Spring wrap up . . . .

There are so many other little things that happened in Spring 2011 . . . so let’s just dump it all here:

My family came to visit for a weekend!  It was fun, and I love when they are here!  Ashley was taking a photography course, so she was taking odd pics around town.

Valentines day!

From Brennen, he knows his Mama!

How things in marriage work!

We had some HUGE hail:

Timmy centered his inner-monkey:

Love our late night fishing trip and bon fire

In April, I started to work in the Intensive Care Unit, and I LOVE it!  It’s a totally different realm of nursing.  I feel like I can make such a difference in my job!  :) One of my good friends bought me a birthday cake when I had to work on my birthday!  Thanks Sherri!

Phew!!! I know I’m missing many things

 

Plan of Action

Back in the day, when I managed restaurants, we always had to have a plan of action.  Depending on what area you were a manager of depended on your plan.  A plan to lower food costs, labor costs, etc, etc, etc.

I have started my plan of action.  I filled out my financial aid information (FAFSA).  Yup, sure did!  I’ve been in contact with UCA and UAMS, and getting advice on whether I should get my BSN or go right into my MSN.  I’m excited, but afraid of the cost!  UCA tuition is $206 for undergraduate and $245.50 for graduate – Per credit hour!  ACK!  UAMS is $198 and $281, respectively.  WOW.  Just WOW.

I’m hoping to start this fall, if not January at the latest.    Wish me luck!  (OMG, what the heck am I thinking, going back to school!!!!!!!)

 

10 Reasons To Love A Nurse

 

Day By Day

 

 

I don’t know how long it takes to get over stuff like this, but each day I’m a wee bit better.  I know the upcoming holidays will bring more emotions on, which will suck, but I’ll deal with it.

I haven’t bought a thing for the holidays.  I’ll go at the end of this week.  With all the other crazy people doing last minute shopping.  Blah.   Ok, I did by myself stuff, lol.  I bought a new camera, my bedding, and some, ummm, toys.  LOL!  I need to go get the perfume I want, and some sexy pjs.  Yeah me.

Work.  I still love it.  The other night I was on my old floor, the cardiac floor and it was rough.  Besides the fact we were short an RN, leaving me with 15 patients, I followed a nurse who had NO clue what was going on with her patients.  No idea of resulted lab work, when the next lab work was due, no clue of the results of CT scans, venous dopplers, etc.  No idea of what the doctors had planned.  Nothing.  One of them she didn’t even realize was on a cordarone drip.  Uhhh hello?  Her documentation of the patients were horrible.  But I still love my job.  I can’t wait til I can go to weekend option after Christmas.  Work 24 hours, get paid for 34!  WOOT!

What else?  Not much.  I worked a bunch the last 2 weeks, and am ready for my break before Christmas.  Because of the holiday rotation and switching a shift with someone, I work Monday, Tuesday, and Wednesday than I am off until Christmas night.  SEVEN days.  WOOT!

Tomorrow I’m calling a therapy chick that is through our work (=free).  I’m just going in to talk to her, sort some feelings out and listen to her suggestions.  We’ll see if I learn anything.

My current gym membership is up in January, and then I’m switching to the bigger, nicer gym in town, where my dear friend Karen goes to.  We’ll be sexy bitches soon.  Holla!

Celexa.  I have to say it has helped.  I don’t know what kind of emotional train wreck I’d actually be in if I wasn’t on it.  Thank goodness that it is cheap!

ok, I’ve hollered (hollared?) at the boys many times to go clean their room, now I must go enforce my Mommy Powers!

 

P.S.  I don’t know what the picture has to do with day by day, but it was on google.  I ain’t hatin’!

 

Primary Care Nursing

The hospital I work at has been on “team” nursing for many many years.  A unit has 30 beds, during the day there are 3 RNs, 3 LPNs, and 3 Techs (CNAs), and each group has 10 patients.  Of course there is a support nurse, and a charge, and the unit manager on the floor.  At night, ideally, there would be 3 RNs, 2 LPNs, and 2 Techs, but at times there might only be 2 RNs.  The RN’s primary duty is to assess, teach, intervene, etc.  LPN is meds and dressing changes, and the tech would be vital signs, feeding, and bed, toileting,  and bath care.

Recently, they’ve tried to go to primary nursing on one floor, with hopes to move the entire hospital to this (and get Magnet status).  During the day, there would be 6 nurses (5 RNs and an LPN).  According to state law, the patient needs to be assessed by an RN at least once in a 24 hour period.  So the charge nurse would assess the LPNs patients, then the LPN could take over and chart from there.  Everyone else would assess and chart, and do their meds, etc.  At night, there would be the charge nurse, and 4 RNs and 1 LPN, and the same concept would follow.

I’ve had no problem when I’ve gone to this floor to work, it’s been great, no problems.  Last week they changed the staffing grid.  So last night, I had 8 patients primary care.  Me.  Me to do meds, assessment, interventions, Dr calling, and so on.  It’s crazy.  How do they except us to give good patient care?  My license, my livelihood is on the line.  If this is what is expected, I will move to the ER, or even another institution.  I really do enjoy my job, but this is not a safe practice IMO.

I understand the nursing shortage, I understand the need for money cuts, but didn’t all take a pledge to do no harm (beneficence) when we entered the field of nursing?

I do plan to make my thoughts known to my supervisor, hopefully my voice will be heard!

 

Being a Nurse

So I’ve been on my own for a month now.  A few things I’ve come to realize:

1.  I love my job.

2.  Yes there is a nursing shortage.

3.  I have great organizational skills and time management skills.

4.  I need to say no.

Let me explain.

1.  I really do love my job.  Being able to teach people, talk to them, change a dressing or two, it’s great.  My paychecks are wonderful!  Better than I had planned.  I love only working 3 days a week.  I really do love it.

2.  Let’s skip this, I’ll hit this one on number 4.

3.  I’ve always been this way.  One of my first jobs was a waitress at Shari’s, which is like an IHOP.   We would have 7-12 table sections, do our own drinks, taking orders, salads, service, etc, and even bussing/cleaning our own table, and many times seating our own guests.  I was really good at it.  I’ve worked as a server and a bartender for many years and am really good at it!  As a manager, I’d be able to to the money count, inventory count, or whatever much faster than others, because I was more organized.  Now that has carried over to my Nursing job, which is really helpful when you have 15 patients.  Sigh, number 4.

4.  Most of our hospital is team nursing, meaning 1 RN, 1 LPN, and 1 PCT (CNA) take care of a group of 10 (sometimes 15) patients.  It works ok, if you have a good and helpful team, and if the other team is also helpful.  One floor does primary nursing, which during the day time they have 5 RNs and 1 LPNs (making 5 patients each) and a charge nurse, and at night it’s 4 RNs, 1 LPN, (6 patients each)and a charge.  The charge nurse opens the charts for the LPNs.  Meaning, they do the assessment and documentation for the first of the shift.  Any other thing that needs to be documented can be done by the LPN.  Of course ER and ICU are all their own entities, so I’m including those units here.

In the last month we have lost our travel nurses.  I believe there is one left on the cardiac unit.  The hospital spent so much money on them, they decided not to renew their contracts.  One bad thing about them, is that most of them live within an hour or two drive and still get paid travel nurse wages.  Well, being in a rural area, most of our nurses travel to get to work anyhow.  So many of them have signed up with travel companies, and we have lost nurses.

So one night, I was put on the primary care unit, and made charge nurse.  Ok, fine.  But due to a shortage of nurses, staffing pieced a staff together.  Which meant there were 2 LPNs, 1 experienced RN, and 2 new RNs (one of which graduated with me).  Ok, fine.  So I had to chart on 12 patients, plus deal with any other issues.  Ok, fine.  But I had to do it all by 11 P.M.  when I would be moved to the oncology floor.  Ok, fine.  I managed to chart on 11, helping a newer LPN with some skills she hadn’t done yet, calling the doctor for the new grad, among other things.  At 11, I went upstairs and received 15 new patients.  The nurse leaving had charted on 5 of them.  One room was empty, and two patients were new and needed to be admitted. That left 7 patients to see.  This is where I began to think it’s crazy.  Thankfully, another nurse (the 3pm to 11pm charge) stayed until 2 am admitting the two new patients.  I had another who was really ill, and had to have his bed changed every 30-45 minutes (not to mention he was in isolation), and be given three units of platelets and some chemo.  Thankfully I did not have any blood to give.  I ended up seeing my last patient at 6am, right before shift change.  Crazy!  I also had to draw the morning lab and get two patients ready for surgery.  Thankfully I had a good LPN and PCT, who were experienced and knew how to get a job done.

Good ol’ hindsight says I should’ve said no.  It’s my license to protect.  My job line.  My family’s income.  I am not superwoman, and I need to say no.

Oh, the week before the night above, I worked on the senior behavioral health unit.  I’ve worked there many times and a PCT, but never a RN.  The paper work is COMPLETELY different, including the three times more paper admission packet.  So two weeks out of orientation, I was sent to the pysch unit.  No problemo.  Except that I had three new admits.  UGH.  Now in this unit, there are 14 patients, 1 RN, 1 LPN, and 2 PCTs.  Great.  So the day RN stayed and did one admission, leaving me two.  I managed to get them 90% complete.  Again, thankfully my team was experieced and worked on that unit, so I didn’t have to follow up on them very much.  The day after the charge nurse/oncology floor experience, I was put back on the psych unit (no, not as a patient), again, with 3 admits.

This past week, I worked on the pysch unit (again).  Except, now they opened 4 more beds.  18 patients, TWO RNs, ONE LPN, and 2 PCTs.  IMO, still not enough staff.  These patients have schizoprenic disorders, depression, combative agression, dementia, etc, etc, etc.  So after a rough start, and somewhat quiet middle, around 4 am, the most ambulatory patient on the unit fell and broke her hip.  Of course she was my patient.  Nice.  I had to call doctors, the house supervisor, get her transferred to the med/surg floor.  What a mess.  Now, I’m not saying that wouldn’t happen with more nurses, but I do think that once again, I should have said no.  NO, NO, NO!

I’m learning, I do love it, we’ll see what the next three nights have in store for me!

 

My Va Jay Jay is better than yours

 

 

  

Last night I had a client who was taking IV steroids for some lung issues.  Of course her blood sugars had increase, and I got an order to administer some insulin per a sliding scale.  The woman was coherent, under 40 years of age, and once I explained why and what we were doing, she acknowledge she fully understood. 

Then she said, “My sugars are usually always high anyways.  My ovaries don’t make eggs, they never have.  They make sugar.”

All I could do is say ok, and walk out.

 

Beans, Everywhere Beans

So for some reason, there is a two pound bag of red beans all over the boys’ room.  It is now a quarter til five pm, and they are still picking them up.  Although there has been more playing, fighting, kicking, watching tv, swording fighting, peeing, needing to ask/tell/share something with me than there has been bean picking.

Boys.

I had my yearly evaluation today.  I did get a raise (WOOT).  LOL, what’s funny was I was evaluated as an RN.  Ok, I have been out of orientation for two weeks?!?!  Oh well.

Speaking of work, last night I was floated to the geriatric psych unit.  I have worked there as a tech and as an LPN, but never as an RN.  The paper work there is completely different, especially the admits.  Of course, at shift change, I get THREE admits.  I called the house super and said that I don’t mind working there, but I don’t know the paperwork!  They said to do the best I could on the admissions.  There are many assessments (mental, cognitive) that I have not been trained fully on to determine the patients level of functioning.  Of course those pages were left blank.  It was a busy night, but a good night.  I had a wonderful RN from day shift stay over and complete ONE of the three admissions, what a  GODSEND!  And thankfully, my LPN and two techs were long term employees of that unit, and already new the patients and of course the way things work. 

And one final thought, as I leave to get ready to work day three of four (what was I thinking).  Another local hospital faces closing.  I know that that link doesn’t show it closing, but they are losing their state funding and close as of September first.  That sucks that those nurses and other staff will no longer have a job.  Also, they had an accidental death this week.  I feel bad for that nurse that made that mistake.  It’s something we all hope we never do.  Protect your liscense people!  We were taught in nursing school to check, check, and recheck!

 

First Night

So I get to work, super excited.  And I’m on oncology from 7pm-11pm.  As an LPN.  Then I was moved to Cardiac from 11pm to 7am.  As an LPN.  So much for a exciting first night as an RN.

 

EEK!

 

So since I graduated, I of course had to go through orientation at work.  I have been an LPN on the cardiac floor, which has become home to me.  But for my greedy little hands, I decided to go to the float pool when I graduated (more money an hour!).  So during normal float pool orientation (as my memory serves me when I was a PCP/CNA in float), you spend maybe a week or so in each floor/unit, so you know the basics of how that unit runs.  Great idea huh?  For my RN float orientation, they put my on the cardiac floor for FOUR WEEKS!  Yes four. Quatro!  Piece.  Of.  Cake.  By the end I was easily able to handle the sometimes necessary 15 patients that we had.  Like I said, piece of cake!

So we go camping, take my boards, diddle daddle, so I’m off for almost two weeks.  I think, hmmm when I go back, I’ll take JUST  ten patients.  Yeah.  Uh huh.  10.  So I spend my first week back on the Oncology unit.  Cancer.  Yuck.  My wonderful father in law died on that floor two years ago.  I hate working there.  I won’t go on about the nurses that work there, because that’s another entire post in itself. 

As I’m sitting in report, listening about patient’s external vaginal tumors, FU5, loads and loads of morphine, cancer here, there, being “ate all up”, I’m thinking WTF?  Where are the post cath, check your groin site, vitals good, pedal pulses good patients?  These people are freaking S-I-C-K.  Ten my ass.  Maybe TWO!

I did have a great very experienced nurse that taught many things.  Our night started with me just following her, since I wasn’t certified to handle any chemo (Thank GOD).  But between having to give 5 units of blood, the chemo, the morphine, and one patient living out his last moments, Ten o’clock came and we had only seen three patients!  I took the last 6 patients, who were the “healthier” ones in the bunch.  Our blood finished, we changed the chemo, our patient passed away, and I somehow survived.  The next two nights were easier, if that’s what you want to call it.

The next week, I went with another float nurse.  We spent our first night in my 2nd love, the ER.   I love it there.  Last year when I was suppose to graduate, that’s where I had a job at.   They offered me a spot again this year, but for some strange reason I opted to stay on the floor.  Most of the night we had level four stuff, you know, the school nurse role.  Cut fingers, bitten off toe nails, headaches, etc.  Pretty simple stuff.  The second night we were on rehab.  Lots of post knee and hips.  Pretty simple despite the bigger load of patients.  And the third night was on our primary nursing floor, neuro.  Again five patients, pretty simple.  Lots of turning and neuro checks.  Again, I survived.

But tonight, alas, my time has come.  I enter the world of nursing by myself.  I will shine my stethoscope and press my whites.  My orientation time has come.  I will have my own group of patients to tend to.  I will wipe the brow of the weary, care for the sick, and love the weak ones.

Ok, wtf!  Really now!  I know that I will forever be in orientation and learning, and I know that I will have other nurses and staff around to ask and get help from.  But holy heck!  I’m kinda scared!  Which if you know me, the know it all, that’s a pretty big thing for me to say.  I wish they’d stick me on the cardiac floor!

Twelve hours!  Ack!  Wish me luck!