Job Frustrations

One thing that I have found really challenging about working on a general floor is retaining some compassion for the drug abusers and alcoholics that get hospitalized over and over again. We call them frequent flyers. We had a patient on our floor for just over FOUR MONTHS who had been originally hospitalized after being found in a ditch in a wheelchair totally cracked out with sores all over. So we took care of this patient for 1/3 of a year, after the patient repeatedly refused to be placed in rehab or in nursing homes, even though he clearly demonstrated a total inability to care for himself outside of the hospital. It's not that he was a difficult patient. He was actually very easy to take care of as far as his physical needs were concerned. The hard part was knowing that one day he'd be discharged and that then it would just be a matter of time before we'd see him again.

Well, he lasted 8 days out there. I showed up to work last night and saw his name on the door and I swear I could have cried. Or punched the wall. Do I believe this man is ill? Yes, I believe drug addiction is an illness, born out of horrible personal choices. Do I believe this patient deserves the best care I can give him? Absolutely, and I try to deliver that each time I am assigned to him. But the frustration that comes when a patient like this single-handedly casts a bright spotlight on everything that is wrong and broken with our health care system is very real and I am still learning how to deal with that. It is quite possible that this patient will spend another few months on our floor. Every time he gets close to discharge, all he has to say is that he is feeling some chest pain or something and then it will be another work-up at taxpayers' expense and more days spent in that warm hospital bed with 3 solid meals a day and cable tv and room service. I believe the plan is to get him involuntarily committed, but they tried that last time and it failed.

I hope I haven't shared too much. I always worry about HIPAA. This patient deserves his privacy and dignity like anyone else. Hopefully I don't sound like Nurse Ratched. But these kinds of patient make me want to work with babies or children. Any population that isn't responsible in any way for its illnesses sounds like a dream.

Horrible horror of all horrific horribleness

A spider whose body was reported to be the size of a silver dollar was found in my patient's bed yesterday, WITH my patient. More specifically and horrifying, it was found crawling out from her undershirt. I got this information during report at shift change and thereby performed the involuntary/uncontrolled heebee jeebee dance in the middle of the hallway, basically unable to really comprehend or digest this information because my brain was trying to reject it. My sweet little 90 year old patient, unknowingly harboring a true terrorist under her fake silk old lady undershirt. I could cry just thinking about it. Lucky for her, she is not, shall we say, "with it" enough to process this information.

The only funny part is that the nurse who reported this to me kept insisting that the spider could have come into the hospital with the lady and her belongings. Like the spider had been hanging out in the bed for the past 4 days, totally committed to this lady, just waiting to be discharged home. Um, no and just, no.

Rut

Work is getting stale. Pneumonia. Acute Renal Failure. Acute Alcohol Withdrawal. Uncontrolled Diabetic. And my favorite: Abdominal Pain. This is pretty much what we get. I am still learning but at a much slower rate. The challenges that came along with being a new nurse are basically over. I don't get stressed out over giving report at shift change. I don't bat an eye for having to call a doctor at 3 in the morning. My time management and prioritization skills are pretty good. I never have to stay late to chart or catch up on things I fell behind on. Of course I still have to ask questions and run things by my fellow nurses every now and then, but sometimes I wonder if I can even completely trust the advice I am given. Let's say the med/surg floor doesn't exactly attract the most ambitious nurses, generally speaking.

I really am nervous that I have become too comfortable too fast as a new nurse, but it's hard not to do that on my floor where we see the same conditions all the time. And our patients are mostly stable and not in imminent danger of sudden unexpected death. I am afraid that I am going to be woefully underprepared for the next step in my nursing career. I so badly want to work with more critical patients where I have a lot more responsibility than I do now.

I guess I should enjoy this period of relative confidence while it lasts because as soon as I transfer to another floor, it will be back to square one in so many ways.

Working Woman Blues

I know it's been a while since I rapped at ya (to steal the words of my favorite Onion columnist), but sometimes night shift just totally owns me. That is how it has felt for the past week. I miss, on average, a full night of sleep each week as I always try to stay up the day after my 3rd night shift, so I can go to sleep that night with Adam. They say night-shifters have a shorter lifespan than day-shifters, and I think this must be why. For a girl for whom sound sleep ranks right up there with puppies, ice cream, and starry skies as far as the finer things in life are concerned, believe me when I say that my days on night shift ar numbered. The money is just so much better, so for now, that's what it is. The VERY BEST thing about night shift though? I never ever have to wake up before the sun. And for those of you who know how hard it is for me to wake up in the morning, you know what an awesome thing that is.

So, this whole "being a nurse" thing is going pretty well. I remember sitting on the front stoop on a clear night at The Milton (the perfect house I shared with Mary in Boulder back in 03-04) with my friend John, telling him I was thinking about going to nursing school because I was becoming so unfulfilled at my job with The Princeton Review and couldn't imagine a lifetime of office jobs where I was always having to consider the bottom line. It's hard to remember a time when anyone has been so supportive of me than at that moment, when he was just dumbstruck that I, or anyone else that knew me, had not thought of this sooner because it was such the perfect marriage of me and a career. After running this new idea by most of my close loved ones, I was so encouraged and hopeful, which grew into total, utter confidence that this was the path I was meant to be on. And I never doubted it since.

Hardly a shift goes by where I don't feel that I've made a true connection with someone in need. I actually can help really sick people feel better. I can listen to someone who has felt totally ignored. I can make someone feel that they have what it takes to live with their condition. I can do the tiniest, simplest things that show I am paying attention to my patient, and those things make the biggest difference. Like wiping the crust out of someone's eyes who can't do that for themselves. Such a small thing, but huge at the same time. These parts of being a nurse, I've got it. And I love it. The other, bigger part, is knowing exactly what is going on with my patient's heart, lungs, kidneys, liver, guts, etc. Trying to remember the past medical history, lab values, current test results, medications, new orders, assessment details and how all of those things play together, and on 5 patients, well that is still challenging.

But I actually feel like a nurse now instead of an imposter. And that is major progress.

I don't like it when....

You know how some people fall asleep - with their eyes half open, rolled into the back of their head so you can only see the whites, their mouths partially open, maybe a little drool making a great escape and sliding down the chin? Combine this with someone sleeping in an upright position so their head is slumped over too. Well it's not a pretty picture in the best of circumstances. But when I walk into a very sick patient's room at 3 in the morning and this is what I see? I freaks out a little. I stand there and stare at the chest to wait for it to rise or fall. And if that is not easily visible, I go to poking. Yes people, I am a professional and this is what I do. I poke you (gently) to make sure you are not dead in the hospital bed. It's science. Any of you out there who sleep like that, you need to cut. it. out.