I wonder what they are doing?

So when you have dialysis at my hospital you'll discover wehave an outside company come in to do Dialysis, and as such they do not have access to our computer charting system, therfore they handwrite their orders and we scan them to pharmacy, they don't have access to our pyxis either so we have to retrieve their saline and such for them...now with this in mind, and knowind this pt started Dialysis at 0615, and I scanned the orders to pharmacy prior to that, why have they not put a single order in on this patient nearly 20 min later, what on earth are they doing down there? I seriously want to know what they could be doing thst they havn't managed to get to at least putting the orders in the computer? Anyone have a clue?

There are days...

There are days I wonder how much we really know about our coworkers. I work in a profession where people talk for 12 hours, and today after talking to my preceptee for a while I wonder despite that how much we hide from each other. She was telling me things I'm certain no one else on the floor knows. And I'm certainly not going to tell anyone, not even on here. In other news I was hoping for a summer slow down, SO not going to happen. I've been on call um 3 times in the last 7 months where I didn't get called in, and one of them (last night) was only for 4 hours. So I don't think that summer slowdown is going to happen. I did however help to engineer a major patient turnover mulitple days in a row last week, we kept trying to send people upstairs to med/surg and all that kind of good stuff. We are trying to increase our productivity so we don't loose tons of money on the 700 pound indigent patient who stayed here from Jan until she died in May (I think) bouncing back and forth from our unit to the ICU. She was very sick, and VERY expensive to the hosptial.

I'm back..and still snarky

I was reading some nursing blogs a friend sent me and it hit me...I havn't updated my nursing blog in FOREVER (Almost a year apparently) In the last year I've gone from Med/Surg to PCU (which at our tiny hospital is basically fancy talk for the telemetry or heart monitor floor) I've actually been doing well, but working a lot, and am currently annoyed that there are about 5000 signs begging everyone to work this weekend, I'm really trying hard to care, but I always pitch in and pick up the extra shift, and damn it it's someone else's turn. I work 4 nights a week minimum, EVERY week, and frequently get pulled into a Charge or Preceptor (training other nurses) postition and have not been trained to do either on this floor. I have been floated to the ER to take our overflow, and they don't even allow me a tech, so I'm basically in the ER with 5 patients, BY MYSELF...because at midnight they close that side of the ER. Oh and lets not forget February where I worked the night before all the training classes they made me take because they just couldn't possibly function without me that night. I worked 7 days straight because they couldn't manage to find one of those days to put me on call. (so not kidding) I asked every single freaking day too. So honestly, I've pulled my weight, and that of several people who so need to get a job here and pick up some slack. And quite frankly it's someone else's turn to be abused. It's not like anyone appreciates it. I'm not anymore likey to get a raise than if I hadn't put in the time. The only good thing that came out of it was I got a nice little flyer from my boss thanking me for working the 7 straight, oh and she's going to let me use an agency nurse to cover a shift I need off, even though I should have asked a staff nurse...yes you read that right, she made me find someone to cover the shift, and then was gracious enough to "allow" me to use an agency. Because I work hard for the floor, but next time I need to find someone who works for the hosptial. SERIOUSLY? Just give me the day off and I might have seen that as a favor. Just sayin'.

Welcome to the Zoo...

Tonight started out all normalish...at least for here. Report from 2 people (better than the 3 I gave report to when I left). Starting rounds. Calling docs. Same old same old. I'm sitting at the computer charting when I hear Bing Bong Bing Bong (in other words the call light code blue alarm) I get up and go running down the hall only to hear, no wait it's a DNR, I grab the chart real fast to check orders, out of hosptial DNR but no actual order, so we have to call the code and the doc (to get an order to stop the code) get the doc before the code team gets to the floor (we paged him STAT) and he orders to stop the code. (we call a cancel code). Ok, back to rounds and charting. Then 2100 meds. 2200 meds (pretty well back to back cause of the code that wasn't). Finally at 2230 I get a second, call Blood Bank for a unit of blood that should have been transfused WAY before now (ordered at 0700). They say it's still not ready but they will call me when it is. Ok...so I go check on the patient. Pt is doing well despite no unit of blood yet. I decide to stuff charts (this is where we add drs orders and progress notes so the docs can do thier job) I'm almost finished with that when blood bank calls back (about 2300) Blood is FINALLY ready. Ok, so I spend 15 minutes futzing with the stupid label maker to get a blood bank sticker for this patient. That's done get the little pick up blood form ready, then the tech comes to get me says this SAME patient has pulled out their catheter. (Well at least it's not the IV, I need that thing for blood). The pt also had a large BM and is playing in it (I really dislike having to explain to confused pts not to do that) So we get the pt all cleaned up. Call the doc, get orders for restraints...*sigh* I hate those too. Get the blood bank form to the tech to pick up her blood, call the family notify them that the pt is going into restraints. Then place restraints, put in a new foley (remarkably easy for a pull, usually the trama makes it harder to replace one). Then grab a computer and a blood pressure machine for the blood transfusion and get ready to do that. It's now about 2400. (Please keep in mind after charting our intial assement of the patient we chart on our patients every two hours for rounds on safety and IV site assessments and I'm doing this too, with all of the other stuff) Now restraints were placed about 2300. I have to round on this pt every hour to check circulation and such since she is in restraints. Around 2400 the blood FINALLY gets to the floor (took the tech forever to go get that). Stand in the patients room for 15 minutes for that. (required to stay for the first 15 minutes of any transfusion because that is when a reaction is most likely to happen). Then come back 15 minutes later for another vital check, then 30 after that, then 60 after that, and the blood finally finished around 0315. In the meantime, we have taken enough admissions to fill the floor. And for some UNKNOWN reason they have closed our other med/surg unit. (and as far as I know do not plan to reopen it...EVER). Right now we have overflow on the tele floor. I think we closed it because half of the tower one (other unit) staff quit like last week. So we can't staff the whole unit therefore we move them to overflow? (don't ask me I have NO clue). Whatever is going on we can totally attribute it to the fact the Director has resigned. I can't believe I'm going to do this all again tomorrow night, I think I've officially lost my mind, I do this 4-5 days a week depending on census...and it looks like we're going back up! I thought summer was supposed to be a low census time? Not this year!

I'm starting to wonder if the people I work with can read....

No less than 3 different people missed something or made a mistake based on not reading information available to them, TONIGHT. We have a new nurse who I try to help out for two reasons, 1) I am not going to be responsible for continuing the stereotype of nurses eating thier young and 2) she lives above me and I like that she's a good neighbor and would like to keep it that way. Doc ordered some CT scans on her patient, she couldn't find the order in our new computer system. It was sorted out quickly once I pointed out the IV and Oral contrast order that was there (it was there the first time she just missed it somehow...dunno...) Then I get a new admit (Kidney infection/dehydration if you're interested) She's on Levaquin (neat little antibiotic, is to be given every 24 hours) Now we have computer charting here, with an electronic MAR that covers all disciplines and levels of care...that means every drug given to any patient, even in ER is on this thing. ER gave her the levaquin. Pharmacy (in all thier infinate wisdom...ok even I'm rolling my eyes) times the next dose for 3 am. I sent them a message, hey this was given at 9pm, 3am might be a little soon for the second dose. (To thier credit they fixed the problem) Then I get a nurse telling me he didn't know that his patient had a specific disease. Now every patient has a THOROUGH history when they are admitted (we even ask if they snore 3 times) I mean the history section has EVERY question you can imagine, do you smoke, do you have diabetes, do you have AIDS, do you have an STD, do you have MRSA, do you have VRE and on and on and on. But instead of looking at the history he comes and asks me what this drug he doesn't recognize is for, I tell him, and he's like I didn't know she had that. (My solution, read the history, or if that's too hard, professional exchange report, it's on there) I happen to know it was filled out on that patient, cause I audited the chart for that patient this morning as part of my annual evaluation. Seriously people, the information is there, all you have to do is LOOK for it. Reading is a dying concept around here....

What do they do in the Pharmacy at night?

Ok prepare yourself for the rant of the century. ... Ready, here we go! Ok, seriously, I was unaware that it was too much to expect a person with a Doctorate in Medication to realize that if a medication is ordered for a patient it need to be sent to the nursing staff to give. It took me an HOUR to get Decadron at work last decadron that was ordered well over 8 hours before I started asking for it. Really, they didn't think I would need it since it was all scheduled and stuff? Are you shitting me? Also, and I can figure this out and I only have a Bachelors Degree, you have a doctorate, if you need to hang multiple IV piggybacks on a patient you can't hang two at the same time, STOP ordering them that way, I cannot hang Ancef and IV Zantac at the same time piggyback with one IV, it's NOT going to happen, order them an hour apart before I start thinking you are either A)morons, or B) torturing the nursing staff, neither is a good option. Although I will say this, kudos for getting the pain med switched for that PCA in 20 minutes, I was in shock. Fastest thing the pharmacy has ever managed to do. I mean I understand we are not the only floor they service, but this isn't a HUGE hospital we are talking 7 patient floors and an ER. There are other hospitals in our system with more floors than that. And they still only have ONE pharmacy. Maybe they get more than one Pharmacist at night though. Granted they have two in ours on the day shift and days have the same problems getting stuff that I do. If you are ordering the med and scheduling the time, you might want to aim for scheduling it at a time you think you can actually get it to us, not 5 minutes after it's ordered. I think they are just thinking up new ways to torture us, these are the same people who force us to give Ambien because it's the formulary sleeping pill. Again I remind you, when frequently woken on Ambien (as you are in a hospital) the risk for Hallucinations and confusion INCREASES. Take note, change our formulary sleeping pill to something less problematic for our patients. You are supposed to be responsible for the reducing the drug issues with these patients.

The Evils of Ambien

Seriously I hate to call out stuff by name, but why does this drug exist? I have a patient tonight who was actually so out of it and hallucinating after taking this drug she knawed her own fingers off...the worst part, she remembers none of it. In fact the finger knawing is why she is in the hosptial. Dumbest part of this story, her family is mad at me because I won't give her any ambien and I refuse to call the doctor to have any ordered for her. Seriously, she chewed her fingers off under the influence of this medication and you think I'm going to give her more? SERIOUSLY? Lets be realistic for a moment, once you're over 60 Ambien is supposed to be off limits, docs order it anyway for thier over 60 patients. Even worse when awakened on ambien (as you would be frequently in the hospital because of beeping, vital signs, rounds, etc.) you are more likely to hallucinate, so the fact this drug is ordered for patients in the hosptial at all boggles my mind. I have been told stories of people going into the kitchen and eating a whole apple on this stuff and have no memory of it. I dated a guy taking the stuff...we had whole conversations he never remembered because he took the ambien before he called me. There is a reason the label says go straight to bed, because after you take the drug anything you do, you will not remember. It's evil and I hope the FDA bans it soon.