Christmas

I worked only 8 hours today. Got to go home early. I had a patient who died this morning and by the time the family left and all the post mortem care was done it was 2 pm and nothing else was happening. I worked Thanksgiving this year and that day I also had a patient who was dying.

It was sad for the family but I know they felt a great sense of relief for their family member who had suffered long enough, in the ICU nearly a month this time. I took care of her about half a dozen times this admission, so I knew most of the family by now. She was deteriorating the past few days and yesterday when I took care of her we put her on comfort care. All I had to do was suction her and give morphine. Then it was all about taking care of the family.

The snow blew in early this morning and the patient had the room at the end of the hall with a big window so if she was able to see, she would have seen the snow falling over the foothills and the city. When she died her husband was there, but he was waiting for the kids and their families to come in from out of town and the roads were bad. I stayed with him or just outside the room while he waited for them.

The hospital was quiet and I sat outside the room while the family went in and saw the patient for the last time. The chief nursing officer and the vice president of something else came down the hall giving the nurses candy and thanking us for working the holiday. Earlier I pulled the curtain across so no one could see in the room while the patient’s husband and I waited for the rest of the family to show up, and when they did, the family had pulled the curtain back so it was possible to see the patient lying there in the bed from the end of the hallway.

When the VP and CNO walked down and got to me, they thanked me for working, and then I could see the unsuspecting looks on their faces and they both almost gasped when they noticed that the curtain was pulled back just far enough to see. I wasn’t about to go into the room just to snap the curtain back 6 inches and disturb the family. There was no traffic down that end of the hall. I thought, let these guys be reminded of what we do here in ICU when we’re working Christmas.

Once I removed all the tubes and catheters and lines and the trach from the patient, and cleaned her up and put her in the body bag and security came with the cart, I helped the security guard move her, trying to avoid the “clunk” that can happen if you don’t lower the body carefully from the bed to the cart. I think that’s one of the worst parts of the whole process for me. It’s like you want to be so careful with this person’s body and then there’s this cold, hard metal cart that you put them on. You’d think they could at least pad the thing so it’s not a hard landing.

I look forward to coming back and working nights for a while. I’ll like the variety. I’m up to my eyeballs with a few of my co-workers on days. I won’t miss working weekends. The usual weekend charge nurse was working today but she wasn’t in charge. Today all she did was whine about her assignment. And then she got floated to another floor for a while. She whined about that, too. I don’t like her. I think she’s vindictive and lazy. She was trying to get the charge nurse who was working today to send me to float.

I was in the middle of taking care of my patient’s family and dealing with the organ donor people, making calls to the coroner and chaplain and all the other things we have to do with a death. This person is a charge nurse and she couldn’t understand that it might be upsetting to the family to suddenly change nurses in the middle of the day when their family member died an hour ago. She was too lazy to go to another floor where she might have to get off her butt and do some work.

This particular nurse and the unit assistant who was there today, I don’t care for either one of them. They like to sit around all day and gossip and they are lazy. Good riddance.

I got my schedule set up for when I come back in January.. Three nights in a row, four days off, a steady schedule. To sweeten the deal I get to work with my favorite coworker, who is also the most awesome charge nurse ever, and the one person who has always been there to make me laugh since I started with him as my first preceptor, way back on nights, ancient history, November 2006. We will have too much fun, I’ll be laughing my ass off, and I should have no problem staying awake!

The other good thing about going to nights is that I’ll finally get to go to codes and traumas, things I need to do but we have so many people on days trying to get checked off on those skills that there’s a backlog.

I am off now for two and a half weeks. One week to travel and run the race, a week and a half to help my immune system recover before shocking it with night shift hours.

Before I left today I wrote the website of the race on the board in the report room so people at work can send me messages during the new years race. There are only a handful of people I’d even care to hear from at work but I know the messages will motivate me.

Besides, most nurses have a sick enough sense of humor to fit right into an ultra. Nurses can relate to double dipping in community Vaseline jar, nasty feet, obsessing about the color, frequency and amount of urine, butt chafing and so on.

I need to go get my beauty rest, if I want to look good on the webcam at the race.

Peace, love, and welcome the new year,

Towanda, ICU RN

Poopsmith's Return to the Dark Side

With winter solstice approaching, it is getting awfully dark around here. A couple more days and the light will return. I feel like we're being kept in the dark at work too. Starting to wonder if our manager is really all there.

See if you can follow this story. It confuses me.

We had a staph meeting last night. The shit is hitting the fan in our department. We are, according to our manager, "overstaffed" for days and desperately understaffed for nights. I would say we're adequately staffed for days and slightly understaffed at night except when it's busy, which we haven't been, and the fact I'm sitting here typing this at home at 6 pm instead of fighting exhaustion through the last hour and a half of my shift is evidence. I got the day off today since we were so slow.

About two weeks ago we had a follow-up meeting to the follow-up meeting to follow up on the shit hitting the fan when the upper management met with the staph and everyone bitched about the department management being out to get them, untrustworthy, etc. and expressed their general dislike for the way the CNS has come in and "transformed" the ICU into a threatening environment.

Anyway we had one of those touchy-feely sessions where everyone had to express the things that were bothering them and it seemed like it all blew over, and then our manager decided to drop the bomb at the regular monthly staph meeting last night. Basically she did this at the same time she was handing out our market adjustment pay increase notices. We need 2-4 people to go from days to nights, temporarily, until the hiring freeze is over and we can hire more night staph to fill the gaps.

I happen to like working nights. If I didn't feel so crappy all the time I would work nights. Our night crew is mostly awesome. The pay is better, it's less stressful, it's more fun, and the scheduling tends to be more consistent.

The rumor was, they were going to make people work a certain amount of night shifts and switch off among day staph so it would be divided equally. It's still a huge commitment, she is essentially asking 15 of us to each work one week out of every month for the next 6 months- or less if we can hire and/or have some turnover sooner than that.

I looked at my plans for the upcoming year and said no way am I going to be jerked around like that when I'm trying to train for Badwater. So I decided I would volunteer to switch to nights for two months- January and February- and return to days in March. January and February will be my recovery and low mileage months after the New Year's race. I told my manager I want my days back as of March.

So I got what I wanted, and they sweetened the deal for me by giving me the exact schedule I want. I'm off the hook. Except for suffering through two months of night shifts and sleep deprivation! Now I'll sit back while the rest of the day crew can rip each others' heads off over who will do night shifts. It's a nightmare and they got stuck on it for the longest time at the staph meeting. The fur was ready to fly.

I work three more shifts, tomorrow, then Christmas Eve and Day, and then I leave for the desert where I'll run my 48 hour run. I look forward to seeing my running friends, "the tribe" as I call them, I missed them last year when I couldn't go. I'll be dancing around in circles listening to trance music for 48 hours less sleep time and and focusing on my list of meditations for the coming year. After a family visit I will come back here and hide out with my weakened immune system from all the nasty bugs and rest up before I become the nighttime poopsmith.

Poopsmith of the Dark Side. MWAHHAHAHAHAHAHAHAHAHAHAHA!

Peace, love and happy holidays,

Towanda, ICU RN

MRSA

It has been pathetically slow in ICU the past two weeks. We have had an average patient census of 3 for 10 days now. I took two days off in the last pay period, I'll be lucky to get a paycheck at all at this rate!

Today I went in to start my 3 day stretch and our census was two. I did "projects" all day and finally went home at 3:30. I attended a lecture at lunchtime by some of the infectious disease doctors about MRSA and what we are doing about it here. The room was packed full of doctors and some RNs and a few other hospital staff. MRSA has been in the news,overhyped by the mainstream media.

Remember all the scare stories about Ebola virus? Omigod people are going to start bleeding from their eyeballs!!!! Again, what we have here is a big scare story that sells newspapers and television advertising. There are lots of antibiotic-resistant bugs out there. But we always need a good scare story to distract us from the important things going on in the world. Like Iraq, Iran, our lack of health care access in this country, among other things...

Anyway I sat with two of my co-workers through this hour-long presentation which was actually quite informative. They talked about the incidence of community acquired MRSA which is much higher than hospital-acquired MRSA. And debunked a lot of the paranoia that the media has been spreading. They also discussed some of the antibiotics that are more or less effective at fighting MRSA.

We don't have nearly as high of an incidence of MRSA in the community here as other places do but the doctors want to get a handle on it and have a protocol in place before we get more MRSA in the community.

What I took away from it was that it will be cost-effective at our hospital to do what they propose, that is, testing all patients admitted to ICU for MRSA in order to catch it if the patient is colonized, since ICU patients are the most likely to develop infection as they are also most likely to be immunocompromised. We will put MRSA positive patients in isolation and treat any infection they have, if they are infected. We will do nasal swabs since most MRSA colonization is found in the nose. But the doctors cautioned, MRSA infections can be found in skin, wounds, urinary catheters, groin, and lots of other places. Nasal swabs will miss these.

And of course handwashing and alcohol gel hand hygiene is most effectve at preventing the spread of MRSA, which we already knew. Using standard precautions is really the key as with any potentially infectious organisms.

The moral of the story: Wash your hands before AND after you pick your nose, and if you pick 'em, don't flick 'em. I can see it now, the new CDC guidelines: If you pick 'em, don't flick 'em, as the new MRSA prevention motto for 2008. I think the Bush administration could understand that. I see my next career on the horizon: healthcare public relations.

I had a terrible bout of homesickness for the desert a few weeks ago. Don't know what hit me. I decided to make tamales this year. I haven't done that since before nursing school but I remember the Mexican workers at the hospital said, "A gringa made THESE?" when they tasted my tamales. I took it as a hgue compliment.

I got ambitious yesterday and made a small batch of green corn tamales after my 20 mile run. I have one more long run to do before I taper for the new years run in Arizona and then I have time to do things like clean the house nand sort through piles of papers and receipts for taxes, etc.

I was so happy to be done with classes. But I am taking a 12 lead EKG class in January. It starts the day I get back from vacation. I have figured out the secret of getting the schedule I want. If I sign up for classes, I get to take some 8 hour shifts so I don't go into overtime. I have decided I will sign up for as many classes as I can stand to take with minimal homework, and that way I get only two 12 hour shifts on those weeks.

Lately I've been feeling better about things. I think part of it is that I feel better physically. After 3 months of messing with medications and patiently waiting in between testing, I finally have my thyroid medication right. I am down to just two PBJs a day and not eating nearly as much. I am sleeping better most of the time too. I feel less emotionally labile.

Ever since taking the TNCC class I feel like somehow things fit together more. Something about the TNCC class helped me put things together. I don't know why but I felt so much more confident and better able to think about what I needed to do. TNCC was a lot more fun than PALS was, too. There were a bunch of us from ICU in there and we got to strap each other down to a backboard for spinal immobilization, a way to take out pent up aggression on each other which was worth every minute we sat through the whole 16 hours of class.

Things have been somewhat volatile at work, there's a lot of political crap going on in the department, some people are not happy with the approach that management is taking toward making changes in ICU. I am okay with it because I think all of it is truly going to make it better. People are resistant to change but I think the people with good attitudes outnumber the whiners. I think our manager needs to not worry so much about pleasing the lowest common denominator. She seems really worried about rumors and I think she needs to stop trying to please the chronic whiners. There aren't enough of them to make it worth her effort.

Peace, love, & hand hygiene,

Towanda, ICU RN