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nursing

Criticals, Cultures, and Codes

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Today was a tough day from the beginning. At 0800, I got a discharge before I even completed the assessment or given any medications, then at 0900 I got a direct admission coming to an empty room, putting me at six patients. Throughout the rest of my med pass I got 3 critical labs, one unhappy family, beeping IVs, calls for pain medications, a positive blood culture, and telemetry notifications of abnormal rhythms. I finally got finished charting assessments, discharging my one patient, and admitting my new patient by 1430, which meant lunch time. Immediately upon my return, I got a second admission. Then, my extern ran to me and was concerned about our patient who was all of a sudden slow to respond to commands… that led to a rapid response call. Luckily, everything turned out to be fine with her and she slowly started to return to her baseline. By now I was at least an hour late on all of my medications, and got a call with a low blood sugar. Quickly, it was shift change at 1845 and I had yet to give 1700 medications.

Long story short, this was one of the worst days I have ever had as a nurse. It was a day where I barely had time to complete my checklist, could not build rapport, or read any progress notes. My motto of the day was “just keep swimming” and I was just treading water.

Until next shift,

Shania

Please, do not wish to die

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Our God is a way-maker, miracle-worker, promise-keeper, a light in the darkness. God will put you out of any situation no matter how wide, how deep, how high, or how low it may be. It breaks my heart to see hurting people believing that ending their life is the only solution.

Suicide is the 2nd leading cause of death for ages 10-24 year olds and continues to increase yearly. Speaking with suicide survivors actually reveals that a majority of them regret their decision to take their life and are thankful that their attempt was unsuccessful.

Patients so often state how “they want to die, they are a burden to their families, they are terminal anyway.” Nurses make comments after a long day such as “kill me. Shoot me. etc.” Our language has power, and we may not realize the hurt someone actually feels behind their “joking” words.

Life is so so beautiful. If you don’t see it, be around those who do. Engage yourself within nature and a healthy community. There is breath in your lungs. Joy comes in the morning.

Please, don’t wish to die.

Until next shift,

Shania

Suicide resources:

suicidepreventionlifeline.org

1-800-273-8255

When you don’t want to let go

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Nurses always say how nurses are the worst patients. One may think this to be silly since nurses can relate to the work, however it has proven to be true more often than not. Emotions run high in the hospital and having a nurse either as a patient or a controlling family member often proves this statement to be true. From every safety step to every decision, the off-shift nurse at the bedside watches the primary nurse’s every move. And when the patient is actively dying, the nurse family member is even harder to handle.

Watching a patient decline, converting them to comfort measures, and switching them to hospice is one of the many tough aspects of nursing. When this patient is a family member, the decisions become harder to make as the wishes of the family conflict with the wishes of the patient and/or the patient’s best plan of care.

I recently had a patient for weeks who originally presented with an ileus and GI bleed. She was NPO for two weeks and connected to an NGT with suction. Throughout the stay her bowels began to function, while her kidneys began to fail. She became sicker and sicker by the day until it did not seem like she would survive the weekend.

She was originally having full conversations and working with PT, then quickly progressed to 1-2 word sentences and was using all of her energy to breathe. Her daughter was a nurse and was active in her plan of care. Throughout this decline, she ordered every lab and test to be completed even if it did not seem to be in the best interest of the patient. Her mother appeared to be actively dying and the daughter stated how she knew in her brain that what she was ordering was probably irrational, however her heart could not let go.

One shift the patient woke up enough when the doctor and daughter were communicating to clearly state her wishes. I will never forget this moment. It was as if she took all of her energy to tell her family that it was okay. She looked at her daughter and said, “Please don’t cry. It is okay. I am ready to go home.”

Everyone in the room started to tear up- daughter, MD, and me included. The patient had the biggest smile on her face. This brought comfort, closure, and the next steps in the plan of care.

When many of the previous nurses complained about the controlling daughter, it is moments like these to make me take a step back and empathize with her feelings. All she was trying to do was ensure that we were providing the best care and holding onto any last hope to prolong her mother’s life. Anybody would react this way, not just nurses.

You are a high fall risk: A struggle between safety and autonomy

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Nursing care is evaluated and structured from several different agencies and protocols. Nurses are expected to timely document, take all recommended breaks, stay hydrated, care-round every hour, educate on all core measures, keep all family members involved/informed in the plan of care, provide recommendations to doctors, thoroughly assess all six patients, ambulate all six patients twice a day, monitor lab values, among many others, all within a “12-hour” shift. It is often difficult to show compassion, communicate slowly, and provide patient autonomy while all these other measures are being graded.

A nurse once stated at huddle that her goal was to “document as I go.” I and all of the nurses around her could not stop laughing as this was a “quite ambitious” goal to achieve. A typical medpass takes around 10-15 minutes for one patient. Multiply this by 5-6 patients and that results in 50-90 minutes of the morning just ensuring all patients have medications. Documenting on each adds another 60 minutes, all while constantly refreshing the screen for any new orders or urgent patient concerns. Some days all patients are accounted for 4 hours later, and sometimes this is without any documentation.. If it’s not documented, it is not done.

A 12-hr shift is granted two 15 minute breaks and one 30 minute lunch break. Many nurses are lucky to take a full 30 minute lunch and will still get interrupted. It can be lunchtime before I realize that I have not had a sip of water for the past 6 hours, nor have I had the chance to pee.

Care-rounding involves checking the 3 P’s: pain, potty, and positioning, and also any needs at that time. This is expected on each patient every hour.

“Yes, we need to look at your skin.” “No, you cannot get up without us.” The Joint commission is an agency that allows for hospital reimbursement if all quality and core measures are met. This is the greatest concern and the greatest frustration on a medical floor. Upon admission, patients are asked to roll over so nurses can look at their butt, as we must assess for pressure injuries, regardless of the patient age. Patients are also assigned a fall risk scale and placed on a bed/chair alarm so they cannot get up without assistance. Patients are also taught that ambulation is important and getting out of bed will help with recovery; however, this depends on how frequently staff can get into the room. Falls are a major issue, however patients are very much limited by the “restraints” that we are forcing upon them.

“There is no particular time that the doctor will be in.” Many patients wait hours for the doctor to come in and then they are gone within 10 minutes. This leaves the nursing staff to educate the patients on the plan of care, while carrying out any immediate interventions.

Nurses became nurses to help people. The way healthcare is regulated at this time creates a major challenge between helping people and ensuring the chart looks perfect. I value moments to sit down and truly listen to each patient, but these moments are not able to be had every shift. Patients, I assure you that nursing staff are trying their best. There is a lot on our hands .

Until next shift,

Shania

Why nursing?

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On difficult days at the hospital, it is easy to question if nursing is the right career. Doubt creeps in as I start to remember all of the things I could have done, should have done, or should have known. There are days when nothing may seem to go right and the whole unit is an organized chaos. On both the good days and the bad days, it is important to remember the answer to “Why nursing?” Here is my story.

I never really had a single event or day that I decided to be a nurse- nursing chose me. Growing up in LA, I dreamed of acting in films. I loved (and still love) the stage. I love communicating, speaking, and working with people of all backgrounds. I realized that becoming an actress realistically needed a plan B and so I began volunteering at a local hospital.

Many of the aspects that I love in acting were actually present in nursing. Long story short, my decision to choose nursing was solidified when I was placed in a recovery center my Junior year of High School. I was sick myself, however I was told how I made such an impact on the other patients in the facility. I decided to use this gift and make it a career.

Now, going on two years from becoming a registered nurse, I remind myself “why nursing?”

I chose nursing because:

  • I can literally change someone’s life in 12 hours
  • I learn something new every day
  • I get to talk with people from all different backgrounds
  • I see all aspects of health care- doctors, PT, nutrition, case management, social work
  • I am a teacher
  • I am always on the move
  • It encourages me to stay healthy and to inspire others for the same
  • Small acts of kindness go a long way
  • I see what really matters at the end of life
  • I witness God’s miracles
  • I get to see the goodness of humanity
  • I can experience genuine emotion
  • I can change positions when I want
  • I have a flexible schedule

Why nursing?

A nurse may be the only voice a person has.

Until next shift,

Shania

The patient with the brain tumor

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It was a 25 y/o male with osteosarcoma of the hip. He was receiving outpatient chemotherapy, but presented to the hospital for uncontrolled pain. After having found to be constipated, he was placed on a bowel regimen. He refused all PO medications due to nausea and vomiting, and also did not want a suppository. It took me nearly 12 hours to get this young man to take the suppository to prevent an impaction. Finally, he took the medication.

When I came back to the hospital two days later, I had found out that this patient had been transferred to critical care after finding a brain tumor. He passed away shortly after. Words cannot express how sad this patient and my interaction with him had affected me. I started to wonder if I had communicated clearly enough? Did I ensure that his wishes and needs were fulfilled? Was I too focused on the simple nursing tasks at hand and disregarding the human being?

Questions like this are what keep me up at night. Tragedies like this refocus my mind to focus on the human, not an order. I hope I did not come off as too hard for this man.

Tomorrow is not guaranteed. Count your blessings.

Until next shift,

Shania

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615-856-8181
shania@shanialynnvo.com