No candles, as this is not a birthday.
Just memories...
Warm August rain outside an apartment
Walks to the park, sitting on the swings. Walking down West Johnson in the dark, holding hands and picking our children's names.
Stolen cinnamon rolls from work and a big orange tabby.
An old Chevy Celebrity...and all the problems that come with an old car. The lemon of lemons, the Subaru.
Chinese food and rented movies.
Leap of Faith. Taking a leap of faith and telling you that I was in love with you. The smell of your room on West Johnson.
Snuggling in a bed too small for the two of us, not minding. Teaching me to play Nintendo games, and teaching me how to use a computer.
Flunking a test for a night of passion. And not regretting it.
Perkin's and Country Kitchen, late night studying and working. Sitting all night in a booth with a GameBoy, waiting to drive home. Sitting up all night playing video games, then going out for breakfast while it was still dark out.
Surgery, diabetes, and more surgery.
Almost flunking a class because we got lost in each other...and giving the worst speech of my life as a result.
Twinkling lights, a first Christmas tree, and a proposal. Knowing in my soul you were the right one.
New kitties, old kitties, and a different apartment that developed Lake Wasson in the Spring. Long Saturdays spent cleaning together and doing laundry.
Little Red Trucks from New Mexico. Camping, golfing, and running cables into the bedroom so I could still watch tv when the guys were over.
Opening wedding gifts together in that old apartment, a box labeled from the cats. Fish tanks and cats that go "Thwack and Thunk" in the night.
Long car trips to Madison and Green Bay, getting lost on the way to the airport. Over the river and back again to Grandma's house in Pepin. Starting to break the oyster stew tradition.
Beautiful flowers for a golden birthday, eaten by a crazy cat. Beautiful flowers on a wedding day, and years later on an anniversary.
Our first dog together--thinking what had we done? Our first house, moving day, waking up together in our bed on that first morning in our new house, your birthday. Having one bed, not two that needed to be pushed together.
Waking up with a fishing pole in bed. Not really minding. Irons on the floor, sweet and sour on the floor. Carved pumpkins on a balcony.
Your, mine, ours. Our memories, our lives. When I look back, this is how they come at me, not linear, not chronological. We are now approaching spending more of our lives together than apart...and I'm overjoyed.
Tuesday, August 25, 2009
Wednesday, August 19, 2009
Sometimes I don't like being right
We had our work meeting yesterday, and as I thought, we did indeed have a new form rolled out to complete with the admissions packets. Virtually no useful information was taught to us by our "clinical director of education". Although I do get 2 CEU's for sitting through this hour of BS.
I also found myself the victim of workplace gossip and BS. It's time for me to stop being so damn nice to the CNAs and start being their supervisor. I hate, hate, hate the workplace gossip. Since I work with 99.9% women, it's surprising I haven't had something like this happen before. I've observed that a particular CNA is very two faced. I've seen her smiling at a co-worker, then muttering under her breath and rolling her eyes as she walks away. She's rather transparent even to those that are a bit slow in these matters (like me) but is sure that she's not. Several weeks ago, she was reported for a pretty serious issue, and she has had "issues" with me since.
Earlier this week, she was told she couldn't switch halls by me. She went over my head, told a pack of lies in collaboration with another CNA and went to our executive director. Unfortunately for her, her 10 year of seniority do not trump my RN. While I didn't feel very supported by management, she certainly did not succeed in getting me in any sort of trouble. Due to my conversation with management after she left the room, she may find herself under closer observation by said management. She sure as hell is under closer observation by me and the other nurses. We are keeping close tabs and documentation on problems we see happening with her and another CNA.
I ended up at the doctor's office this morning, where I was weighed again. It's clear that I must do something about my weight and health NOW. Not just for going on vacation, but because I look and feel like crap. My sex drive is affected, my feet are always sore, I already need surgery on the one, and I'm tired all the time. I don't wsnt to do weight watchers again, because I don't feel like they can help me anymore. I know the program but I'm not motivated to use their system. I hate to say it, but the concept of mindful eating has popped into my mind. People are constantly bringing food into work and I just grab a handful of whatever it is. I do the same thing on the way home. Usually I'm so hungry I'll grab something out of the snack machine or do a drivethru.
I'm not sure how to start again, but I am thinking on it. The first step is the mindful eating. Step two is planning for the hardest areas, such as the drive from work and while at work. It's not too hard to have decent food at home--it's the other places that are at issue. I know I'll have to log what I eat for a while, and eventually I'll have to start exercising. But exercise at my current weight is really freakin' hard. I will need to see some scale progress before I can start exercising again.
Back to square one.
I also found myself the victim of workplace gossip and BS. It's time for me to stop being so damn nice to the CNAs and start being their supervisor. I hate, hate, hate the workplace gossip. Since I work with 99.9% women, it's surprising I haven't had something like this happen before. I've observed that a particular CNA is very two faced. I've seen her smiling at a co-worker, then muttering under her breath and rolling her eyes as she walks away. She's rather transparent even to those that are a bit slow in these matters (like me) but is sure that she's not. Several weeks ago, she was reported for a pretty serious issue, and she has had "issues" with me since.
Earlier this week, she was told she couldn't switch halls by me. She went over my head, told a pack of lies in collaboration with another CNA and went to our executive director. Unfortunately for her, her 10 year of seniority do not trump my RN. While I didn't feel very supported by management, she certainly did not succeed in getting me in any sort of trouble. Due to my conversation with management after she left the room, she may find herself under closer observation by said management. She sure as hell is under closer observation by me and the other nurses. We are keeping close tabs and documentation on problems we see happening with her and another CNA.
I ended up at the doctor's office this morning, where I was weighed again. It's clear that I must do something about my weight and health NOW. Not just for going on vacation, but because I look and feel like crap. My sex drive is affected, my feet are always sore, I already need surgery on the one, and I'm tired all the time. I don't wsnt to do weight watchers again, because I don't feel like they can help me anymore. I know the program but I'm not motivated to use their system. I hate to say it, but the concept of mindful eating has popped into my mind. People are constantly bringing food into work and I just grab a handful of whatever it is. I do the same thing on the way home. Usually I'm so hungry I'll grab something out of the snack machine or do a drivethru.
I'm not sure how to start again, but I am thinking on it. The first step is the mindful eating. Step two is planning for the hardest areas, such as the drive from work and while at work. It's not too hard to have decent food at home--it's the other places that are at issue. I know I'll have to log what I eat for a while, and eventually I'll have to start exercising. But exercise at my current weight is really freakin' hard. I will need to see some scale progress before I can start exercising again.
Back to square one.
Saturday, August 15, 2009
Paperwork, paperwork
Work has made a point of having several trainings lately that are useless, boring, and lead to only one thing: More paperwork for the nurses to do. Approximately a month ago, we had a mandatory nurses meeting on TB. Per state law, we give a mantoux to all new residents within 48 hours of admission. Protocol dictates that we follow with a second mantoux a week after the first one is read.
Several areas have been lacking by various nurses in this administration.
1. The lot number, exp. date, and manufacturer have not been recorded in the chart.
2. The results are not recorded in the nursing notes. For that matter, the administration of the mantoux is rarely recorded in the nursing notes.
3. The location of the mantoux is supposed to be recorded, at minimum, on the MAR.
Admittedly, I was unaware that there was a spot to record this information in their charts until nearly a year after I started. I found out because I asked. Seems to me that this is a matter of improper training on the part of administration.
Meanwhile, our clinical educator drags out a new poster from the CDC and a new form. This poster http://www.cdc.gov/tb/education/Mantoux/wallchart.htm is now plastered up in our medroom, covering up the actual useful poster from our main pharmacy, with expiration dates for medications. I cursed the CDC under my breath.
The new form that we are required to fill out upon admission includes such questions as
-Where were you born?
-Are you HIV or Hep B positive?
-Have you traveled outside the US in the last two years?
I'm wondering if I should ask these questions before or after I do the basic cognitive questionaire, which is another new form we are required to fill out upon admission, which is designed to determine (but not by the floor RN or LPN) if the new resident is A&O x3-4.
Either way, most of our residents are admitted with a family member at their side, who interfere with the cognitive questioning--and the floor nurse gets chastized if the resident if the form is not filled out upon admission. It's a real PITA to spend 30 min. or more of my time doing an admission in the room (this does not account for the time spent at the desk filling out the rest of the paperwork) attempting to get VS, do a head to to exam, a full skin assessment, starting a tissue tolerence test, getting a CNA to get a weight, orienting to the room, get a pitcher of water, bedpan, and basic toiletries in the room. These are the things that the family wants to see done ASAP.
My main concern when doing an admission is safety. Did I communicate enough information to the resident that they know how to use a call light and know where everything is? Have I spent enought time with them to know if they are cognitively aware enough to use a call light and/or ask for help aka Do they have "Impaired safety awareness." Just like in foster care, we strive to provide the least restrictive environment. Does their diagnosis require that they have assistance in transferring? Can they bear weight on both legs? Does the CNA know all of this?
My good CNAs will rush into the room with the weight chair loaded down with toiletries, ask about continence, and grab some incontinence pads. They will wait in the room under the guise of getting a weight and adjusting their toileteries to find out how A&O the new resident is, if they can bear weight, etc. I wish we had more of those.
But the rule in health care is "If it's not documented, it's not done." Therefore, despite MY priorities, I have to fill out a shit load of paperwork after I leave the room. Some of this info can't be determined in the first 30 min. Sometimes the resident/family doesn't know. The tissue tolerence test takes 4 hours--two hours sitting, two hours laying. I'll admit that I cheat. If I go back into the room two hours later (I'll tell the CNA to get me the first time they ask to go to the bathroom) I'll check their skin at that time and if it's all good, I back track the tolerence. If there is an issue, then I'll re-assess to find out where in the two hours it becomes an issue. More often than not, I just saved myself a big ass hassle.
Then there is my least favorite rule in nursing: If a nurse is at the nurse's station, it's because he/she is just waiting to leap up and do your bidding. The nurse is bored, has nothing to do, and is just waiting to run and help someone. We are never swamped with admissions paperwork, we are never swamped with regular charting or day to day paperwork. And we are never, ever, ever trying to take a break or tape report. If two nurses are at the nurse's station, the rule is that we are either playing on the computer or that we are chit-chatting. It's not possible that we are collaborating and trying to solve a problem that's happening with a resident. It's not possible that we are working together. Nope, those lazy nurses are doing nothing.
Needless to say, I'm not looking forward to our upcoming mandatory training. I know another form is going to be dragged out. None of these mandatory meetings are truly mandatory, but if I don't show, there's no system in place for me to get the information. Nope, no newsletter, no meeting summary or notes. I've suggested this very thing...and was thanked for my thoughts and input. Our clinical education director is stale, stagnant. She's been in this position too long. Most of her information is bad and outdated. It would be so nice if real education could happen.
I need to come up with something, but I'm not sure how or what. I've been thinking/brewing on a few things for a few months now, but haven't been able to effectively put anything together. Damn, I'm just as useless as she is. Maybe I can get her job when she retires?
Several areas have been lacking by various nurses in this administration.
1. The lot number, exp. date, and manufacturer have not been recorded in the chart.
2. The results are not recorded in the nursing notes. For that matter, the administration of the mantoux is rarely recorded in the nursing notes.
3. The location of the mantoux is supposed to be recorded, at minimum, on the MAR.
Admittedly, I was unaware that there was a spot to record this information in their charts until nearly a year after I started. I found out because I asked. Seems to me that this is a matter of improper training on the part of administration.
Meanwhile, our clinical educator drags out a new poster from the CDC and a new form. This poster http://www.cdc.gov/tb/education/Mantoux/wallchart.htm is now plastered up in our medroom, covering up the actual useful poster from our main pharmacy, with expiration dates for medications. I cursed the CDC under my breath.
The new form that we are required to fill out upon admission includes such questions as
-Where were you born?
-Are you HIV or Hep B positive?
-Have you traveled outside the US in the last two years?
I'm wondering if I should ask these questions before or after I do the basic cognitive questionaire, which is another new form we are required to fill out upon admission, which is designed to determine (but not by the floor RN or LPN) if the new resident is A&O x3-4.
Either way, most of our residents are admitted with a family member at their side, who interfere with the cognitive questioning--and the floor nurse gets chastized if the resident if the form is not filled out upon admission. It's a real PITA to spend 30 min. or more of my time doing an admission in the room (this does not account for the time spent at the desk filling out the rest of the paperwork) attempting to get VS, do a head to to exam, a full skin assessment, starting a tissue tolerence test, getting a CNA to get a weight, orienting to the room, get a pitcher of water, bedpan, and basic toiletries in the room. These are the things that the family wants to see done ASAP.
My main concern when doing an admission is safety. Did I communicate enough information to the resident that they know how to use a call light and know where everything is? Have I spent enought time with them to know if they are cognitively aware enough to use a call light and/or ask for help aka Do they have "Impaired safety awareness." Just like in foster care, we strive to provide the least restrictive environment. Does their diagnosis require that they have assistance in transferring? Can they bear weight on both legs? Does the CNA know all of this?
My good CNAs will rush into the room with the weight chair loaded down with toiletries, ask about continence, and grab some incontinence pads. They will wait in the room under the guise of getting a weight and adjusting their toileteries to find out how A&O the new resident is, if they can bear weight, etc. I wish we had more of those.
But the rule in health care is "If it's not documented, it's not done." Therefore, despite MY priorities, I have to fill out a shit load of paperwork after I leave the room. Some of this info can't be determined in the first 30 min. Sometimes the resident/family doesn't know. The tissue tolerence test takes 4 hours--two hours sitting, two hours laying. I'll admit that I cheat. If I go back into the room two hours later (I'll tell the CNA to get me the first time they ask to go to the bathroom) I'll check their skin at that time and if it's all good, I back track the tolerence. If there is an issue, then I'll re-assess to find out where in the two hours it becomes an issue. More often than not, I just saved myself a big ass hassle.
Then there is my least favorite rule in nursing: If a nurse is at the nurse's station, it's because he/she is just waiting to leap up and do your bidding. The nurse is bored, has nothing to do, and is just waiting to run and help someone. We are never swamped with admissions paperwork, we are never swamped with regular charting or day to day paperwork. And we are never, ever, ever trying to take a break or tape report. If two nurses are at the nurse's station, the rule is that we are either playing on the computer or that we are chit-chatting. It's not possible that we are collaborating and trying to solve a problem that's happening with a resident. It's not possible that we are working together. Nope, those lazy nurses are doing nothing.
Needless to say, I'm not looking forward to our upcoming mandatory training. I know another form is going to be dragged out. None of these mandatory meetings are truly mandatory, but if I don't show, there's no system in place for me to get the information. Nope, no newsletter, no meeting summary or notes. I've suggested this very thing...and was thanked for my thoughts and input. Our clinical education director is stale, stagnant. She's been in this position too long. Most of her information is bad and outdated. It would be so nice if real education could happen.
I need to come up with something, but I'm not sure how or what. I've been thinking/brewing on a few things for a few months now, but haven't been able to effectively put anything together. Damn, I'm just as useless as she is. Maybe I can get her job when she retires?
Thursday, August 06, 2009
Slug
I have been a slug all day. Called in sick to work, but not until 5am. I'm supposed to give 4 hours notice, but no one calls for replacements at 2am...had I really been thinking, I would have called last night when I got home from job number 2.
Complication: I have a resident at job #1 who is related to my client at job #2. They knew at #2 that I wasn't feeling well, had bronchitis, but of course I know they'll know that I called in to #1. I'm supposed to go to #2 tomorrow.
I'll be a slug, again. It sucks. My family is going to be here by around 7pm, and they I'm "on" for the weekend. I'm somewhat placated by the fact that I'm getting paid all weekend, I'm using some vacation hours for this family vacation. I tried to get the house in decent shape, still a few things left to do, but I did the best I could considering how dragged out I feel.
This has been a rough summer for me health wise, but DAMN this one bites big time. My ribs are sore from coughing. I hope they leave early enough on Monday so I can spend the day recovering.
I do like that I will be away from job #1 for 8 days. I do wish family was coming when I felt better. I wish I felt less like a slug and more like myself. I don't know that that's supposed to feel like anymore because I've felt so crappy for so long. Whole damn summer.
One great big whine. Just can't help myself.
Ex-foster son stopped over for a bit, he's exactly the same. Tried to be kind/polite and ends up coming across like Eddie Haskel. I know he's up to no good with DS. I'm just hoping they won't get caught doing anything that I'd hate to speculate about. As a slug, I just don't think I could cope with that tonight.
Here's hoping tomorrow I feel better. Praying to God.
Complication: I have a resident at job #1 who is related to my client at job #2. They knew at #2 that I wasn't feeling well, had bronchitis, but of course I know they'll know that I called in to #1. I'm supposed to go to #2 tomorrow.
I'll be a slug, again. It sucks. My family is going to be here by around 7pm, and they I'm "on" for the weekend. I'm somewhat placated by the fact that I'm getting paid all weekend, I'm using some vacation hours for this family vacation. I tried to get the house in decent shape, still a few things left to do, but I did the best I could considering how dragged out I feel.
This has been a rough summer for me health wise, but DAMN this one bites big time. My ribs are sore from coughing. I hope they leave early enough on Monday so I can spend the day recovering.
I do like that I will be away from job #1 for 8 days. I do wish family was coming when I felt better. I wish I felt less like a slug and more like myself. I don't know that that's supposed to feel like anymore because I've felt so crappy for so long. Whole damn summer.
One great big whine. Just can't help myself.
Ex-foster son stopped over for a bit, he's exactly the same. Tried to be kind/polite and ends up coming across like Eddie Haskel. I know he's up to no good with DS. I'm just hoping they won't get caught doing anything that I'd hate to speculate about. As a slug, I just don't think I could cope with that tonight.
Here's hoping tomorrow I feel better. Praying to God.
Tuesday, August 04, 2009
That Bitch Hope
That bitch hope snuck up on me again. After 6 weeks without a period, and intermitent spotting over the last 4-5 days, I decided to do what I vowed never, ever to do again: POAS. I DID get the cheapest one I could find, and I DID wait until the end of the day to try it, and I DID justify it by the fact that I've been taking the tramadol.
So why did my heart beat a little faster? Why did I get a little more anxious? Why? Because that bitch hope managed to work it's way into my heart again. I hate that. It was, as it's always been for me, lily white. Negative, Nada, sign of the empty womb, barren. F'ing INFERTILE. No miracle surprise bad timing baby for me.
And just the tiny, tiniest bit of bitterness as evidenced by my words above.
I went to the Quickie Clinic, found out I've been running a fever, and got the good cough syrup along with a z-pack and an inhaler. If my period doesn't show up by next week, I'll go and see my regular MD.
Another busy day at work today, leaving little time for anything else. At least I feel better knowning that it's not "just" my allergies, or that it's not "just a cold." The low-grade temp makes me feel better about being a bum at home. The to do list just keeps growing. It'll get done, eventually, right?
Just hoping for some real sleep tonight. Some real, actual, sleep. The kind where I wake up in the morning thinking "Wow, I slept ALL night." Or at least 4 hours. I can take the cough syrup every 4 hours, so if it gets me that much sleep, I'll be thrilled.
Work vent: our reports are like playing the telephone game. There are several ways this can be accomplished:
1. The report where I get the same report from the NOC nurse as I gave the PM nurse. This includes any task I was unable to complete, any issue I was not able to follow up on, that ends up getting passed back to me the next morning.
2. The report where the oncoming nurse makes a note she then can't interpret when she reports off to the next shift, there by I get "Her orders need to be clarified" when in fact the reports was "Got coumadin orders for tonight from the on-call, please call primary in the morning for additional orders".
I got the jumbled version of #2, wondered which orders, checked the MAR and couldn't find anything that didn't look right and promptly got so busy with a less than likeable pt who was on her light every 5 minutes:
HER: Your supposed to wrap my legs.
ME: Yes, I know, but it's 6:30am, and I have a few other things I need to finish first, I plan on doing it before you have therapy.
A few minutes later, the CNA tells me she wants me.
HER: Don't forget my foot cream
ME: Of course not!
HER: Well are you going to get it?
ME: Yes, when I wrap your legs after breakfast (thinking, if you could REACH them, you COULD DO IT YOURSELF)
An amazing 30 minutes pass before the next issue
HER: What's that gurgling?
ME: That's water in your circuit hose, I'll drain it, and show you how you can.
HER: THERE'S NOT supposed to be water in there! You did something WRONG!
ME: I did not do anything to the set up, it's water that's condensed in there. That's what this collection bag is for, see?
I take her morning medications in about 30 minutes later, she questions every pill. Tells me I checked her blood sugar "wrong". The other nurses poke her finger dead center, not on the sides. Hmmm....I wonder why? Then I gave her insulin wrong because she could actually feel the needle.
Fast forward to after breakfast. I get the supplies to do the wraps, and she tells me again I'm not doing it right. I'm supposed to wrap cotton underneath the ace wraps first. Fine. I get back in the room and get asked why there is water on the floor. I calmly remind her that she spilled it a moment ago--and that's why I had a towel in my hand.
After I did the leg wraps, I thought I was off the hook until lunch--but then she wanted suction and lavage. Lucky me, she hacks out a huge nasty booger, and then there was nothing to suction. No loss as far as I was concerned. I also still had to bet her vitals, and brought the manual cuff. As a big woman, I know how bad those automatic cuffs can hurt, they are excruciating. So I did a manual and she wanted me to do it on her lower arm. I'm very, very bad at this, so I tried, didn't get it, and then did it on her upper arm--she kept thinking/saying how it would hurt.
By the end of the day, I was at my wits end. I'm trying hard to remember why she is with us, and why I'm supposed to be nice. The final straw was when she came out of her room--and told me her O2 set up was wrong. Um, except I didn't change a thing all day. And after spending 1/2 hour on the phone with RT on Sunday night, I'm about the only person who actually knows what to do with her circuit and set up. Most of our A&O residents on the TCU side get the fact that the goal is independence and the ability to get home...some are not. I'm trying hard to remember that there are underlying issues for this, like mental health problems, but it's hard when you see one resident working so hard and getting home while another acts like they are at a resort and they are the only person in the place with a staff of 20 to cater to their needs.
Spending 1/2 the day playing head games with myself didn't help either. So when the PM nurse came on tonight, I had to admit I had dropped the ball. I figured out what the report should have been when I finally was able to sit down to chart 30 min. before the end of my shift. That's when I saw her note from yesterday. The thing is, I know she'll complain about me all night for missing this while to my face she says "no big deal."
I do the best I can in the limited time I have. More work vents to follow. It's good for me.
So why did my heart beat a little faster? Why did I get a little more anxious? Why? Because that bitch hope managed to work it's way into my heart again. I hate that. It was, as it's always been for me, lily white. Negative, Nada, sign of the empty womb, barren. F'ing INFERTILE. No miracle surprise bad timing baby for me.
And just the tiny, tiniest bit of bitterness as evidenced by my words above.
I went to the Quickie Clinic, found out I've been running a fever, and got the good cough syrup along with a z-pack and an inhaler. If my period doesn't show up by next week, I'll go and see my regular MD.
Another busy day at work today, leaving little time for anything else. At least I feel better knowning that it's not "just" my allergies, or that it's not "just a cold." The low-grade temp makes me feel better about being a bum at home. The to do list just keeps growing. It'll get done, eventually, right?
Just hoping for some real sleep tonight. Some real, actual, sleep. The kind where I wake up in the morning thinking "Wow, I slept ALL night." Or at least 4 hours. I can take the cough syrup every 4 hours, so if it gets me that much sleep, I'll be thrilled.
Work vent: our reports are like playing the telephone game. There are several ways this can be accomplished:
1. The report where I get the same report from the NOC nurse as I gave the PM nurse. This includes any task I was unable to complete, any issue I was not able to follow up on, that ends up getting passed back to me the next morning.
2. The report where the oncoming nurse makes a note she then can't interpret when she reports off to the next shift, there by I get "Her orders need to be clarified" when in fact the reports was "Got coumadin orders for tonight from the on-call, please call primary in the morning for additional orders".
I got the jumbled version of #2, wondered which orders, checked the MAR and couldn't find anything that didn't look right and promptly got so busy with a less than likeable pt who was on her light every 5 minutes:
HER: Your supposed to wrap my legs.
ME: Yes, I know, but it's 6:30am, and I have a few other things I need to finish first, I plan on doing it before you have therapy.
A few minutes later, the CNA tells me she wants me.
HER: Don't forget my foot cream
ME: Of course not!
HER: Well are you going to get it?
ME: Yes, when I wrap your legs after breakfast (thinking, if you could REACH them, you COULD DO IT YOURSELF)
An amazing 30 minutes pass before the next issue
HER: What's that gurgling?
ME: That's water in your circuit hose, I'll drain it, and show you how you can.
HER: THERE'S NOT supposed to be water in there! You did something WRONG!
ME: I did not do anything to the set up, it's water that's condensed in there. That's what this collection bag is for, see?
I take her morning medications in about 30 minutes later, she questions every pill. Tells me I checked her blood sugar "wrong". The other nurses poke her finger dead center, not on the sides. Hmmm....I wonder why? Then I gave her insulin wrong because she could actually feel the needle.
Fast forward to after breakfast. I get the supplies to do the wraps, and she tells me again I'm not doing it right. I'm supposed to wrap cotton underneath the ace wraps first. Fine. I get back in the room and get asked why there is water on the floor. I calmly remind her that she spilled it a moment ago--and that's why I had a towel in my hand.
After I did the leg wraps, I thought I was off the hook until lunch--but then she wanted suction and lavage. Lucky me, she hacks out a huge nasty booger, and then there was nothing to suction. No loss as far as I was concerned. I also still had to bet her vitals, and brought the manual cuff. As a big woman, I know how bad those automatic cuffs can hurt, they are excruciating. So I did a manual and she wanted me to do it on her lower arm. I'm very, very bad at this, so I tried, didn't get it, and then did it on her upper arm--she kept thinking/saying how it would hurt.
By the end of the day, I was at my wits end. I'm trying hard to remember why she is with us, and why I'm supposed to be nice. The final straw was when she came out of her room--and told me her O2 set up was wrong. Um, except I didn't change a thing all day. And after spending 1/2 hour on the phone with RT on Sunday night, I'm about the only person who actually knows what to do with her circuit and set up. Most of our A&O residents on the TCU side get the fact that the goal is independence and the ability to get home...some are not. I'm trying hard to remember that there are underlying issues for this, like mental health problems, but it's hard when you see one resident working so hard and getting home while another acts like they are at a resort and they are the only person in the place with a staff of 20 to cater to their needs.
Spending 1/2 the day playing head games with myself didn't help either. So when the PM nurse came on tonight, I had to admit I had dropped the ball. I figured out what the report should have been when I finally was able to sit down to chart 30 min. before the end of my shift. That's when I saw her note from yesterday. The thing is, I know she'll complain about me all night for missing this while to my face she says "no big deal."
I do the best I can in the limited time I have. More work vents to follow. It's good for me.
Monday, August 03, 2009
Sleepless night
After getting to bed way too late, due in part to the only storm we've really had all season, and in part due to my own stupidity, I managed to survive AND do my good deed for the day. I worked a PM shift so I can have this Sunday off, which makes for a nasty short turn around for this morning. Couldn't fall asleep until after the storm passed, and then hacked my way through the night, promising my self I'd stop and the walk in clinic on my way home to beg for some codeine cough syrup.
Backing up to last night, utter chaos. Dementia is a horrible thing. We currently have a resident who is just two years older than one of our nurses, they actually went to high school together. Ugh, so sad...Nursing wise, this guy has what we call "Impaired safety awareness". He's also a mean old coot. He's hurt several of my CNA's, and has threatened to hit, kick and throw things at several other staff members. Fun guy. Between him and two other residents with similar issues, I should have sweated off at least 5 pounds. It was hard to get anything done other than just babysitting these three residents. I had an admit to finish, new TB paperwork to finish on all of our current residents, and several of our nurses are boycotting doing the TB paperwork catch up. Vent to come later on that.
The night nurse is as slow at getting report as she is at giving it, so I didn't manage to leave until 45 min. after my shift ended. It was already 11:30 when I got home. I fixed myself a snack, settled into bed with my 'puter and the TV when the sirens when off--which immediately gets my adrenaline going. No sleep for me until the storm passed. I tried falling asleep about 12:30, and thought "Well I can still get close to 5 hours if I go in late." I had warned the night nurse I'd be late.
The night went something like this: Hack, hack, hack. Cough, cough, cough. Roll over. Repeat. Flip the pillow to find the cold side. More coughing, nose drains to the other side. Debate taking more robitussin. Get up to pee. Still spotting, a little crampy, but where's my period? Back to bed...kick the dog out of my spot. Hack, hack, hack. Cough, cough, cough. Roll over. Alarm rings...
No shower this morning. Hotter and sticky at work. Sweating dripping off my forehead. Crappy slow CNA's. No real problems with the wing, nothing unexpected, just slow CNAs. There is one who can't seem to get it through her head that when I have a pt. on M-W-F weights that I really will expect that weight on those days! She acts like a surprise every time I remind her. This resident has been a 3x a week weight for the last 6 months--what the heck? Maybe I'll try and get that one discontinued since she's been stable. Easier than fighting with the CNA three times a week.
Now for my good deed. One resident was determined to get some new yarn and knitting stuff. It's the beginning of the month, so she has her monthly spending account re-filled. Less than $100/month...how sad is that? She spends it mostly on snacks and soda. Truthfully, if I end up in a LTC, that's where my money will go too. Anyway, she tends to obsess when she gets an idea in her head. So I agreed to get the supplies she wanted. At times in my life I've had close to $1000 in cash, yet I clutched onto her $16 like it was gold. If anything had happened, I just would have paid out of my own funds--but still. When you get less than $100/month to call your own...Anyway, I made her day. My good deed was done.
It ended up being 4:30 when I got home. Too late for a nap, but I tried anyway. Hack, hack, hack...here we go again. Beloved called me on my crap "Thought you were going to the quick clinic?" yeah, I was...
I'm anticipating another sleepless night. But I will HAVE to take a shower in the morning. Poor Beloved has to sleep next to my stink.
Backing up to last night, utter chaos. Dementia is a horrible thing. We currently have a resident who is just two years older than one of our nurses, they actually went to high school together. Ugh, so sad...Nursing wise, this guy has what we call "Impaired safety awareness". He's also a mean old coot. He's hurt several of my CNA's, and has threatened to hit, kick and throw things at several other staff members. Fun guy. Between him and two other residents with similar issues, I should have sweated off at least 5 pounds. It was hard to get anything done other than just babysitting these three residents. I had an admit to finish, new TB paperwork to finish on all of our current residents, and several of our nurses are boycotting doing the TB paperwork catch up. Vent to come later on that.
The night nurse is as slow at getting report as she is at giving it, so I didn't manage to leave until 45 min. after my shift ended. It was already 11:30 when I got home. I fixed myself a snack, settled into bed with my 'puter and the TV when the sirens when off--which immediately gets my adrenaline going. No sleep for me until the storm passed. I tried falling asleep about 12:30, and thought "Well I can still get close to 5 hours if I go in late." I had warned the night nurse I'd be late.
The night went something like this: Hack, hack, hack. Cough, cough, cough. Roll over. Repeat. Flip the pillow to find the cold side. More coughing, nose drains to the other side. Debate taking more robitussin. Get up to pee. Still spotting, a little crampy, but where's my period? Back to bed...kick the dog out of my spot. Hack, hack, hack. Cough, cough, cough. Roll over. Alarm rings...
No shower this morning. Hotter and sticky at work. Sweating dripping off my forehead. Crappy slow CNA's. No real problems with the wing, nothing unexpected, just slow CNAs. There is one who can't seem to get it through her head that when I have a pt. on M-W-F weights that I really will expect that weight on those days! She acts like a surprise every time I remind her. This resident has been a 3x a week weight for the last 6 months--what the heck? Maybe I'll try and get that one discontinued since she's been stable. Easier than fighting with the CNA three times a week.
Now for my good deed. One resident was determined to get some new yarn and knitting stuff. It's the beginning of the month, so she has her monthly spending account re-filled. Less than $100/month...how sad is that? She spends it mostly on snacks and soda. Truthfully, if I end up in a LTC, that's where my money will go too. Anyway, she tends to obsess when she gets an idea in her head. So I agreed to get the supplies she wanted. At times in my life I've had close to $1000 in cash, yet I clutched onto her $16 like it was gold. If anything had happened, I just would have paid out of my own funds--but still. When you get less than $100/month to call your own...Anyway, I made her day. My good deed was done.
It ended up being 4:30 when I got home. Too late for a nap, but I tried anyway. Hack, hack, hack...here we go again. Beloved called me on my crap "Thought you were going to the quick clinic?" yeah, I was...
I'm anticipating another sleepless night. But I will HAVE to take a shower in the morning. Poor Beloved has to sleep next to my stink.
Saturday, August 01, 2009
Sunset
At work, there is a poster that has the caption "the sun setting is no less beautiful than the sun rising." The faces on the picture are in profile, a young child throughout life to an elderly woman. This week I was part of a sunset.
As I arrived at work and prepared to get report, I heard an alarm going off. The night nurse and I went into the room and helped the man back in bed. I could hear a gurgle in the back of his throat, but this has happened before. In nursing terms, he was having difficulty mobilizing his secretions. I ran through the list of nursing interventions available: Nebs to thin secretions, morphine to enhance O2 uptake, ativan to help him relax, atropine to help dry up the secretions, warm liquids, encouraging deep breathing and coughing, elevate the HOB, and checking his O2 sats. I started with the warm liquids and elevated the HOB. He said he felt a bit better, but was still gurgling. I gave the atropine drops and started a neb. The other nurse was still giving report and counting narcs, so I checked on him when the neb was done.
He was talking to me, and I adjusted his bedding. This man has severe COPD and uses a lot of energy to breath, often becoming very sweaty. I put a cool cloth on his face and washed his face--he thanked me and asked me not to leave. I told him I would check on him in a few minutes, and did he want some morphine? He said yes. After giving it to him, I told him it would take a few minutes to work and I'd check back, he said okay and thanked me. I asked the other nurses if they could think of anything else I could do to help him with his secretions and one came in the room and suggested Robitussin. After suggesting this to him, I also remembered he could have ativan. Since he was still restless (not uncommon with COPD'ers) he said yes, he would like some, he said he was feeling restless. So I gave him the ativan.
Again, he asked me not to leave him. I sat and held his hand for a few minutes and told him I'd be back, but I'd be just outside the room if he needed anything. He looked at my name tag and thanked me by name. I quick got report and then took the robitussin back into his room...to find that somewhere within the last 5 minutes, he'd passed away.
I wish I would have sat with him those last 5 minutes. I didn't realize he was dying at that point, as I had never had the experience of having a pt be that awake, alert, and talking. I hated having to wake his wife with this news. I hated knowing she was alone. My CNAs cleaned up his room and did the post-mortem care. They did a wonderful job, and by the time hospice arrived and waited for his wife to arrive I had to get on with my job for the day. I had 9 other residents that needed care, medications, blood sugars, pain management, etc, etc, etc...the day had to go on.
It reminded me of the losses in my life: The day my mom died, for example. The rest of the world goes on despite my grief. One of the few social workers I liked told this story: After his parent's death, he was stuck in traffic on his first day back to work. He was stuck next to a car where the driver was in a good mood, jamming out to his tunes. Tim flipped him off--he was completely pissed that this guy was happy and he was suffering trying to re-organize a life without his parents. After our IVF, there was a definitive "before and after". After my nephew's dx last year, I wanted to kick over all the college displays at Target.
Of course I couldn't know just how this man's wife felt walking into our facility where the hustle and bustle of the day had started, but I had a good idea. All I could do was tell her how sorry I was, and that he was comfortable at the end. It felt so damn lame. I didn't tell her how he asked me to stay and how I didn't.
Where's my mojo?
I keep wondering where I've gone. I haven't regretted stopping therapy a few years ago, and I think I have better body image than ever, but I'm as fat as I ever was at my highest weight, working more hours in a physically, mentally, and emotionally demanding job. And I've been getting sick. A lot. And my foot is killing me. It's time to get back to basics...
1. Journaling was the best thing that came out of my therapy. I've said it again and again. Still, at times it's a struggle. It's hard to see my words and feelings written down. It's hard to re-read them. But when I do, it's self-validating. I read it, remember what I was feeling and thinking, and think "that's not so bad!" But then I won't right anything for a while and it ends up coming out as word vomit. Time to do this more, to avoid the word vomit.
2. Self cares: Good points: I've spent about $600 on clothes and shoes this summer. I've spent another $300 or so on self-beautification at the spa. Bad points: I wait too long to do these services. I would be better cared for if I did these things in smaller $$ amounts, on a more regular basis.
3. Church: We've joined a new one, I love it, but I have issues. It forces us to spend more time with MIL, who I love and adore. It chews up a good part of my Sunday and it seems like I'm missing the day somehow. I think there are old issues here re-surfacing in a weird, unhealthy way.
4. Pain issues: I found out this spring that at some point, I really should have reconstructive surgery on my foot. I don't want to. So I'm taking pain killers, which help a lot. My headaches are virtually gone.
5. Family issues: My brother continues, of course, to deteriorate. His wife is a psychotic bitch who told my sister she prays we get huntington's disease. We have no contact. I'm not all that sad, but do wish I could have a united family. One that isn't crazy. So my only real family outside of my marriage is my sister's. I love her dearly and at times wish I lived closer. It would be fun to pop over for dinner, meet up with them and my Dad for lunch, occasionally babysit for her kiddos.
6. Wife and Marriage issues: My poor husband deserves a much better wife. I work a minimum of 40 hours a week, more like 50-60. Add in drive time back and forth and orientation at the hospital and I'm tired. A lot. Which leaves no time for #1 or #2, and even less time for sleep. Which makes me a pretty absent wife. This feeds into all sorts of fears that he'll leave me. I wouldn't blame him a bit.
My garden looks like how I've been feeling, chaotic and full of weeds. Nothing is growing. It's stagnant and so am I. My focus these last months has been to keep our heads (financially) above water and to build my career. I want to advance and learn as many skills as possible. First, to be a better more knowledgeable nurse. Second, because that's just how I am. I want to be the best I can be. While I love working at the LTC/TCU, and I have grown to enjoy my PT home care job, these are the two least respected areas of nursing. Not sure why, but it's true. Neither is easy, but both are considered the bottom rung of the ladder. If my pay was better at the LTC, I would probably be content to stay. However, there is little room to grow and that would eventually cramp my style too. So I found a local hospital that was hiring, and I'm enjoying it. I'm finding myself very different from my preceptors in that they are content in their small-town hospital. One says "I'm a med surg girl through and through." I'm not. I want to learn it all. After going through college once and coming out with a very limited set of skills, I don't want to be limited again...that is also part of my motivation.
The cost has been high, and my personal mojo is gone. My list making, all the things I used to get done in a day--gone. At work, I hate sitting still. I want to be productive and busy. I constantly think about beloved and coming home to him, but once I'm home can barely interact with him. It's enough to just have him near. I need him near, and draw strength from him. But I look at him and have a hard time figuring out where to start or what to say. All I have to talk about is work.
It's taken a toll on my immune system. I'm constantly sick, which affects my sleep, which I desparately need. I used to love to cook and just don't have the energy to do so anymore. So I eat crap and junk. This is not helping my weight or my immune system. I have no energy to work out--so I'm not sleeping well and of course it's affected my weight. The constant sick has affected my weight too.
I want, I want, I want...so many things. I want to take care of my house the way I used to. I want to take care of my garden the way I used to. I want to take care of my husband and myself the way I used to. I want my mojo back so I can work out and play hard, and have fun with my husband again.
I miss myself.
1. Journaling was the best thing that came out of my therapy. I've said it again and again. Still, at times it's a struggle. It's hard to see my words and feelings written down. It's hard to re-read them. But when I do, it's self-validating. I read it, remember what I was feeling and thinking, and think "that's not so bad!" But then I won't right anything for a while and it ends up coming out as word vomit. Time to do this more, to avoid the word vomit.
2. Self cares: Good points: I've spent about $600 on clothes and shoes this summer. I've spent another $300 or so on self-beautification at the spa. Bad points: I wait too long to do these services. I would be better cared for if I did these things in smaller $$ amounts, on a more regular basis.
3. Church: We've joined a new one, I love it, but I have issues. It forces us to spend more time with MIL, who I love and adore. It chews up a good part of my Sunday and it seems like I'm missing the day somehow. I think there are old issues here re-surfacing in a weird, unhealthy way.
4. Pain issues: I found out this spring that at some point, I really should have reconstructive surgery on my foot. I don't want to. So I'm taking pain killers, which help a lot. My headaches are virtually gone.
5. Family issues: My brother continues, of course, to deteriorate. His wife is a psychotic bitch who told my sister she prays we get huntington's disease. We have no contact. I'm not all that sad, but do wish I could have a united family. One that isn't crazy. So my only real family outside of my marriage is my sister's. I love her dearly and at times wish I lived closer. It would be fun to pop over for dinner, meet up with them and my Dad for lunch, occasionally babysit for her kiddos.
6. Wife and Marriage issues: My poor husband deserves a much better wife. I work a minimum of 40 hours a week, more like 50-60. Add in drive time back and forth and orientation at the hospital and I'm tired. A lot. Which leaves no time for #1 or #2, and even less time for sleep. Which makes me a pretty absent wife. This feeds into all sorts of fears that he'll leave me. I wouldn't blame him a bit.
My garden looks like how I've been feeling, chaotic and full of weeds. Nothing is growing. It's stagnant and so am I. My focus these last months has been to keep our heads (financially) above water and to build my career. I want to advance and learn as many skills as possible. First, to be a better more knowledgeable nurse. Second, because that's just how I am. I want to be the best I can be. While I love working at the LTC/TCU, and I have grown to enjoy my PT home care job, these are the two least respected areas of nursing. Not sure why, but it's true. Neither is easy, but both are considered the bottom rung of the ladder. If my pay was better at the LTC, I would probably be content to stay. However, there is little room to grow and that would eventually cramp my style too. So I found a local hospital that was hiring, and I'm enjoying it. I'm finding myself very different from my preceptors in that they are content in their small-town hospital. One says "I'm a med surg girl through and through." I'm not. I want to learn it all. After going through college once and coming out with a very limited set of skills, I don't want to be limited again...that is also part of my motivation.
The cost has been high, and my personal mojo is gone. My list making, all the things I used to get done in a day--gone. At work, I hate sitting still. I want to be productive and busy. I constantly think about beloved and coming home to him, but once I'm home can barely interact with him. It's enough to just have him near. I need him near, and draw strength from him. But I look at him and have a hard time figuring out where to start or what to say. All I have to talk about is work.
It's taken a toll on my immune system. I'm constantly sick, which affects my sleep, which I desparately need. I used to love to cook and just don't have the energy to do so anymore. So I eat crap and junk. This is not helping my weight or my immune system. I have no energy to work out--so I'm not sleeping well and of course it's affected my weight. The constant sick has affected my weight too.
I want, I want, I want...so many things. I want to take care of my house the way I used to. I want to take care of my garden the way I used to. I want to take care of my husband and myself the way I used to. I want my mojo back so I can work out and play hard, and have fun with my husband again.
I miss myself.
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