Tenth week and counting...

Survived another one! Today I was on the orthopedics floor and it was a good day, maybe a little slow, but plenty of learning opportunities. The nurses there are so nice, they are great with the students. They go out of their way to help you find things you can do for their patients, and they are nothing but helpful and welcoming toward the students. This was my first week with 3 patients. I had to pick two yesterday and do care plans on them, and then when I got there this morning I had to pick a third patient during morning report. The ones I chose for care plans were a woman about my age with every endocrine problem in the universe, and a woman in her mid-eighties with a dislocated hip prosthesis and hip fracture. She had a hip replacement a few weeks ago but fell and re-injured it. She needs to have the whole thing replaced again! The third patient I chose was a 70 ish man who had a knee replacement yesterday.

The morning was a challenge, doing all the assessments and working with two different nurses. I gave all the oral meds and it was so much easier not having to page the instructor every time. I did have to have the instructor there for giving injections and anything else. I took out a foley catheter while Denise was there and she gave me the okay to do it on my own now. The woman with the endocrine problems had extensive surgery with a scar across the entire width of her torso, they took out her adrenal glands because she had tumors, which turned out to be benign but were causing her to pump out all this cortisol and caused all kinds of problems. Imagine if you took a ton of corticosteroids all the time, what you'd look like- all bloated with fluid and fat face and upper body and brusiing, fragile skin, osteoporosis, this woman had all that, plus she had other glands removed prior to this. Basically you name the endocrine gland, she's had it removed. Amazing. She was actually doing quite well despite her history. We ended up transferring her off the floor later in the day because they needed more ortho beds- there were 17 hip and knee surgeries going on today. I learned a lot from her, it was amazing all she's been through with her body and she's functioning as well as she is.

The elderly woman with the hip fracture was going in for surgery today, she left around 2 pm for that. Before that I helped the aide change her brief and give her a bath, she had this huge pressure ulcer on her sacrum and was incontinent, so she had a nasty looking wound there. The wound care nurse came and prescribed some dressings and ointments. She was moaning a lot in pain, the nurse gave her morphine a few times, she couldn't get comfortable with that broken hip. She only weighed about 90 pounds and there was nothing but skin and bones, she had no padding to protect her. This poor woman, she could hardly speak. She was a little confused and her mouth was so dry she couldn't make any words come out. I gave her mouth swabs several times and she finally got enough secretions out of her mouth to be able to whisper a few words. She reached up and held on to my wrist with her little bony hand and whispered "I like you". I almost cried.

The one thing I wish I had done with her was to do a better assessment of her in the afternoon. I was busy transferring the first patient and giving medications, and I didn't get back to this woman's room until transport arrived to take her to surgery, and I realized her IV was infiltrated and I told the nurse, but it was too late and the nurse sent her down to surgery, they will have to put in a new IV there. Not a terrible thing, an inconvenience for the surgery people, who will have to take the time to do the IV before they can prep her for surgery. One of those little things I need to add to my mental list of things to check before sending a patient to surgery. Looking at this woman, her labs weren't too bad and she wasn't dehydrated, but she was so frail and she is a DNR (had advance directive orders not to resuscitate). I wonder if she'll make it through surgery. Scary. They didn't call from surgery with a report on her by the time I left, so I don't know how it went.

The knee replacement guy was good too. He was good because I got a chance to talk with the physical therapist while he was working with him. I still think it is so amazing that these people have knee or hip replacement surgery and the next day, sometimes even later the same day of surgery, they are up and walking around. With this guy he had oral meds but also he was getting Lovenox injections, they do this routinely with orthopedic surgeries to prevent blood clots in the legs because they are lying in bed most of the time. He needed to be taught how to give his Lovenox injections to himself since he would be on it at home. I checked with Denise to see if I could do that. I figured she would want to be there while I taught him, because she wants us to have her present when we give any injections. But when I asked her, she was okay with me teaching him myself and she didn't feel she needed to be there! That felt good, to know that she was confident in my ability to teach a patient the right way to give an injection. So I did it, I taught him and I had him give himself the shot, and it went great.

My afternoon was slow after the transfer and the patient to surgery, I was down to one patient so I went asking nurses if they had anything they needed done. One of the nurses asked me if I wanted to start an IV, so of course I said yes, and she didn't tell me anything about the patient. I paged Denise and got the supplies ready.

We went into the room and first thing we saw was a sign, "No IV, BP, or blood draws in left arm". Turned out the guy was a kidney transplant recipient who was having some problems and had a fistula in his left arm for dialysis, in case. He actually had not received dialysis, but the fistula was there in case he ever needed it. I went to look at his right arm, and turns out he had a plate in it from a fracture, from the wrist almost to his elbow. He had an IV in his right hand but we needed to put in a new one because the old one had been in there too long. I checked out his arm and put the tourniquet on, and the only good vein access I could find was on his wrist, right where it bends. Not a good spot. He was getting all his blood draws in the antecubital vein (in the bend of the elbow) so I couldn't use that, it's also a lousy spot for an IV. You don't want to put it where they have to bend their arm all the time, plus it makes the IV pumps beep all the time and drives everybody on the floor crazy. Plus, like Denise says, anytime you have to wipe your butt with your non-dominant hand, it sucks.

After looking for veins, I finally told him I'd rather have someone more experienced start his IV, because if I missed, there would be one less spot that they could use, and there weren't many options to begin with. Last thing I did for the day was go in with the nurse to watch where she put the IV in this guy. When I left to go to meet the class at 6:30, she had tried in the inside of his upper arm (ouch) and missed and created a huge hematoma. I told Denise about it and she said, "Glad it wasn't us!"

The three patients wasn't bad today, because of the way it worked out. It could have been overwhelming. And the nurses were nice, which helps. I am dreading the uro-neuro floor, hoping to avoid the bitch from hell, the meanest nurse in the entire universe, who has been in her usual form with other people in my class while they've been there. They all complain about her. Denise knows about it and says it's part of dealing with different personalities, like we will have to as nurses. She's right, but that nurse is exceptional. I am going to do my best to avoid her. At least the day I am on that floor is only an 8 hour day.

During our mid-afternoon conference Denise gave us a scenario where she described all these things happening with a hypothetical patient - the situation, the labs showing electrolytes way off, white blood cells high, super high pulse, poor circulation in the feet, etc. and we had to figure out what was going wrong. We all had to take a guess at what was going wrong. The answer was hypovolemia and early septic shock, and I was close when I asked what was happening with the kidneys, I asked if they did certain labs for looking at kidney function, I thought that it sounded like poor blood flow to the kidneys. I remembered what Roger said, he always was asking about the kidneys. Denise told us how she thinks about what's going on with a patient in ICU. Like CPR, you think about ABCs first. I thought it was great- I wish we could do these scenarios all the time to get us thinking on our feet. I am such a nerd I like this stuff. I think I would like the ICU.

On Monday when I was picking my patients I saw the hospital's vice president of nursing. I talked with her about a year ago, and I think that's how I got my spot in the accelerated program. Dale introduced me to her one day shortly after I started working in the hospital. She was interested in the fact that I had an advanced degree and was going into nursing. She set up a meeting with me and we talked. Shortly after that, the newspaper called and wanted to do an article on the nursing program and they included me and took a picture of me, and the hospital PR people wanted to talk to me. My brother never lets me live it down, kissing ass to the corporate types. He still gives me a hard time about meeting with her. Who knows, maybe it helped. I got in!

Anyway I saw her walking by on the floor, which never happens, and she actually saw me and stopped and asked me how it's going, I told her good, she asked how I liked the program and of course I told her I love it and blah blah blah, she asked me what I want to do when I graduate and I told her right now it's between oncology and ICU, I felt like such a little brown-nosing shit. Omigod. What I should have said was IT SUCKS! IT'S HELL! IT'S MISERY! JUST PAY MY FREAKING TUITION AND LET ME NOT WORK! FIND DOGGIE DAY CARE FOR ME! SEND ME ON VACATION TO BAJA! ALL EXPENSES PAID! BUY ME THE WINNING LOTTERY TICKET! WRITE MY CARE PLANS FOR ME!

Last weekend at work I did talk with another aide who floated to our floor from upstairs. She is in the same boat as me as far as stress and thinking of quitting work. She is quitting at the end of the semester. We commiserated and she agreed with me about not getting anything out of being a CNA at this point. It was nice to get more validation from another person. What I thought was funny was that she put it the same way I did- she said she's wiped enough butts and she's ready to move on. She did her Block 3 med-surg clinicals at Memorial and said they were professional over there and she loved it. I think it would be nice to go see how another hospital is run. Next semester we might have an opportunity to do that- at Memorial Hospital, and at whatever psych facilities we go to.

She did say that Block 3 will be more stressful, and the classes get harder. She said she hated Block 2, I'm not to the point of hating it but I am not enjoying it all that much. I do look forward to the things we'll learn in Blocks 3 & 4. Block 2 is a hoop to jump through, the way I see it. I feel like I could have done this semester's classes online, where last semester I was glad I didn't take it online. The teachers we have this semester basically suck.

The dogs are not getting enough attention either. With Dale's schedule getting to the point of ridiculous- he is putting in 11-12 hour days and being asked to come in on his day off, and me being gone, we got a note from a neighbor who said our dogs were barking the other day. I am sure they were barking, although this guy is a little weird and he is the only one who ever complains about our dogs- he's been gone all summer and no one else ever complains. I might have to hire someone to come by the house and open their doggie door after 9 am. The girls miss having attention too, they had a mom at home with them most of the time before I started school. They never stayed home alone all day like this. I have enormous guilt over leaving them if we are both gone all day.

Dale was home today and he called about 6 different dog sitters. I will have to find time to call the ones he liked most, so we can hire someone by next Tuesday. I have more homework than I can wrap my mind around tomorrow. I have so much to do that I decided I am going to have to take a personal day from work on Friday and get a few more things done. Fortunately today Dale managed to sweep up about 2 extra dogs worth of hair accumulating on the Pergo floor under the furniture. The house is a disaster. I have a Pharm test on Thursday and I haven't even begun to study for our big exam in Process coming up. I am so far behind in that class I'd have to go without sleep for a week to get back on track.

Speaking of sleep, I haven't slept well the past 3 nights and it's getting to be bedtime now. I hope I can relax tonight and catch some Zs. Tomorrow I need to make time for my girls, take them for a run and go to the dog park with them. And then I need to study, study, study.

One more week of ortho and then it's one week in uro-neuro before we start leadership. Two more weeks of care plans from hell. Pure misery.

Peace, love, and restful, undisturbed, refreshing sleep,

Towanda, RN2B

Smelling the barn, or having a meltdown?

I'm writing this halfway through the weekend. It's late and I have to get up at 5 to go to work, but I'm not sleeping and my mind is racing. I am stressed as hell, I spent 8 hours on homework today on my one day off, and I am PMSing to boot. One of my favorite colorful expressions I like to use when I'm feeling stressed is "I don't have time to wipe my ass", and now I'm wiping so many other people's asses, I don't have time to wipe my own!

I am definitely at the highest level of stress I've felt since I started school. I know that 3 weeks from now when med surg is done and I get my Mondays back, it will feel a lot easier. But I talked to some Block 3 students while I was at work on Friday, and they forewarned me- whatever stress I am feeling now in Block 2, it will be that way all the time in Block 3. I have decided I need to do something about this before I have a meltdown. Next semester we have 2 days of classes plus care plan day before clinicals, and the care plans in Block 3 are even more time consuming, plus our 12 hour clinical day. Add that to trying to work 2 days a week and I'm going to lose it. As it is I don't have enough time to get all my reading and assignments and studying done right now, I can imagine going for a a whole semester like that would put me over the edge.

When Dale came home from work today he told me about one of his employees who is in nursing school in the BSN program at the university and she called off today, she was all stressed out and crying on the phone. I know her, and I can completely understand. Dale started telling me about it and I started crying... hormones are great for that!

On Friday I was at work and I was a sitter for 2 patients, which means I am responsible for watching them to make sure they don't injure themselves. Usually it's for a dementia patient- they try to pull out their IV lines, their foley catheters, try to get out of bed when they might fall and break their hip or worse, etc. While I was sitting outside the two rooms all day with the nurses and students and externs and other staff going in and out of the rooms, I got a chance to talk to a Block 3 student in our program. She told me she is an extern at University Hospital, downtown, in the ICU! She said she loves it and she is learning a ton and the nurses have been great. That's all I needed to hear.

I began having my epiphany as soon as she said ICU extern two shifts a month. Being an extern in the ICU is what I wanted to do by now, but Desert Valley doesn't offer that option unless I can work full time as an extern through the summer. Our program doesn't break in the summer so it doesn't work for accelerated program students. And even as an extern I would end up working as an aide when it's not summer, or if they were short an aide on the floor. Forget that. At this point I am done being an aide, I can wipe ass all day long but I need a little more challenge than that. I'm basically bored out of my mind most of the time at work unless a nurse is doing something interesting at the same time I have a spare minute to watch.

This coming week we register for classes, and when our teacher told us about bringing the registration forms to class next week, it was this amazing feeling like here we are about to register for Block 3..our last FULL, long semester! I was thinking about it and it's like I can almost taste it! Definitely smelling the barn!

The other thing that happened this week is we started our Leadership class, which makes our day longer and gives us more homework. In fact, we have 6 papers to write, a presentation, and reading to do, plus SURPRISE! another "field trip" to a job fair in two weeks...which also happens to be on a day when I have already committed to work. What pissed me off was this... they treat us like slaves, or infants, or something. They totally disregard the fact that we are human and we have lives. They told us we have to sign a contract to get the grade we want in the class. Because, as their rationale goes, we are "adults" and "professionals". Give me a f***ing break! The job fair and the paper that needs to be written about your experience at the job fair is part of what is required for an "A". When several people raised their hands that they already had to work on that day, the teacher (who happens to also be my clinical instructor now) said, "well this is school. You need to prioritize, if you're going to have all these other things outside of school you need to figure out what's important to you."

Somebody tell this woman, and all these teachers, and the whole freaking nursing program that this is 2005, it's the 21-freaking-first century and they need to wake up to the reality that most people cannot get by without working, even in Desert Valley, and 90% of our class is over age 25, more than half the class has families and kids, and furthermore, the hospital we work for is paying for our tuition for this program so we do have an obligation to them too...I suppose keeping your obligation to your employer doesn't count as professionalism? Anyway she pissed off a good portion of the class.

For me, I am going to sign my contract for a B and blow the stupid job fair field trip off. It's easier than having to find someone to cover for me at work, and one less thing I have to do. I don't think I need to get a 4.0 this semester. But I will let them know my dissenting views. This class looks like a big waste of time for most of us. The syllabus was so confusing no one could figure out what the assignments are. They even told us they put the class together 30 minutes before class started. Thanks for sharing. After all the anxious questions got answered, we watched a video about Florence Nightingale for the rest of class.

For this I spent half my day off writing papers for this one class! AAAARGH!!!

Peace, love, and 3 more weeks of gut wrenching, teeth-grinding, care plan raging, sleepless HELL of med surg clinicals!

Towanda, RN2B

Yo quiero?

296 days to go and counting...I have classmates emailing me asking how many days are left. I guess I am now the official timekeeper of our class.

This past week has been packed full…as usual. It's a good thing we have enemas to unplug things when they get stuck. First thing I got was a preview of Block 3: "Yo quiero Taco Bell?"

Last semester I dug around by talking to some of the nursing students in the semester ahead of our class, and managed to get pre-warned about our sociopathic instructor. Turned out to be right-on, highly accurate. I've done it again. Talking to my sources, I managed to pick up some leaked information.

As you already know, this semester we have the sociopath. But next semester we have the... "Chihuahua on Steroids".

The Chihuahua is a psychiatric nurse, and in Block 3 we get a heavy dose of psych. We get a live preview in a few weeks when she gives a lecture in our pharm class, when we get to Psych drugs. I'll let you know how much she resembles the Taco Bell dog.

Last week we had two exams. I aced the Pharm test but then fell flat on my face in the Process test. Guess my coconut wasn't as sharp as it should have been. I think I squeaked by with a C. As they say, C=RN. I'll find out this Thursday what the real damage was. Lots of people walked out of there saying they did terrible.

This week we start Leadership, a class that lasts the second half of the semester. That means I have less time in the morning on Thursdays to ease into my day. Gotta get up early and get my run in, then it's 7 hours of class. Ugh. I can't wait to see what kind of crap we have to do for that class.

At work last week I gave my first enema. I wondered when I was going to have to do that. It was a normal saline enema with the bag held high up to allow the water to go in to the colon. It was on a young/middle aged guy. It was a successful one as far as I'm concerned- because there were no leaks. He had the wherewithal to hold it until he got to the bathroom. Otherwise it could have been ugly.

Monday this week I went early to the hospital to pick my patients. Got two cancer patients. One I remember from when I was working as an aide. He's been in the hospital before and things do not look good for him. Pancreatic cancer is nasty. The other is a woman my age who has esophageal cancer and a feeding tube. I hoped there were different nurses when I show up Tuesday because they were both bristly with students. Excuse us for existing, but who's gonna save your sorry ass from doing overtime in another year or two when you're all shriveled up?

I got done early from doing my care plans, was actually done in 4 hours. I don't feel like I did as good of a job this week, I kind of slammed through them, but it gets so old. I was needing to get outside and run. Yesterday I had the worst run- I felt so low energy. Maybe the weather changing? Hormones? Or pre-care plan rage? I ran a little in the morning but felt like I needed to get the care plans started earlier so I wouldn't be up late. I decided to go out and run about a half hour after I was done, so I did. A storm was moving in. I could see lightning on some faraway ridges and the wind was starting to pick up. I stuck close to my neighborhood, and about 20 minutes into it, the sky closed up and turned this dark orangish-gray and all of a sudden these huge gusts started howling and throwing palm tree bark (which is nasty stuff!) and all kinds of dust and crap. I ran to a neighbor's garage about a block from my house and took cover- the wind was ripping metal real estate sale signs off and hurling them across the street- could get decapitated by one of those! No matter how miserable nursing school is, it would suck to lose my head. I stood there in the protection of the garage door, wondering if it would turn out to be the garage of a guntoting redneck.

I waited a few minutes until the wind calmed down to maybe 40 mph, and sprinted my ass off the last block to my house. When I got there, the grapevines and trellis were down in the driveway, and the acacia tree in the back yard had tipped over. That's the second time we've had a storm and lost a tree in the past year. Trees sure are hard to grow here. They always die when it rains. At least we got a little rain out of the storm. We'll have to salvage the grapes and build a new trellis. It also knocked over our umbrella and the little gate we use to keep the dogs from barking at everyone who walks down the street.

The dogs were scared, their ears were folded back and they looked like they wanted to shrink into the floor. I looked outside at the destroyed back yard and went out to pick up what I could. The tree was completely uprooted. Passed out and leaning against the prickly bougainvillea. Pure misery. I feel like that tree. Then the freaking storm kept me up all night, again the night before clinicals I didn't sleep so well.

Tuesday I was on top of my meds and interventions, I had my little sheet to organize my day. It went a lot smoother. I gave 5 different oral meds including a Lovenox injection to the first patient, and I had to encourage him to walk because his lungs were sounding crackly in my assessment. The nurses I worked with were all nice, no problems there.

Then I had to give meds through a PEG tube for my other patient (a tube to feed into the stomach). I also got to do a dressing change around the tube, gave my first Fleet enema, and assisted the nurse with getting the patient ready for discharge. This patient was a trip. First she freaked out on the enema. I had her lying on top of a pad over the bed so if anything happened she wouldn't mess the bed, and I got in there in time to offer her a bedpan, but she let it go before I could get the bedpan under her and let's say the enema was a HUGE success! I am so proud of my enema skills! But she freaked out because she didn't get to go to the bathroom, she thought she was going to be able to hold that enema and get to the toilet unscathed. After 3 days of tube feeding and no bowel movement for 6 days, that's a fantasy.

I spent quite a while in there cleaning her up. Finally she got to the bathtub and insisted on taking a bath- but I couldn't let her with that unhealed incision from the new PEG tube. Fortunately the doctor was on the floor so I asked him directly if she could take a shallow bath without getting the PEG tube wet. He said yes. Plus all she had to do was have a bowel movement and she would be discharged, so he wrote her discharge orders.

When I gave my meds in the PEG tube, I had to be with my instructor. I had all the supplies in the room- the syringe, the irrigation water, the towel, everything we would need so I'd be prepared. We had to give her morphine and an antibiotic and flush the tube. When Denise walked in the room I was ready to go except I tripped over the bedside table, and the full plastic water pitcher went flying across the room, hit the back of the door, the lid shattered, and water went everywhere, leaking out into the hall under the closed door. Amazingly I didn't spill the medications, sitting there in the little shallow open cups on the same table as the water pitcher. I had to run around grabbing towels and soak up the water before I could give the meds. I did okay with the tube, but afterwards Denise said "You're doing great but you need to slow down! The patients will stay calmer that way too."

This patient was anything but calm, as it turned out when it was time for her to get discharged, the doctor wrote the order so she had to tolerate 240 cc of the feeding solution first before he would let her go. She insisted that she wouldn't be able to. It took us 3 hours to get her to comply with the orders, the nurse had to call the doctor and he said if she didn't take the feeding he would keep her overnight again. Finally she agreed and it went in no problem. . WHAT-ever!

I am seeing more of the psych aspect of nursing that goes along with most of the patients in the hospital. Now I understand why our teachers make us come up with psych diagnoses in addition to the med-surg ones. Often the people we see in hospitals have contributing mental health issues that might not cause their illness but certainly contribute to it.

I got the okay from Denise to give oral medications on my own. Now I don't need to call her every time I have to give a pill. We still need to have the instructor present when we give any kind of injection and pretty much anything else we do. We all get to do 3 patients as of next week. We still only have to do 2 care plans on Monday but we have to pick a third patient on Tuesday morning when we get to the floor. And find out their history, their labs and their meds.

Next week I go to another floor. I'll be on the orthopedics floor for the next two weeks. Hips and knees again. This is where last semester's care plans will help out, because I had one hip and one knee in Block One.

Until next week,

Peace, love, and Fleet feet...

Towanda, RN2B

One week down of Care Plan HELL

We are officially in the 8th week of our 16 week semester and it feels like a slow crawl toward the top of a high peak when you're 50 miles from the finish in the cold rain and puking your guts out, maybe with a few blisters underneath your toenails and the bottom of your heel peeled off. That's my ultra metaphor for the week.

Monday at 6:30 pm I got done with my 2 care plans. Ugh. I was working on this crap since 9:30 a.m. when I went to the hospital to get my patients. I HATE CARE PLANS!!!!!! I have to reinvent the wheel every single f***ing week and there is no way around it. What a waste of time. What a frustrating futile aggravating annoying wasteful stupid unresourceful use of time.

And now...
Here it is Tuesday night and my attitude has improved slightly, I did have a good day, but I am still unchanged in my attitude toward care plans. They suck. But I think the word of the day is sputum. I saw, listened to, examined, smelled, poured, wiped, tossed, and cleaned lots of it today. Colorful, too: green, yellow, red, tan.

I had two patients, one with abdominal abscesses, the other with lung cancer and pneumonia. The guy with the abscess wasn't all that bad off, he was getting antibiotics and was doing pretty well. He had IV meds and was doing okay on pain and refusing pain meds, so other than doing his vital signs and checking in periodically, there wasn't that much to do. The cancer patient was a handful. I gave lots and lots of medications, started an IV successfully on the second stick and had to keep a close eye on him for 2 hours when he came back from his bronchoscopy because his oxygen saturation was so low after getting all that sedation.

I was about to help him shave when the oncologist came in to speak to him and his family, his prognosis is not good. The oncologist drew a picture on the dry erase board in the patient's room and showed the obstruction that is blocking his lung from getting any air in and keeping the infection associated with the pneumonia from resolving. He said surgery is not an option because of the infection being in there and the nature of the tumor. The oncologist suggested chemo and maybe radiation to try to get the tumor to shrink enough so he can use that lung again. The patient asked how much time he has left and the doctor told him if he does nothing, 2 weeks to 2 months. If they are able to shrink the tumor with chemo and radiation, maybe 6 months to 2 years if the chemo is successful. There are lots of complications with chemo and radiation, not only anemia and being weak and knocking out his immune system, but there could be other things like a rupture of lung tissue or heart attack that could kill him.

The oncologist didn't tiptoe around, he said it, like that. I was standing there in the room with the patient, his wife, and one of his daughters. I don't think they had any idea that his cancer was so advanced. He was only diagnosed a few weeks ago. He is in his 60s and smoked several packs of cigarettes a day for nearly 50 years. He looks much older than his age. It seemed like they all took the news calmly but I am sure they are going to have to let it sink in. The patient immediately said he would do the chemo. He didn't hesitate, and he agreed to start the chemo tomorrow. That means they are going to have to put in a port for the chemo drugs and he is so weak. He is coughing up all this thick multicolored goop and blood, and his sats are low even on a lot of oxygen. He has lost a lot of weight lately and isn't eating much. I wondered how soon they will offer a hospice consult, maybe they have to give the guy a little time to let it sink in and think about it with his family. I wonder if he will change his mind about the treatment. He didn't even think about it before he said he would do the chemotherapy. I wonder how he'll feel if he does start the chemo tomorrow and goes through the port placement, medication to prevent nausea, and all the other details, teaching, and paperwork associated with starting chemo. He is in a lot of pain too. I gave him pain medication all day.

I asked the nurse I was with lots of questions about the chemo and she said she thinks he won't make it very long, given his physical condition right now- that he probably won't do well and she thinks he would be better off doing hospice and enjoying his last few weeks. I was thinking he can hardly breathe though, he'd be on a lot of oxygen and pain medication. It would be hard to enjoy your last few weeks when you are in that condition. Everyone has their own ideas about what they would do, but you can never predict what is going on in the patient's head. Situations like this don't leave the patient with much time and I can see how it would be hard to make a decision that would be the best possible option.

I wondered what I would say to the patient if he asked me for guidance in what to do. I couldn't tell him not to do chemo even if like in this case it seemed unlikely to buy him much time, and possibly could cause more suffering. Everyone knows what the quality of their remaining time is worth, and that is what guides the decision. I guess as a nurse you can only teach the patient as much as possible about the different possible options and let them sort through it. You can't ever let your own personal opinion or what you would do for yourself affect the way you present the patient with options- it has to be their decision with their family. Everyone knows what they are going to need as far as time to get their loose ends tied up and say their goodbyes.

The nurse I worked with today was great. She graduated from nursing school 3 years ago so she knows what it's like. She let me do everything. It is luck of the draw with nurses on clinical days. They make or break your day.

I also cleaned a patient's trach today. One of the other nurses I know from work was on the same floor as me today and when I saw her this morning I asked her if I could do anything for her patients. She had a trach dressing to change and she was waiting for the respiratory therapist to bring some supplies for it. It took until 2:30 in the afternoon before he brought them but I finally got to do it. It was a patient with laryngeal cancer who had burns from his radiation treatment. I replaced the dressing and cleaned around it, and put some antibiotic ointment on his neck.

Our teacher is good- she was there a lot today. Every time I paged her she showed up within minutes. She asks a ton of questions and you have to know your stuff. Every medication I gave, she asked me different questions about it, or about what I needed to check for before and after giving it. She asked me all kinds of questions about my patient's low oxygen sats as I was doing his post-op vital signs. She stayed there while I did the trach care, I was glad she was there because even though they taught us a certain way at school, it's done a different way in reality and it's never the same. I wouldn't have had a clue.

My boss was there today- she manages both the oncology floor and the floor I work on. She kept seeing me around every corner and asking how it's going and if I liked it. I think she's trying to recruit anyone she can to work on this floor. She has the hardest time getting nurses to stay there. When I had my evaluation last summer as an aide, I mentioned something about working up there more and she asked me if I wanted to transfer up to oncology, and I said NO! so fast and forcefully I think her head spun around 360 degrees. It's a hard floor to work on, the patients are so sick. The nurse I was with today is transferring to a different department completely in the next few weeks, she said she started having nightmares about the patients and that it's too intense to stay there long. And she's only been on that floor 3 years.

I've been up for 16 hours and change and that is way longer than I usually can stay awake, so I'm going to bed! I have two exams on Thursday- one on mommy baby coconut, and the other on immune system medications. Tomorrow if I can get a decent run in I'll be happy, and then I have to finish my care plans and study my butt off. And maybe get caught up on this week's reading about kidneys.

The good news is, it was 60 degrees this morning outside!!!! FREEZING COLD! The water came out of the tap COLD this morning too! A first since maybe last April! (Did I get to enjoy it? NO. I was busy brushing black dog hair off my white scrub uniform pants in the second level of the parking garage of the hospital at precisely 6 am)

As of today we are down to 9 months and 29 days left to graduation!

Peace, love, and clear secretions,
Towanda, RN2B

Easy week and some thoughts on nursing

Here I am in the middle of my 7th week of the semester. I guess it's gone by fast so far. The hard part starts next week, though.

Today we didn't have clinicals, only our skills testing. I got NG tube insertion, as I hoped I would. I passed, even though I did the nose tape wrong. I guess it was a minor thing. I apologize to any of you who might ever get me as your NG tube inserter. I promise not to tape up your nose the wrong way. I've now rehabilitated myself and I know better. I'll never forget how to tape up an NG tube. Promise!

I am glad to have that behind me. I also used this opportunity with the free day to attend a staff meeting at work. I don't know why I felt like I needed to go to this one because they always suck and our manager talks about all the corporate crap she has to do and she is totally out of touch with reality. To compound things, this hospital is going for something called "magnet status" where they get some kind of designation that makes the corporate dudes at the top happy, probably increases their bonuses without the trickle down effect, etc.

My brother says it's going to be a reverse polarity magnet, it sends people out the door. Mostly right now the upper management is doing all these little tasks to groom themselves for the Magnet Status Gods when they come and inspect the hospital with a white glove to make sure it's worthy of that dubious honor. Apparently the nursing program I'm in and the new orientation program for new RNs are part of this magnet thing- they have to show they are involved in education.

My boss yapped about all these surveys on patient satisfaction and we always get complaints about the color of the room, the taste of the food, the parking lot being too far away, all these things that our nurses have total control over... the boss is always happy that they don't complain about the nurses. We asked her about whether we are going to be fully staffed when we move in a few weeks to a bigger floor (going from 24 to 32 rooms) and she went into this whole thing about trying to get nurses, they were having a job fair this week and that competition for travel nurses is tight, and she's trying to hire people but there's no one applying. Which means that this winter is going to be fun again, heavy patient loads for the nurses, one aide to 16 butts, all with C-diff, etc.

I don't understand why they don't offer more money to nurses, if they have to pay out the butt for registry and travel nurses, why don't they pay more to regular staff nurses? The nurses I work with work for registries on the side and they make $50 an hour. The hospital pays around $25 an hour to their staff nurses, even less if they are new. You know they have to pay a fee for the registry- they are paying a lot more for them. So why don't they offer more money and incentives to get nurses to stay? I am sure there are a million corporate excuses for this situation.

As far as this hospital goes, they seem to be about average, maybe a little above average in pay, but have good benefits. The benefits are a big deal. They aren't as big of a company as some of the others out there, which is a good thing. I am already looking for prospective employers. I've heard of some cool hospitals that aren't into stuffing their CEOs at the expense of the nurses and everyone else, but they are RARE. My patho teacher from last year works for a hospital in Minneapolis. It sounded like a great place. Maybe there are others. I am searching. I think I want to work in a large urban hospital for a while, get confident in my skills and then I can think about going somewhere in a smaller town.

I think I see what nurses are thinking: Why should I work my butt off to get overtime when I can work half the time for better than overtime pay? Why should I have any loyalty to a big corporation that stuffs the CEOs pockets and underpays front line workers who are responsible for people's lives? I won't be a slave with that kind of responsibility. I am going to give my prospective employers a freaking scope up the butt before I agree to work for them.

Today when I showed up to the trailer to get my skills test, one of my classmates said I looked stressed. I didn't feel stressed. I do feel tired and overloaded. Last week someone told me I looked pale. I have been feeling so crappy while running. I have gained a few pounds since this summer, which hasn't been all that long ago! I know I've been eating a lot and not running as much as I'd like to. All that cortisol in my body, making me hungry and fat. My legs are toast on every run. I know that I have been eating so much that I can't be deficient in any nutrients. No way. But never tell a nursing student that they look unhealthy in any way, or they will be imagining that everything under the sun is wrong with them. I know when this one pair of shorts I like to wear are getting tight, I know, I am being a porker.

It's the chocolate. Did you know chocolate is good for your brain? On test days, which are almost every day of class, someone always brings chocolate. Soon we’ll be a class full of chocolate cows.

Peace, love, & nose tape,

Towanda, RN2B