When the cat’s away, the mice will play

I was gone last weekend for the AORN convention. This was planned in advance. I had to find coverage for my shifts. I had to tell people that no, sorry I couldn’t take their call for the weekend.

I come back on Thursday and run headlong into my shift. It was a busy shift and it took me until Friday to realize what the problem in the core was.

The latex gloves and the latex free gloves are kept separate. On purpose. Because are you really sure you opened latex free gloves for your latex anaphylactic patient? And micro dust, especially latex is a thing and can also lead to latex allergy.

Latex gloves and latex free gloves are meant to be kept apart.

While I was gone, they were intermingled. Sigh.

I was only gone for five days, people

The hell?

I took the sign that someone had oh so helpfully hung up explaining where the rest of the contents of that particular cart now were housed. And I wrote NO!!! on it in black sharpie, with the explanation that latex free gloves and latex gloves could not be next to each other.

But first I separated the gloves again.

Oh, I know who did it. They and I will be having words on Monday. I don’t want to shake them and tell that if they liked it so much at their old hospital they are welcome to return but to stop trying to remake this hospital into their old hospital. If they liked it so much, why did they leave?

Now I have to find supporting articles for my claim that the two kinds of gloves cannot coexist peacefully.

Gah!

Convention time is here again

I’ve been a busy little bee these last two weeks.

I’ve just been to the AORN convention in Nashville, TN and I had a wonderful time. I drove. It’s only a 6 hour drive. Some people thought I was crazy for driving and not flying. Well, it cost me two and a quarter tanks of gas, roughly $60. And I got to have my car and I could pack as much as I want.

And if you are me, you think you have more time than you do to work on work or school projects.

LOL, no.

Of the four planned projects I had, I did one. It was the one that will make me a good chunk of change this month. But one.

Otherwise I was at the education sessions.

Or eating out with the chapter folks.

Or sleeping.

Or eating.

It was fun.

Oh, and I also participated in market research, both for a drug company and for an AORN journal session. Yes, I was compensated, which was awesome. I must find more of these to do.

Patients we all carry

While I was in nursing school I worked as a tele-tech and a CNA in a small rural hospital. I was responsible for reading the tele monitor on all the patients who were on tele during the shift, as well as taking off orders.

If there were no patients on tele and no orders to take off, or the evening shift was in need of workers, I worked the floor as a CNA. I also worked extra when I could, especially during breaks from school. I made better than minimum wage but not much more. Therefore I picked up extra when I could.

One week in late December I was working as a CNA on the evening shift and we were unusually busy and all the rooms were full. In room 249 was a patient who no one wanted to take care of. He was mean and didn’t participate in the ADLs. When we were turning him in the bed he would reach out to pinch our rear ends. Twenty plus years later I realize that he had no control over anything, including his own bowels and that made him frustrated and mean and prone to strike outs.

Compounding his general demeanor he had had a radical neck dissection and a permanent trach, essentially making him nonverbal. He had a “pipe” that he used to communicate with. He would put the pipe up to his mouth and speak into it. It translated the air into sounds. The sounds weren’t very loud and he was difficult to understand.

He was terminally ill, though, and became sicker as he was under our care. This was due to the cancer disease process. He knew he was dying and he hated it. He hated it, hated us, hated the food, hated the nurses. He made sure we all knew it.

And then his pipe broke and he was without even that meager communication tool. And he was madder than ever. He was dropping weight rapidly and becoming diminished. Which also made him mad. Not much made him happy.

Remembering my classes I made him a communication board. So that he could communicate through pictures.

He went home to hospice not long after than. The last image I have of him is him gesticulating widely at the EMTs as they were transferring him to the gurney and shaking his communication board.

Why I remember him is that communication is key. Not only among the caregivers, but also from our patients to us. Patients may be in our hospital, but we have entered their lives at a time of no control. We have to use any means necessary to communicate with each other, even with unconventional means.

That didn’t take long

Want to hate on me for how I run the board?

Well step right up, CRNA! Step right up to dislike me.

That did not take long.

There is this other CRNA. No I don’t know how I collect these people.

As soon as he joined the call ranks he started to send every other CRNA home as soon as possible in the evenings, sometimes as early as 1600. And invariably a case would show up, which would have to go after the case we were already working on. Instead of running two rooms concurrently, which we are supposed to be able to do until 1900, the case had to follow after. Much to the delight of the surgeon who had to wait, and the evening folk who had to be in a room all night and not get their evening chores done, and the day shift who depend on those chores getting done.

I get it, man, I do. EVERYONE wants to go home early, and since the CRNAs get paid for the whole shift regardless of hours worked, they especially do.

But see above reasons for running concurrent rooms.

And no, I will not start a third room at 1815 because you asked Surgeon A if he was going to be done by 1900. Surgeon B absolutely would be done at 1830, but Surgeon A is lying to you. Or thinking only of his time, which doesn’t account for the waking up and going to PACU time. And no, I will not make my coworkers stay the extra 10 minutes. Just, no.

I will not start a third room at 1815.

I don’t care if you scowl at me. It really isn’t that impressive.

Don’t invoke how unhappy the patient is, or their dropping H&H. The surgeon should’ve taken the opportunity to bump when I offered it to her. But she didn’t and now that case is going to have to wait until Surgeon A and Surgeon B finish their cases.

I do this all night, every night. I think I know what I am talking about.

Stop pushing me to arrange the schedule for YOUR convenience.

Where do they find these people?

Oh, and Surgeon A didn’t finish until 1930.

I’ll explain it again for the ones who can’t hear in the back

Personal responsibility is a thing.

This is a hard taught thing but a thing none the less.

I’m a big fan of procastination, for example, see my life.

But not where it counts.

Not where it impacts my livelihood and job.

Because at the end, I’ve only got myself to blame.

So I keep a close eye on things that impact my ability to work, such as my nursing license expiration date, and when my CPR expires.

I don’t rely on others, including my boss, to remind me.

As always, I don’t understand those who don’t keep a close eye on what they need to work. And I’ve been called cruel for that, uncaring. Because what about life, parenting status, illness, work that get in the way of paying attention to the things that keep us employed?

We all have obstacles to our lives.

It is our part of personal responsibility to make sure that everything is done in a timely manner. So that we can continue to work to earn money to live.

Why don’t people get that?

What patients teach us

Before I was a registered nurse, before I was an OR nurse, I was a CNA. And I worked in two places: a nursing home and a hospital. In the hospital I floated between two units: the medsurg floor and the skilled nursing floor.

All the while I was rehabbing my shoulder and looking to get back into nursing school.

Always one to look for the next opportunity I jumped at the chance when the medsurg floor was looking for an evening shift teletech. It would mean more structured days, it would mean more learning, it would mean also sometimes stepping into the CNA role.

So I applied and got it. This was in the nascent computer charting phrase. Yes, we had computer charts, but only for narrative nursing  notes. The orders and the MD notes were still done by hand, to be transcribed into the computer ordering system by the teletechs. The nurses validated our work, but we were the ones that inputted them.

Yes, that is one of the reasons I say I read scribble. No, the doctor’s handwriting thing is not a joke.

And while this was going on, the orders, and the CNA work, I monitored the tele machine. That means I watched all the different hearts on monitor and alerted the nurse when there was a problem.

There was one patient, who was still tele, with all the chest pain standing orders, with all the monitoring. However, this patient had a rare DNR order while on tele. Do Not Resuscitate does not mean do not treat. All of his needs were met, including the antibiotics for the pneumonia, but he didn’t want to be shocked, or CPR done to  him. This was his choice.

He was dying and he knew it.

And me, out at the desk, knew that he had a DNR but the nurses still treated his chest pain, and infection.

He had a pacemaker that had a low threshold of 60. That means that if his heart was beating above 60 it wouldn’t fire. But if his heart went below 60, the pacemaker took over.

One night, late, his tracing started to look different. Where before there hadn’t been any paced beats, now it was one out of ten. I alerted the nurse and she went in his room. By this time we all knew that his death was imminent. His family had come and said their last goodbye, his doctor was just waiting for the phone call.

His paced beats became more frequent.

And then the paced beats stopped capturing and all there was was the pacer trying to coax the heart back into beating. With no electrical response from the heart.

I couldn’t turn off just his line on the monitor. I had to get the nurse to disconnect the tele box.

But until she did it was sad, watching that pacer try to restart the man who had died’s heart.

What I learned from that is that technology, as magnificent as it is, doesn’t really hold anything over the body.

 

Thank fuck, the winter rush is over

The winter rush seems to be dwindling.

Not that I don’t want to work.

Not that I want patients to suffer.

But the winter rush seems to hang on and on and on.

Our hospital is full to bursting.

Our ED may as well have revolving doors.

The flu is in full  bloom here.

But the thirty case days seem to be ebbing.

And like a calvary that got lost, there are to be two travelers for the department. The first showed up this week. I hope she can relieve some of the pressure on the staff.

You know, when the winter rush comes, well, rushing back.

Because right now is only an intermission. A remission of sorts.

The crazies will bounce back.