashes? He can't walk to the bathroom by himself right now. He was demanding his car keys this morning, right before he managed to get into the elevator and wouldn't come out without the kind assistance of four security guards.
It's horrible to watch her go through this. She didn't see the episode this morning, so she doesn't *really* believe me when I tell her he was combative. He tells her to "get the fuck away from me" and she looks startled. I'm sure he has never spoken to her this way in his life. Even with that verbal slap to the face, she doesn't believe he could be violent. I tried to get the patient to open his eyes by gently rubbing his shoulder and saying "Joe Schmo, open your eyes for me please" and he balled up his fists and said, "Leave me alone or I'll fucking fight you." She heard these things, and she cannot believe it. "This is the man I love," she says with tears in her eyes. Yes. And given some time, he will come back to you. Right now, his judgement is impaired, and self-control at a low and higher cerebral function is out the window. He's operating at a bit lower on Maslow's hierarchy of needs. Hit scary strangers trying to make me put pills in my mouth first, dialogic reasoning a couple weeks later.
Did I mention he's a good 6 inches taller, a good 60 pounds heavier and substantially more muscled than me? Ergo, he's in a bed that zips up so he cannot easily get out. (I'm sure someone has managed to escape a Vail bed, I just haven't seen it yet.)
Did I ever tell you that when I was a CNA, I worked with a woman who'd had her jaw broken from a brain-injured patient?
Did I ever tell you about the time a guy threw a telephone at my coworker while we were 2:1 sitting him?
How bout the guy that swung at me for an hour, screaming at the top of his lungs that he wanted a cigarrette? (Bless some aspects of brain injury: rotten aim)
Just so you realize that I don't find restraints funny, nor are people with brain injury funny. (Except when they are.) We don't restrain people here unless we absolutely HAVE TO. We don't gork patients out on meds for fun or don't want to deal with them. But I'll be damned if I'm gonna devote my career to caring for other people and helping and DOING something real for the world...and then have one person who's confused bust my jaw cos s/he can't have a cigarrette.
On the upside: the guy with the telephone? IV Niacin cleared him up like nothing ever happened. Once out of the ICU, he came back to us just the politest, kindest, most lovely patient you could hope to have. He didn't remember any of us, didn't remember the night of the 42 blood sugar, didn't remember the night of the seizures, didn't remember the babbling and drooling and, as Laura memorably put "he's lookin like a yard sale". This was a new man.
Nobody mentioned the projectile telephone bit. He's home, doing well, back to being independent.
Anyway.
****************
I'm looking at this book and still weirded out. Why is the CNO giving me, new grad + 1 yr out RN, a ...leadership book. I'm getting Soylent Green/podpeople kind of oogies. This IS weird, right?
A book, mind you. Not a bookLET, a 280 page softcover book.
By the way, I've been busy with holidays and ...okay, that's a lie. I've been busily taking Sudafed, eating soup and quilting. Okay, SOME of the things I've been doing is shopping and wrapping presents. I want to have been busily writing cards, but I haven't.
I wanted to post a followup to what I said last time in "Babel Fish". I don't want anyone to think that I'm laughing at people with TBI. Ever. I hope it didn't sound that way. I wanted to write about restraints, actually. Another blog I pop over to, Death Maiden's place, was talking about that a few weeks ago. Some fleeting brain dump on the subject:
The patient with the Great Escape plan did just that today: he went AMA. (Against medical advice.) I hear he's "better", but if he's leaving AMA, clearly physical or occupational therapy thought there was room for hospital-based improvement, and not just outpatient.
But I have a new brain injured patient tonight. He has a posey bed (Vail bed), and I don't have it zipped up so he's not actually restrained at the moment. He's sleeping and refusing all oral medications. Fortunately a 97/63 bp means I wasn't gonna give the bp meds anyway. But there's some antipsychotics NOT floating around in his body that should be and I'm waiting for the crazy any minute.
I spent an hour tonight with his sweet wife, who tearfully tells me "He's not like this, he's a NICE PERSON." Nobody said he wasn't, regardless of how he's called each of us several expletives today. I believe her. It's part of the pathophysiology. She's 100 lbs soaking wet and saying, "If I just took him home and got him to clear from the meds, he'd be okay, right?"
No, my dear, we all want that to be true but it is not. Right now, your beloved husband is not himself and he could hurt you. He could hurt himself. What happens when he says, "Honey, I'm going to work", gets behind the wheel of a car, seizes, and kills himself and the family of 4 in the minivan he crashes? He can't walk to the bathroom by himself right now. He was demanding his car keys this morning, right before he managed to get into the elevator and wouldn't come out without the kind assistance of four security guards.
It's horrible to watch her go through this. She didn't see the episode this morning, so she doesn't *really* believe me when I tell her he was combative. He tells her to "get the fuck away from me" and she looks startled. I'm sure he has never spoken to her this way in his life. Even with that verbal slap to the face, she doesn't believe he could be violent. I tried to get the patient to open his eyes by gently rubbing his shoulder and saying "Joe Schmo, open your eyes for me please" and he balled up his fists and said, "Leave me alone or I'll fucking fight you." She heard these things, and she cannot believe it. "This is the man I love," she says with tears in her eyes. Yes. And given some time, he will come back to you. Right now, his judgement is impaired, and self-control at a low and higher cerebral function is out the window. He's operating at a bit lower on Maslow's hierarchy of needs. Hit scary strangers trying to make me put pills in my mouth first, dialogic reasoning a couple weeks later.
Did I mention he's a good 6 inches taller, a good 60 pounds heavier and substantially more muscled than me? Ergo, he's in a bed that zips up so he cannot easily get out. (I'm sure someone has managed to escape a Vail bed, I just haven't seen it yet.)
Did I ever tell you that when I was a CNA, I worked with a woman who'd had her jaw broken from a brain-injured patient?
Did I ever tell you about the time a guy threw a telephone at my coworker while we were 2:1 sitting him?
How bout the guy that swung at me for an hour, screaming at the top of his lungs that he wanted a cigarrette? (Bless some aspects of brain injury: rotten aim)
Just so you realize that I don't find restraints funny, nor are people with brain injury funny. (Except when they are.) We don't restrain people here unless we absolutely HAVE TO. We don't gork patients out on meds for fun or don't want to deal with them. But I'll be damned if I'm gonna devote my career to caring for other people and helping and DOING something real for the world...and then have one person who's confused bust my jaw cos s/he can't have a cigarrette.
On the upside: the guy with the telephone? IV Niacin cleared him up like nothing ever happened. Once out of the ICU, he came back to us just the politest, kindest, most lovely patient you could hope to have. He didn't remember any of us, didn't remember the night of the 42 blood sugar, didn't remember the night of the seizures, didn't remember the babbling and drooling and, as Laura memorably put "he's lookin like a yard sale". This was a new man.
Nobody mentioned the projectile telephone bit. He's home, doing well, back to being independent.
Anyway.
****************
I'm looking at this book and still weirded out. Why is the CNO giving me, new grad + 1 yr out RN, a ...leadership book. I'm getting Soylent Green/podpeople kind of oogies. This IS weird, right?
Saturday, December 9, 2006
Babel Fish
Okay, the truth is that I do enjoy working with brain injured people sometimes.
We got an admission tonight who reminds me of M, who I told many stories about few months back on livejournal. (I could repost here.) I was really fond of M. From M's condition and prognosis on arrival to where he was when he left? We made a rocket scientist out of him. And the entire team here fought tooth and nail for every inch. That crazy bastard enriched my life more than I ever did squat for him.
So tonight's admit is not even my patient, but P is stepping back a lot and letting me kind of manage him. It's been okay in this case that she wants me to take over for (yet another) patient she can't manage well because she's not pretending it's so I can "practice", I'm getting paid to be charge tonight and she actually asked for a hand tonight BEFORE something went horribly awry.
And he's nuts. Nuts in that way only the head-bonked seem to be, which is not the same as dementia or Axis I psych. He's quite friendly, and so far hasn't taken a swing at anybody. He tried to leave and we did have to do some IVP meds and he's got a posey bed, which he hates. (As you would, too.) But we're managing and he's having a fantastic night all things considered.
But he's uniquely funny in the way of someone with a TBI too. And I'm not laughing at...what I find funny is how beautifully the mind works and the connections it makes. It's like there's a layer of film of varying murkiness between some people with TBI and you...a layer that can only be crossed with a Babel Fish.
Had a patient once substitute "train" for the word "clock". Once I had that translation click through the Babel Fish, not only did I understand the patient, I felt like I got this glimpse of color about the person's life. His look was of someone who speaks a language you do not, but through charades and well-intentioned, but mangled conjugations, meaning suddenly shines through. Yes! You know what I'm saying! And to me, it felt like a deeper understanding somehow than if he'd used the proper noun.
Train. Clock. A smidge of viridian green left over from here, or an arch of charcoal over there. Color worth the work it took through translation.
So this new guy woke up at 0300 (in his poseybed) and he called out, "Can I get some help in here?" So S (CNA) gets up to go help. "....And can I get a butter knife?"
And I think of the Great Escape and somewhere I wonder if he's planning on hiding the butter knife in his sock so he can hunker down and dig his way out of his posey bed when we're not looking.
And it makes me laugh deep. Because that makes SO much sense.
And I have decided that I really like this guy and I'm looking forward to more through the Babel Fish.
/jo
We got an admission tonight who reminds me of M, who I told many stories about few months back on livejournal. (I could repost here.) I was really fond of M. From M's condition and prognosis on arrival to where he was when he left? We made a rocket scientist out of him. And the entire team here fought tooth and nail for every inch. That crazy bastard enriched my life more than I ever did squat for him.
So tonight's admit is not even my patient, but P is stepping back a lot and letting me kind of manage him. It's been okay in this case that she wants me to take over for (yet another) patient she can't manage well because she's not pretending it's so I can "practice", I'm getting paid to be charge tonight and she actually asked for a hand tonight BEFORE something went horribly awry.
And he's nuts. Nuts in that way only the head-bonked seem to be, which is not the same as dementia or Axis I psych. He's quite friendly, and so far hasn't taken a swing at anybody. He tried to leave and we did have to do some IVP meds and he's got a posey bed, which he hates. (As you would, too.) But we're managing and he's having a fantastic night all things considered.
But he's uniquely funny in the way of someone with a TBI too. And I'm not laughing at...what I find funny is how beautifully the mind works and the connections it makes. It's like there's a layer of film of varying murkiness between some people with TBI and you...a layer that can only be crossed with a Babel Fish.
Had a patient once substitute "train" for the word "clock". Once I had that translation click through the Babel Fish, not only did I understand the patient, I felt like I got this glimpse of color about the person's life. His look was of someone who speaks a language you do not, but through charades and well-intentioned, but mangled conjugations, meaning suddenly shines through. Yes! You know what I'm saying! And to me, it felt like a deeper understanding somehow than if he'd used the proper noun.
Train. Clock. A smidge of viridian green left over from here, or an arch of charcoal over there. Color worth the work it took through translation.
So this new guy woke up at 0300 (in his poseybed) and he called out, "Can I get some help in here?" So S (CNA) gets up to go help. "....And can I get a butter knife?"
And I think of the Great Escape and somewhere I wonder if he's planning on hiding the butter knife in his sock so he can hunker down and dig his way out of his posey bed when we're not looking.
And it makes me laugh deep. Because that makes SO much sense.
And I have decided that I really like this guy and I'm looking forward to more through the Babel Fish.
/jo
Thursday, December 7, 2006
Twelve more shifts of rehab
...and every single one is gonna be like climbing over boulders to the summit.
With hail the size of golfballs, and not having the sense to turn around and stumble down the mountain. And the black clouds boiling just past the summit, which you can see beyond Mt. Massive, for example.
It's nice that I can speak nicely of rehab on my days off. When I'm here, I can't. I'm cranky about having to go to work from the moment I wake up and notice that my bedroom light is dimming. As always, I like my patients. I spent good time with all four. Everybody is sleeping, pain-free (as far as the snoring tells me), properly anticoagulated (strokes, THAs and TKAs), have happily percolating GI tracts, are voiding adequate amounts, and the two with stage 1 sores are being flipped q2...and a few have specimens in petri dishes to see if anything grows.
It's my colleague who isn't managing the geriatric COPD'er with the new small bowel obstruction...the woman who has been wailing and gnashing her teeth for (Jo looks at clock) nine solid hours so far.
Snippets from a real conversations....
The players:
RN of six years experience, who took this job "because it was babysitting"
Me.
Other RN: "She might need an NG tube."
Me (who, at 0200, is already reading pulp fiction being done with everything I can think of to do): "Mmm. Might."
Other RN: "Would you like to practice putting an NG in?"
Me, looking up and she's avoiding looking at me: "Considering I'm the only nurse who's put one in this year, yes, I can do it for you if you don't feel comfortable doing so yourself, OtherRN."
Other RN doesn't reply. I go back to my book.
Other RN gets the countremand order to not place it, anyway. Other RN: "I don't know why Dr. K doesn't want one when Dr. B does."
Me: "Mmmmummmummm. (I don't know.) Maybe cos she's not vomiting and she pooped today and he's coming to see her early in the morning and the Xray was preliminary and he didn't look at it himself cos he was home asleep ...and he maybe figures she's NPO now. Dunno. An NG's gonna slurp up gastric juice, it wouldn't resolve an obstruction or ileus just by having suction, would it?" I wasn't being sarcastic with her. I genuinely don't know why no NG tonight. I'm not a gastroenterologist. Maybe I'd sink one, maybe I wouldn't. Not a GI nurse, either. I don't know these things, but apparently OtherRN is having a hard time thinking that through.
....But might it have occurred to her, since the woman has been moaning and crying for (Jo looks at clock) TEN hours, to get the poor thing something for pain?
Am I just mean? I feel mean.
She called the nursing supervisor to start a peripheral IV. Before attempting it herself, and before saying, "Hey Jo, would you look at her veins?" The woman might be elderly, but she had pipes. A drunken monkey could've found a vein and poked it.
Gah!
Twelve more shifts. The vast majority of them with this nurse, too.
/jo
And I'm already dreading tomorrow, where we send two patients home and I'll have THREE tomorrow night. At least there's a NOC magnet meeting (yes, we're trying to join the club) to give me something to do for an hour. Gah.
It's only 5....
p.s. Of COURSE I *cough* suggested she ask the MD for more pain meds. Reply? "But I just gave her (insert mild narc here)." gah...
With hail the size of golfballs, and not having the sense to turn around and stumble down the mountain. And the black clouds boiling just past the summit, which you can see beyond Mt. Massive, for example.
It's nice that I can speak nicely of rehab on my days off. When I'm here, I can't. I'm cranky about having to go to work from the moment I wake up and notice that my bedroom light is dimming. As always, I like my patients. I spent good time with all four. Everybody is sleeping, pain-free (as far as the snoring tells me), properly anticoagulated (strokes, THAs and TKAs), have happily percolating GI tracts, are voiding adequate amounts, and the two with stage 1 sores are being flipped q2...and a few have specimens in petri dishes to see if anything grows.
It's my colleague who isn't managing the geriatric COPD'er with the new small bowel obstruction...the woman who has been wailing and gnashing her teeth for (Jo looks at clock) nine solid hours so far.
Snippets from a real conversations....
The players:
RN of six years experience, who took this job "because it was babysitting"
Me.
Other RN: "She might need an NG tube."
Me (who, at 0200, is already reading pulp fiction being done with everything I can think of to do): "Mmm. Might."
Other RN: "Would you like to practice putting an NG in?"
Me, looking up and she's avoiding looking at me: "Considering I'm the only nurse who's put one in this year, yes, I can do it for you if you don't feel comfortable doing so yourself, OtherRN."
Other RN doesn't reply. I go back to my book.
Other RN gets the countremand order to not place it, anyway. Other RN: "I don't know why Dr. K doesn't want one when Dr. B does."
Me: "Mmmmummmummm. (I don't know.) Maybe cos she's not vomiting and she pooped today and he's coming to see her early in the morning and the Xray was preliminary and he didn't look at it himself cos he was home asleep ...and he maybe figures she's NPO now. Dunno. An NG's gonna slurp up gastric juice, it wouldn't resolve an obstruction or ileus just by having suction, would it?" I wasn't being sarcastic with her. I genuinely don't know why no NG tonight. I'm not a gastroenterologist. Maybe I'd sink one, maybe I wouldn't. Not a GI nurse, either. I don't know these things, but apparently OtherRN is having a hard time thinking that through.
....But might it have occurred to her, since the woman has been moaning and crying for (Jo looks at clock) TEN hours, to get the poor thing something for pain?
Am I just mean? I feel mean.
She called the nursing supervisor to start a peripheral IV. Before attempting it herself, and before saying, "Hey Jo, would you look at her veins?" The woman might be elderly, but she had pipes. A drunken monkey could've found a vein and poked it.
Gah!
Twelve more shifts. The vast majority of them with this nurse, too.
/jo
And I'm already dreading tomorrow, where we send two patients home and I'll have THREE tomorrow night. At least there's a NOC magnet meeting (yes, we're trying to join the club) to give me something to do for an hour. Gah.
It's only 5....
p.s. Of COURSE I *cough* suggested she ask the MD for more pain meds. Reply? "But I just gave her (insert mild narc here)." gah...
Monday, December 4, 2006
What I learned in rehab nursing, pt 2
I do have a few favorite ministories from this year. Things I learned by doing something good:
Healing has to be in your head first
We all know this. There are people out there (and some of them are patients, and some are friends, some are family) who love their diseases. Most people just need the unyielding not-up-for-discussion nudge from their rehab nurse.
I had a patient with pancreatitis who hadn't been up OOB in 6 months. "Let's get you walking up to the bed here." "But I haven't stood in 6 months." "That's okay, B (my fabulous CNA) and I are here to support you. Just put your hands and feet where I tell you to, and do the best you can." Leaving no time to argue, B and I get her up and supported, she walks to the bed. B and I get her tucked in with teamwork that shows this is No Big Deal and we have done this A Million Times Before. We make sure patient's comfortable, is properly fluffed, and I gather up my clipboard to go see my next victim. I'm about to say Can I Get You Anything Else Right Now, and she's staring off into space.
"What is it?" I ask.
"That was the first five steps I've taken in six months."
I grin evilly. "I know it was."
She focuses for a moment. I'm still grinning as I turn and airily say, "Bang on the call light when you need me."
I close the door behind me and she's still staring into space, only with the beginnings of a cockeyed smile on her face.
She walked home (with a walker.) Before she left, she knitted hats for me and for B. Knitting was part of her personal mission to get her fine motor control back. My hat is peach and pink and has a fuzzy on top. She was truly one of my favorite people this year.
Good pain control works wonders
I had a middle-aged man who'd had several back surgeries tell me how it's so hard to get up and move because he hurts so much. So I woke him up through the night to give scheduled pain meds. At 0600, this patient got out of bed, walked himself to our unit shower, dress himself, walked 600 FEET to the next unit which has the good coffee machine and brought back cups of coffee for all three of us NOC shifters.
I certainly didn't always do the right thing this year. I'll tell those stories, too. But on these two, I did something right.
/jo
Healing has to be in your head first
We all know this. There are people out there (and some of them are patients, and some are friends, some are family) who love their diseases. Most people just need the unyielding not-up-for-discussion nudge from their rehab nurse.
I had a patient with pancreatitis who hadn't been up OOB in 6 months. "Let's get you walking up to the bed here." "But I haven't stood in 6 months." "That's okay, B (my fabulous CNA) and I are here to support you. Just put your hands and feet where I tell you to, and do the best you can." Leaving no time to argue, B and I get her up and supported, she walks to the bed. B and I get her tucked in with teamwork that shows this is No Big Deal and we have done this A Million Times Before. We make sure patient's comfortable, is properly fluffed, and I gather up my clipboard to go see my next victim. I'm about to say Can I Get You Anything Else Right Now, and she's staring off into space.
"What is it?" I ask.
"That was the first five steps I've taken in six months."
I grin evilly. "I know it was."
She focuses for a moment. I'm still grinning as I turn and airily say, "Bang on the call light when you need me."
I close the door behind me and she's still staring into space, only with the beginnings of a cockeyed smile on her face.
She walked home (with a walker.) Before she left, she knitted hats for me and for B. Knitting was part of her personal mission to get her fine motor control back. My hat is peach and pink and has a fuzzy on top. She was truly one of my favorite people this year.
Good pain control works wonders
I had a middle-aged man who'd had several back surgeries tell me how it's so hard to get up and move because he hurts so much. So I woke him up through the night to give scheduled pain meds. At 0600, this patient got out of bed, walked himself to our unit shower, dress himself, walked 600 FEET to the next unit which has the good coffee machine and brought back cups of coffee for all three of us NOC shifters.
I certainly didn't always do the right thing this year. I'll tell those stories, too. But on these two, I did something right.
/jo
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