Showing posts with label Nursing-work. Show all posts
Showing posts with label Nursing-work. Show all posts

Seven O'clock Shift

Sunday Scribbling, nurse, nurse's life,For years I have worked at 7, either 7 in the morning or seven at night when I started working in a nursing home as a nurse's aide, and through February 2016 as a registered nurse. I would say, since I was 19. I am 45 now, so do the math.
It is the beginning of my self-sufficiency when I could support myself, pay for my rent, car payments, food, and tuition in the community college. It is when I started my shift as an aide in the nursing home. I wore all-white then—bright white, ironed, uniform in the beginning of the shift, and wrinkled at the end. I had a special cleanser for my white working shoes, and a polisher with a matching brush. I was so neat. Now I hardly clean the top of my Dansko shoes I wear all day in the hospital. I also do not own a shoe brush for a long time now. I even do not iron my scrubs. Thank goodness for a good clothes dryer. My royal blue uniform comes out wrinkle-free, well almost.

We had some interesting residents in my first job in the nursing home. One, I remember because he was so handsome. He looked like Bruce Willis, and even with amputated legs (he lost his legs from the war) he sat up so tall in his bed in good posture—stomach in, chest out. He was always sitting up when I get to work, waiting to get help to sit on the wheelchair for his breakfast. Always with his smile on his face, I help him first. He always won the first-smile-first serve of the day when it comes to me. He brightened my day. 

Another resident I cannot forget was the skinny little lady who I could not figure out how to please. She was always grumpy and unsatisfied. I bet she had a busy, controlled life when she was younger and just frustrated living in the nursing home too weak to fend for herself. Looking back, I think she was so cute. 

Both residents did not get visitors. I worked in that nursing home for four years and both of them did not get visits from anyone but the staff and volunteers. I tried to spend as much time as I could with this two however different they were with each other. I miss those years. I miss them.

Now, in the ICU, as a registered nurse, it is not common to bond with patients as before. My patients generally do not stay long enough in the intensive care which is a good thing. A few comeback walking to our units  weeks or months later to give gratitude. I love these times. And I love to see them vertical and not lying down in our bed with all kinds of monitors, and tubes inserted in many orifices. They have big smiles on their faces. They make my week.

I do not work at 7 anymore. I start at 10 a.m. and leave at 7:30 p.m. working 9 hours a day, four times a week. It still adds as 36 hours a week, and so my little blog's title  remains the same – 36 Hour Work Week.

What's the significance of the number 7 in your life? View more number Seven posts through the Sunday Scribblings or better, yet, join us.


Resources for Nurses

nurse OK, nurse resources, nurse blog


"Carin-approved" sites

Here's a partial list of resources I use.  I will add some more in the future.

  1. American Association of Critical Care Nurses (AACN)
  2. Arterial Blood Gas--ABG Calculator
  3. EdX -- ACLS online
  4. Medical Intensive Care Unit (ICU) Notes
  5. Ebola Virus Disease Resources
Do you have valuable nursing resources that may be added here?


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1 Fiction: A Frothy Day

Sunday scribbling, lady massaging neck, challenges quote
Giving self massage at home because 
I neither have the money nor the time 
for a professional massage.


Nurse Weekly Stories
1 Fiction: A Frothy Day

Join us  in Sunday Scribblings 2. The prompt word this week is froth or frothy.

“Is it cream?”
“No,” I screamed.
“It's a froth, oh Darn.”


The cardiac monitor was alarming. I rushed into little Ken's room. He was my 20-year old patient in the intensive care unit trapped in a small-10-year-old-size body. He had a lifetime problem of seizures that was pretty much controlled until lately.

His sitter, one of our staff, was pertaining to his secretion that looked like he had some foam coming out of his mouth.

“He is seizing,” I continued. While suctioning his mouth, I signaled nurse Carrie to come in the room. She hurried in asking what she could do.

“Get me ativan.”

Little Ken stopped seizing after I gave the Ativan. He had his eyes closed when his father walked in.

“I brought his liquid medical marijuana,” dad said.

I heard about it before that it was one of his home medication approved by his neurologist, a neurologist who did not have privileges in our hospital.

I looked at him without saying a word.

“It really works,” he continued.

If so,  why is your son here? I was just thinking.

“Dr. Sullivan said it is okay for me to continue giving it to him . . . It has to be refrigerated.”

“I can give you some ice for it but I cannot put the medicine out it in the common refrigerator where visitors of other patients can have access. And you know, you have to wait until he is awake before you put drops in his mouth, right?”

The unit was busy. Thankfully, my other patient did not keep me so busy that I had the time to help other nurses. One patient was delirious and had to be tightly restrained on his wrists. His sedation medications were discontinued because the doctors wanted him to wake up more to be ready for extubation. He was trashing in bed. Nurse Mary and I repositioned him a hundred times so he did not fall out of bed. Okay, not a hundred times, but close.

Her other patient, Paige, was in extreme pain screaming. We gave all the pain meds ordered with no relief. I called the neurosurgical resident, Dr. Samantha Plum, to help the patient (and Mary). I asked her to come and see the patient right away as she had severe headache after craniotomy and screaming her lungs out. Her agony was so loud I had to close the sliding doors of rooms nearby.

“She has to wait. I am busy and she's not in a life-or death situation.”

*sigh* It would probably take a while before we see Dr. Plum.

Surprised, I saw her walking the hallway within five minutes. She went straight to me asking if I was the one who called.

“It is not okay that you called me like that. It is not an emergency . . . You did not even tell me who you are, the patient's diagnosis, the room number . . . and screaming her lungs out is not a medical term “

“I told you who I was. I said hi, this is Carin calling about the patient in 6701, Paige Ball, status post crani . . . I never said it is an emergency“

She seemed to have an answer to whatever I said, then I realized we were acting like kids and and we were going nowhere. 

Pride set aside, I gave in and said, “Sorry, doctor, I called in desperation. I just want to help the patient, and Mary, the nurse assigned to her. Will you go and see the patient?”

She headed to the room as Paige just started screaming again. 

Dr. Plum ordered medications I suggested, plus more, as needed. 

It was now around three pm. Jolly Shelly was going around asking if anyone wanted anything from Starbucks. She was my saviour.

“Oh yes,” I said, “I want a Grande chocolaty, frothy, drink with a triple dose of sugar.”

This was my cup of “happy” this shift, a cup of happiness I could buy and afford.

***

To my surprise for the second time, Dr. Plum apologized to me for not hearing me clearly earlier when I sat next to her while she was charting. It was the only chair available.

I think it was more like, she was not listening, but she was now. Besides, patient Paige's pain was finally relieved, and I was joyfully sipping my cup of "happiness." Those things are what matters. 

Little Ken did not have anymore seizures, before and after dad gave him doses of marijuana. I did not agree with the Marijuana. It was not officially ordered that Ken could have it, but maybe it helped?

***

I accepted the challenges today and had some victories.

At the end of the shift, I went home thinking about my frothy day. I put my pink robe on and started rolling my back with a massage stick. 

Oh, that feels painfully good.

Nurse's Heart


Caring, cheering, healing, feeling
She/He feels the pain the you are in
She gives you more than just aspirin
Or tissue to wipe your tears with

She gives you attention despite her busy profession
She speaks to you close to get a connection
She listens and serve you with her heart
For her, you're not just a name on the chart

This week is Nurse's Week
If you have time, please greet
Deserving nurse that you come across and meet
You'll add a flavor to their day that's sweet

Do you have a post or picture that can make the readers "Aww?"Link to Sandee's "Aww Monday" here.



Theo

therapy dog, volunteer dog
Theo, the therapy dog with his Hospital Volunteer ID


Meet Theo, one of our therapy dogs
However big, he's very cute
He walks along the long hallways
As instructed, stops at each doorway
Greeting staff to lift the weight
Of heavy loads they have that day

He wags his tail to whoever looks
"Pay attention to me because I'm cute."
He also puts a smile on family's faces
And erases frowns on some patients' faces

Have a cute picture to share? Link with this group.



The Hair

hair doll, strange hairdress
photo borrowed from Magpie Tales


Some visitors I can remember. Some visitors' gifts, I can remember as well after several years. The reason is usually because they are memorable, unusual, or uncommon.

One day, a lady came to my patient's room in intensive care unit. Acting as a guard for my vulnerable patient (as most patients in the unit are critically ill) I almost stopped her at the door.

“Hi, I am Carin. I am her nurse,” I introduced myself as I look in the direction of my 32-year old patient.

“Oh, I'm K__. I am her sister.

I would not have guessed. My patient was pale with thinning straight hair. K has a lot of hair sticking up from her head to all directions. How can she drive with that hair thing? I wondered. As if her head was not enough, she handed my patient a voodoo-like doll.

I can't help but ask, “What is that?”

“It is a doll I made from my hair for her. So she will remember me. I am always here for her.”

I believe that the doll is made out of her hair tied in places to make figures of head, hair, arms, body, and limbs.

Weird, I thought, but whatever works for my patient (within limits) is fine with me. She seems to like it, anyway.

Intensive Care


A Day In a Life of an Intensive Care Nurse


I normally get a open-heart-surgery patient direct from operating room. But not the other day. Evelyn, our charge nurse said a patient was coming from emergency department, already intubated.

The emergency room nurse gave me report. Before taking the patient to me in the intensive care unit, they would have to go to Cat Scan to check for stroke.  Moments later, they arrived. The patient, who I will call Mr. M, barely responded to me. I had to rub his sternum to get a weak grimacing response from his face. On the monitor, his blood pressure read 50/30—incompatible with life. I asked for a bolus of fluids to administer through his intravascular access and more pressors in addition to what he already received. Not too long after, I had three pressors going to keep his blood pressure up. Then we heard the confirmation that he had a massive stroke. It was too late for any intervention. He was already on ventilator with three pressors and his blood pressure was barely holding up. 

He had two daughters flying in from out-of-state and his family asked to keep the life support until they arrived. Meanwhile, I let numerous family members visit, even children, which were normally not allowed in the unit. Our policy was only three visitors at one time, and no children during the flu season. I broke the rule in this case and even ordered them a bereavement tray which include coffee, bottled water, and fruits. 

I did what I could to make Mr. M as comfortable as possible—turning him from side to side, giving him mouth care, pain medicine, and smalls talks even though he could barely respond with his raising of eyebrows. Close to the end of my shift, he became unresponsive. The night shift nurse took over. I hugged one of the relatives good bye.

I thought about him when I got home from work, and first thing when I woke up, still in bed. I checked his room when I went back to work the next day. The bed is already made. The room is clean, ready for the next patient. I felt a pinch on my chest.

Mr. M's body gave up around 11 pm last night even with the life support. I was not there but I could imagine the sad faces sobbing around him. I am sure he is loved. May he rest in peace.




Sweet Cake, Daisies, Flowers

ttot, ten things of thankful, gratitude blog
I am thankful for the Daisy award nomination I received from work by two family members of patients I took care of. It still amazes me that some people can take time to fill out the form on a very stressful time their loved ones are in critical care. 
I am thankful for the relaxing bath that I can take every once in a great while. Talk about a mini-vacation spa for twenty minutes or so.
I am thankful for relaxing walks. The earth is beautiful.
I am thankful for the flowers I strategically place in my messy kitchen. At least I have something pretty to look at. :)
I am thankful for paper decor. I can quickly patch up some imperfections on the walls before a visitor comes. 




I am thankful for my son who willingly did the steam cleaning for the whole house. I paid him with a whole year's supply of contact lenses. We are both happy in the end. Velvet seems to be satisfied too as she supervises his work.

I am happy for my backyard as an emergency jogging place when I don't have time to go to the park. A breath of outside air can fool my body that I am out exercising. So refreshing.

I am thankful for neighbor's animals. I don't have to take Velvet to the zoo to watch other animals.

I am thankful for Paul with his good taste in food. This night was Korean barbecue night.

I am thankful for my son for sharing my birthday cupcake with me. It is our favorite Tres Leches. Last year, both of my children were on a run on my birthday. So this year is special. I know where they are.


What are you thankful for this week?

Thankful and Hopeful This Cold Season

1. I am thankful to my friend for reminding me about one of the joys of the Christmas season--the beautiful lights. I should put up some Christmas decor for the spirit of "it" tomorrow.
2. I am thankful for my pets for keeping me company when I am lonesome. Here is Velvet who would squeeze herself in the same couch I am sitting on, her favorite seat in the house.
3. I am thankful, my tearful daughter got calmed down over her favorite ice cream. See, my son, his brother, ran away  more than a week ago. Last Friday was his 17th birthday. My daughter, and I, celebrated a little, as planned. We left the parlor without tears in her eyes anymore.
4. I hope to have many more years of this Philippine Nurses Association of Colorado. Spending another Christmas party with these volunteer nurses serving the community was a joy. We played fun parlor games and I admit, I forgot my problems for a while.

5. We also had a potluck of mostly Filipino food. It is a day to get to eat dishes from my home country aside from what I cook. We had Puto-bumbong too. It is a a purple delacy covered with coconut and dipped in brown sugar served on Christmas season in the Philippines. It is something I never made but really like. YUM.

6. I would have worn red but thinking of my late father, I shouldn't. I wore black instead. It has not been a month since he passed away. I am still thankful he was not suffering in sickness anymore.





7. I am not so  thankful to my neighbors who make me look bad want to conserve on energy so I can be more efficient. I will do better using less energy, I think, next year.

8. I am thankful for this quote. It pushes me to move and do something good.



9. I am thankful for my health and my continued availability to my teens regardless how they act at times "not needing me."

10. I am thankful I can be of service to increasing population in the intensive care unit this cold season.

I really hope my son goes home soon. My son. My 17 years and two days old first born.



Call Lights, Tired Nurse, Ill Patient


We nurses, sometimes have one or two patients calling us with their call lights repeatedly, sometimes even before we leave the room.

Not again, we think.

Why do "frequent callers" call so often? 

A lot of times I find that deep down, they are afraid to be alone. As nurses, we should try to make our patients as comfortable as possible.


A nurse

Exhausted, Annoyed

Answering, running, serving

Tired from answering repeatedly

Server

***


An inpatient

Indignant, impatient

Calling, asking, needing

Afraid to be alone


Sick




How to Reduce Call Light Use

  1. One way to reduce the call light issue is with hourly rounds. This may be easy to do in intensive care unit with two patients, but with more patients, it can be a challenge. Anyway, the benefits of hourly rounds is evidenced-based according to a post in Medscape
  2. A list of what a staff can do or check for during these rounds can be simplified into these four P's-- pain, positioning, personal needs (using the restroom) and placement of necessities (call light, phone, TV, tissue, water). 
The patients knowing that a staff will come back in an hour to check on them may resolve some of the issues of frequent call light use. In addition, this hourly rounding will also help those quiet patients who would not call otherwise thinking they will bother the staff. 

Do you have other ideas?




Passage at Work

We moved our old hospital to a brand new building last December. I put around 10,000 steps each work day ever since because of the distance we walk from the employee parking, through a very long employee-only basement passage, to the intensive care unit where I work. Considering that I typically only care for two critically ill patients per shift, ten thousand steps is a lot. 


Long, narrow

Tiring, boring

Happy to be passing

Exit



Anyway, I used to hate this new passageway. I certainly do not walk like I am modelling on a runway here. I more like sprint my way to work through here. It used to put me on a bit of a depressed mood walking the plain floor with bare walls. As service employees, we were discouraged to walk in the main floor where patients and visitors are, and I used to think, "What is wrong with us? Why do we need to hide going and leaving work?"

I got used to it now. The walls are partly decorated now and some monitors hung from the ceiling with weather updates. They are something to look at anyway.

In any case, after a long 12-hour day's work, I am usually happy to walk this passage I can then call "exit."


Nurse, a Name I Call Myself

It is the letter N week in ABC Wednesday. I am joining this creative group this week with the easiest poem one could write—the acrostic style. 
My word? Nurse! Because I am one.
Here it goes.
nachos supreme
Nachos!

N-achos-loving-nurse

U-naffected by nauseating aromas,

R-ancid odors,

S-uffocating smells, and

E-ar-splitting alarms or bells



(Beside the humor, I save lives with my team of therapists, pharmacists, doctors, and other nurses. I am proud to be a nurse).

Don't Send Flowers to the Hospital

Feeling like a kindergartner, I got angry with red crayons,
and green, and purple, on a blank greeting card.

Roses are red
Fresh leaves are green
Offer them to her
And watch her face gleam


Red flowers, violet flowers, orange flowers, yellow flowers . . . I like them all.  They offer thoughtfulness and sweetness.  I gave mine to my boyfriend last Valentine’s day. You may think it is weird, but he liked them, at least he said so.  He gave me the flowers below.  Matched with a box of chocolates, my face gleamed with delight when I saw them.  Simple pleasures.

Med error

Words to live by after making a medication error

  1. It's discouraging to make a mistake, but it's humiliating when you find out you're so unimportant that nobody noticed it. -- Chuck Daly
  2. So then, if you get caught, be relieved. You are the father  important.
  3. But if you caught yourself making a mistake, that is even better. The sooner you realize, the better.
  4. And if the patient did not have injury as a result of your error, that is the best.
  5. Nevertheless, we should all learn from our mistakes. 
  6. Norepinephrine is not NEOsynephrine. Duh.


What the F – Wednesday

Ha-ha, it is not what you think.  My F today is all about positivity, fun, or calm.  I have a few things of F to share with you today.  Wonder what they are?  I promise, they are e-FF-ing good.

Fear and anxiety consumes me (again) since my sixteen-year old son ran away for the 20th-something time.  Beyond reporting, it and trying to reach out, I can either stay in fear about what if something bad happened to him or do something about my feelings.  I started to practice anxiety-reducing techniques to deal with this stressful situation.  One of them is meditation.  Another is art.  

Focusing on Who is Present


“Who do you think made this, mom?”



The display of a miniature house welcomed us in the library.  I was reading the information right on the table . . .



“A miniaturist.” She is exactly called that.  I could not help but to take some pictures until a lady sipping soda approached us.



“Hi, my sister made this.  So if you have any questions, just ask.”


My daughter and I got a personal virtual tour of the house and around it (virtual, because we could not get inside the display case and the miniature house itself). The house is a replica very close to their house they lived in in the state of Virginia, complete with farm and tons of animals.  There were even pictures of their actual family all over the display.


The lady talking to us look like she is about 70, so the house must be a replica from sixty years ago, in the fifties. Wow.


My daughter and I were amazed about the detail of the art. 


For once in a long time, I found a common enjoyment we did together (aside from spending money shopping).


My daughter, she is so important to me, my only female child.  I love my son too, but he is not with me.
He ran away. Yes, he ran away from his temporary foster home for chronic run away boys.


I focus on my daughter now.  She is here, even a little forced (maybe) because she wears an ankle monitor to keep her at home and stop sneaking out in the middle of the night, or leaving the house for days.


I went away for thirteen hours to a busy day at the hospital today.  It is one of those days when both patients I had a code brown, twice. 


I got home and I see her, my precious daughter. The malodorous aroma the got stuck in my nose was forgotten.


She is here at home.




As for my son, I pray for him.

 .

A Day in a Life of a Nurse and a Single Mother With Teens #2

What did I do today?

  1. Did my morning ritual, a five minute calming meditation and prayer . . . in the bathroom, sitting on the thrown.  Yes, I’m weird.
  2. Worked extra day, Sunday, on my scheduled day off.  We were busy alright.  The intensive care unit was full.  Unlike the previous day, nobody cried today out of frustration.  It was a decent day.
  3. Walked 11,000 steps in the hospital.  It qualifies as my workout. I said so.
  4. Skipped Sunday service because . . . I worked for twelve hours: 7a.m. to 7:30 p.m.
  5. Visited son for a short time in his new foster home with my daughter.  He looked happy.  I met his foster mother and two small, barking-tail-wagging dogs for the first time, and saw two teens peeking at us.  The boys did not face us. They were just peeking. Funny.

How was your Sunday?

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Saturday Fun From Life of a Nurse, Volunteer, and Parent

Continuing education, volunteer group
meeting, and dinner on a Saturday evening.
I have confined myself inside lately except for running chores and doing tasks I could not do remotely (online) because of the cold weather. I have been writing and reading more, cooking, cleaning . . . Yes, cleaning the house.

Reasons to Pray

W
hen talking to God with prayer, I feel this delicate connection going on with mind and
spirit.  It is a meditation of some sort.
Velvet is thinking about praying too.
I still have to train her how to kneel.

When I pray, I usually ask for something I do not have—peace with my teens, the silver bullet to target their defiance, the miracle to get them to turn around and walk towards the right path . . .

I pray to God and ask for anything.  He hears me, and He will respond to me in His own way.


What Merry Christmas is All About

“Why can’t they just close the hospital today, mommy?”
Christmas scene with manger tree
A Christmas corner at work.

This question, I cannot forget, from the mouth of my daughter, only five years old then.  I was working and she did not want me to go to work so I could spend the Christmas day with her. She was so innocent.

***

These days I get shallow sometimes.  I worried about buying gifts.  I do not have enough in my budget to purchase what I want for gifting.

The priest made a sermon this morning that struck me.

“Today is the day to celebrate Jesus’ birth.  It is the main reason we were preparing weeks ahead. . .  ”

This holiday should be focused on caring for each other, loving each other, thinking about each other, and spending time together.