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.
Showing posts with label Nursing. Show all posts
Showing posts with label Nursing. Show all posts
Wednesday, August 19, 2009
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?
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.
Saturday, August 01, 2009
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.
Friday, April 24, 2009
When Nurses Have Meltdowns
When a nurse is having a bad day, here are a few handy tips for coworkers:
1. Jump in and help. Don't wait for the nurse having the bad day to ask. This is a good time to put the phrase "Just do it" into action. Thankfully, I have such a co-worker, actually, surprisingly two. And one of those is a manager. Color me surprised!
2. Don't bitch about what a rough day YOU'RE having and ask for my help. This will rapidly piss me off even more--and make your day harder for sure.
3. Don't walk by me and announce "Oh you're going to love me for sure! Guess what? You're getting an admit in about an hour. This makes me want to give you an enema--after taking a running start, without the lube.
4. For God's sake, do NOT give me the slowest TMA on the planet--nice woman, good heart, good CNA, HORRIBLE TMA. Oh yeah, don't do that AND short me on an aid.
5. Jump in and help with the needy, cranky, demanding family members.
I have a pt. dying, with family calling for updates. I happen to have a distant connection to this family as well, making them expect more from me. Under normal circumstances, I want to go that extra mile. I want all of my pts. to have the highest quality of care. I have high expectations of myself in this regard.
Next, had a discharge. Fairly simple, straight forward, anxious to leave. Fine, until he calls me because he can't get the meds he told me he didn't need me to order. Why is this my problem? Could have solved it at 7:30am before my day went to hell.
Next pt. is sure that the meds are WRONG, and don't you dare bring me those meds after my food is here. Fine, eat your food cold...want one to one care? I'm a lot more expensive...so a call's made to try and straighten out the meds and spouse harrasses me for not getting a reply fast enough. PLEASE NOTE: I'M NOT THE SECRETARY FOR THE MD WHO WORKS OUT OF AN OFFICE DOWN THE STREET. This one doesn't want to eat either, refuses her supplements, can't figure out why she's so tired. Surely there's a reason...could it be the terminal dx, the high dose pain meds? The lack of food? Nah, probably the inhaler you insist I didn't order correctly for you, even though I didn't enter your orders.
This one still has a port a cath access needle in (and I need to figure out what to do with it, um, how to get it out) wants a suppository--but not now--maybe later. Asks me why the maintenence man would know the therapy schedule. Maybe because he's a really nice guy, trying to be helpful, and was here to set up your requested equipment that therapy provided. Maybe you could treat him a little crappier, eh? After all, he's JUST the maintenence man.
Next pt. has c-diff...lots of fun. Doesn't want to eat, despite this, a shocking amount still coming out the other end.
Opps, another one started hospice and is rapidly declining. Someone else can convince him to deep breath and cough every hour. Doesn't want to eat.
Super Gay Hospice Nurse had to add a little dig at the end and piss me off..."Just a friendly reminder to do oral cares frequently." WTF? I personally did oral cares x2, there were swabs bedside, and vaseline bedside. Did it look like efforts were not being made? Asshole.
Damn, trays are late and I gave insulin to another pt...crap...should I re-check his insulin? Where the hell is my TMA? I already have my medicare vitals done, how can she not have that cart done yet?
Why isn't anyone in my dining room? Thankfully Super Nurse Co-worker is on top of it and now a bunch of my pts are in the dining room. No clue where my CNA is....
Great, the discharge from yesterday wants us to round up the O2 cylinders he brought from home. Dude, call your O2 company, not me. You have been DISCHARGED.
Okay, guess I'll have to pass meds for the second cart. Crap, there are three people who have crushed meds. Oh, there's my CNA, someone is refusing to get dressed until I change his saturated dressing. YUCK. Gross...it's smelly too...What does he mean I slapped the bandage on wrong? How many ways are there to put a giant band-aid on? Seriously? You won't get up until I get a new one? Oh my, that IS tempting. Of course the other nurse does it right...she works with you every single day and I'm just a big old loser replacement nurse in charge of double the amount of pts that she is because we're working short handed again!
Oh, pain meds, pain meds, and more pain meds. Pain follow up, ice packs, and rubbing sore joints. Answering hospice questions, social worker questions, and doing treatments down the other hall that has the best TMA ever. Damn, why couldn't I have had her instead? Doctor's call...I hope it's on one of my regular pts. Thank God, it is and I knew what he wanted to know/hear.
This is why I had the meltdown when I found out my admit was early. I seem to keep finding more and more problems, have no time to fix them, and can't get my assessments done.
Thankfully, my Super Nurse Co-worker validated my crappy day. I was actully feeling bad about crying, but she made me feel better, told me I was right, and that a lot was being asked of me (yeah, I know it's pathetic that I still felt bad) Just call me the doormat.
Thank God it's my weekend off!
1. Jump in and help. Don't wait for the nurse having the bad day to ask. This is a good time to put the phrase "Just do it" into action. Thankfully, I have such a co-worker, actually, surprisingly two. And one of those is a manager. Color me surprised!
2. Don't bitch about what a rough day YOU'RE having and ask for my help. This will rapidly piss me off even more--and make your day harder for sure.
3. Don't walk by me and announce "Oh you're going to love me for sure! Guess what? You're getting an admit in about an hour. This makes me want to give you an enema--after taking a running start, without the lube.
4. For God's sake, do NOT give me the slowest TMA on the planet--nice woman, good heart, good CNA, HORRIBLE TMA. Oh yeah, don't do that AND short me on an aid.
5. Jump in and help with the needy, cranky, demanding family members.
I have a pt. dying, with family calling for updates. I happen to have a distant connection to this family as well, making them expect more from me. Under normal circumstances, I want to go that extra mile. I want all of my pts. to have the highest quality of care. I have high expectations of myself in this regard.
Next, had a discharge. Fairly simple, straight forward, anxious to leave. Fine, until he calls me because he can't get the meds he told me he didn't need me to order. Why is this my problem? Could have solved it at 7:30am before my day went to hell.
Next pt. is sure that the meds are WRONG, and don't you dare bring me those meds after my food is here. Fine, eat your food cold...want one to one care? I'm a lot more expensive...so a call's made to try and straighten out the meds and spouse harrasses me for not getting a reply fast enough. PLEASE NOTE: I'M NOT THE SECRETARY FOR THE MD WHO WORKS OUT OF AN OFFICE DOWN THE STREET. This one doesn't want to eat either, refuses her supplements, can't figure out why she's so tired. Surely there's a reason...could it be the terminal dx, the high dose pain meds? The lack of food? Nah, probably the inhaler you insist I didn't order correctly for you, even though I didn't enter your orders.
This one still has a port a cath access needle in (and I need to figure out what to do with it, um, how to get it out) wants a suppository--but not now--maybe later. Asks me why the maintenence man would know the therapy schedule. Maybe because he's a really nice guy, trying to be helpful, and was here to set up your requested equipment that therapy provided. Maybe you could treat him a little crappier, eh? After all, he's JUST the maintenence man.
Next pt. has c-diff...lots of fun. Doesn't want to eat, despite this, a shocking amount still coming out the other end.
Opps, another one started hospice and is rapidly declining. Someone else can convince him to deep breath and cough every hour. Doesn't want to eat.
Super Gay Hospice Nurse had to add a little dig at the end and piss me off..."Just a friendly reminder to do oral cares frequently." WTF? I personally did oral cares x2, there were swabs bedside, and vaseline bedside. Did it look like efforts were not being made? Asshole.
Damn, trays are late and I gave insulin to another pt...crap...should I re-check his insulin? Where the hell is my TMA? I already have my medicare vitals done, how can she not have that cart done yet?
Why isn't anyone in my dining room? Thankfully Super Nurse Co-worker is on top of it and now a bunch of my pts are in the dining room. No clue where my CNA is....
Great, the discharge from yesterday wants us to round up the O2 cylinders he brought from home. Dude, call your O2 company, not me. You have been DISCHARGED.
Okay, guess I'll have to pass meds for the second cart. Crap, there are three people who have crushed meds. Oh, there's my CNA, someone is refusing to get dressed until I change his saturated dressing. YUCK. Gross...it's smelly too...What does he mean I slapped the bandage on wrong? How many ways are there to put a giant band-aid on? Seriously? You won't get up until I get a new one? Oh my, that IS tempting. Of course the other nurse does it right...she works with you every single day and I'm just a big old loser replacement nurse in charge of double the amount of pts that she is because we're working short handed again!
Oh, pain meds, pain meds, and more pain meds. Pain follow up, ice packs, and rubbing sore joints. Answering hospice questions, social worker questions, and doing treatments down the other hall that has the best TMA ever. Damn, why couldn't I have had her instead? Doctor's call...I hope it's on one of my regular pts. Thank God, it is and I knew what he wanted to know/hear.
This is why I had the meltdown when I found out my admit was early. I seem to keep finding more and more problems, have no time to fix them, and can't get my assessments done.
Thankfully, my Super Nurse Co-worker validated my crappy day. I was actully feeling bad about crying, but she made me feel better, told me I was right, and that a lot was being asked of me (yeah, I know it's pathetic that I still felt bad) Just call me the doormat.
Thank God it's my weekend off!
Thursday, January 08, 2009
Pain is NOT subjective!!
Today I got called into my DON's office, where our executive director--who is not a nurse--yelled at my for charting "Pt. states pain is an "8/10". I listed my interventions, what her response was, etc. ED told me that "If her pain was really that bad, we should be sending her to the hospital. You need to do a full assessment then to see if that corelates to what she's saying." I asked her if she was concerned about drug seeking....
This pt. is A&O x4, has an infection in her hip incision, AND has fibromyalgia, for which she takes methadone 5mg BID. "You need to use the faces scale then if the objective assessment does not agree with what she's saying." And then what? Only give her 1 pain pill instead of the two that I did that reduced her pain to a "3/10"???? Why, why, why would I use the dementia pain scale for someone who is A&O? That is then saying we are not taking our pt's pain complaints seriously.
She had previously stated "7/10" and the day nurse gave her one vicodin and vistaril, she was asking for more within 3 hours...What ever happened to pain is subjective?
And I wonder why I can't get anyone to believe me about MY pain issues. This is Nursing 101: "The patient is always right; Pain is subjective, a sensory experience unique to each indivdual".
Chronic pain sufferers do not cope with pain the same way as people with acute pain. I attempted to argue this point, with the response being "An 8 is acute pain." Period? Says who? Not my patient.
If I talk to the patient and say "If your pain is that bad, we should send you to the hospital. Remember 0 is no pain, 1-3 is mild, 4-7 is moderate, and greater than that is severe. Now is your pain REALLY THAT BAD???" I'm telling my patient that I don't take her seriously.
Piss of, you business worried about your survey PITA!
This pt. is A&O x4, has an infection in her hip incision, AND has fibromyalgia, for which she takes methadone 5mg BID. "You need to use the faces scale then if the objective assessment does not agree with what she's saying." And then what? Only give her 1 pain pill instead of the two that I did that reduced her pain to a "3/10"???? Why, why, why would I use the dementia pain scale for someone who is A&O? That is then saying we are not taking our pt's pain complaints seriously.
She had previously stated "7/10" and the day nurse gave her one vicodin and vistaril, she was asking for more within 3 hours...What ever happened to pain is subjective?
And I wonder why I can't get anyone to believe me about MY pain issues. This is Nursing 101: "The patient is always right; Pain is subjective, a sensory experience unique to each indivdual".
Chronic pain sufferers do not cope with pain the same way as people with acute pain. I attempted to argue this point, with the response being "An 8 is acute pain." Period? Says who? Not my patient.
If I talk to the patient and say "If your pain is that bad, we should send you to the hospital. Remember 0 is no pain, 1-3 is mild, 4-7 is moderate, and greater than that is severe. Now is your pain REALLY THAT BAD???" I'm telling my patient that I don't take her seriously.
Piss of, you business worried about your survey PITA!
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