Dear ICU

When you are bringing over a patient and you draw blood before you transfer the patient, and you get a call that a result is critical, please check the other lab values, and then call the doc for orders if you need them.

Thank you,

PCU

Anyone Got a Fire Extinguisher?

Sometimes work feels like just one fire after another. I sometimes work charge, what this means is that I am in charge of the floor for that shift. This is something that can be rewarding and wonderful, or horrid and stressful, especially when it's just one *fire* after another. At night on my unit we need 3 nurse techs. We had one. We assigned a nurse to work as one, however this nurse threatened to go home (not cool) if we didn't make her a nurse, another nurse graciously gave up her group to work as a tech. At that point we realized a tech we thought was coming wasn't (causing us to drop from 3 to 2) so we had to call in a nurse who had been put on call to work as a tech. This nurse was also very gracious. This gave us three, however the third tech, who was actually the only staff member who was working as a tech that actually was a tech, was running late because she had been locked out of her house.

Guys, the shift starts at 7, it was only 7:30 at this point. We were also starting a new lab system, and we had two patients go bad, one was transferred to ICU, the other was still possibly going to go when I left at the end of my shift, Oh and we had a family who wanted me to page the surgeon about the patient eating at 8pm, cause no surgeon had seen the patient. I really wanted to spray down the floor with a fire extinguisher.

Stuff and Things

The more I do stuff the more I find that we all mess up sometimes, what's good is when it's admitted and we can all move on, what's bad is when you keep talking about how so and so said whatever and you can't understand how they would think you did that. Can we all just admit we screwed up?

Rules

If you ever go, or bring a loved one to the hospital, these rules are important to remember:

 1. If your mom/dad/aunt/sister/brother is confused and yells at me I will ignore the yelling and continue to do my job, however if they try to claw my face off, I'm going to refuse to care for them again for the duration of their stay no matter how nice you think I am. Also I promise confused people become more confused at night, please have someone stay with them overnight, trade off with other family members if you have to, but this helps keep your loved one from injuring the one person who truly only wants to help them get better so they can go back to where they are living (with you, in a nursing home, what have you)

 2. If you agitate the confused patient who is normally kind to the staff, we won't like you, but we will be fakely nice to you. I had that cute music from their childhood on for a reason, it's calming, and you scare them.

 3. If you have cancer in more than once place in your body, it's quite unlikely you are EVER going back to a normal life, please get your affairs in order and teach your spouse how to run all the things that you've taken care of including but no limited to house maintenance, financial affairs and insurance stuff.

 4. If you act crazy on Ambien, I will tell your doctor not to let you have anymore. This is not negotiable, I don't care how well it helps you sleep, it's not good to find you on the couch when your IV (with running fluids) is still on the bed...especially when you don't walk well. This makes me cranky. (I promise to just complain to my coworkers and not take it out on you though)

 5. Don't forget if you do something crazy, everyone who works on that unit (and some on the other units) will hear about it. The best advice I can give you is: Never do anything you don't want to explain to the paramedics...or your nurse, or well anyone who is inclined to laugh at you when they leave your room/house/what have you.

 Rules for the doctors at any hospital:

 1. If the patient is supposed to be going home on hospice because they have dementia and their once in remission cancer has spread, you don't have to fix their electrolytes before you send them home, cause um...they are dying, you aren't going to fix them.

 2. When confused patients who now also have a UTI are admitted, order ativan, haldol or some other anti-psychotic sedative so that when they decide to go batshit crazy and try to claw their nurses face off (see patient rules above) they can put them to sleep for everyone (including theirs) safety. This prevents restraints and staff injuries.

 3. Please explain to families when you don't reorder a home med, especially when it's a patient whose spouse only leaves the room to walk up the hall for coffee...they always want to ask me at like 2am, and I so have no idea how you think...I'm a nurse not a mind reader.

 4. Make sure the answering service knows who is on call so I don't spend a hour trying to get ahold of the wrong doctor. Neither that doctor nor I will be happy at the end of that hour.

 5. Do not get snippy on the phone when I page you, I promise I have a reason, and besides your getting paid to sleep and take phone calls for emergencies, and likely are getting paid more than I am getting paid to stay up all night and save your ass when the patient crumps.

 And for my dear coworkers:

 1. I don't care how much experience you have at *another* hospital, you are new to us and you will treat your preceptor with respect, especially if it's the nice coworker who helped me move in July two years ago, and is going to help me move when I get my house. She may not have been a nurse as long as you, but she knows *ALOT* more about how we do things than you do. Being rude to people we know, and trust makes us not like you, if we don't like you, you won't work here long, experience or not.

 2. Please if you help me by going to stop my fall risk patient with the bed alarm going off, don't walk them to the bathroom and then go sit down to chart, outside the room, so the patient can fall off the toilet. (special thanks to the PCT who was working as a unit secretary that night who prevented that, you are my bestest work buddy)

 3. Be nice to your PCTS/MT/US, be especially nice to the ones trained to do all three, they will more often than not save your butt by keeping your patient's clean, upright, and letting your know when the vitals have gone stupid. Being mean just makes them not want to talk to you, and overusing them makes them REALLY cranky, and trust me I hear about it, and would you like to know why? Because I'm nice to them, and they know I'll back them up over you. Especially if they are right and you're being an idiot. (Looking at the nurse who didn't get up for the bed alarm that the PCT working as a US told you about because your tech was in a room and couldn't go to the room, you're lucky I was charge and saved your ass...)

 4. Be nice to your charge nurse, and tell them if they screw up, Charge nurses are human too, and I would so much rather hear my shortcomings from you when they happen and not from the boss lady two weeks later when I'm called on the carpet and made to feel an inch tall, that's *NOT COOL*.

I'm not good at blogs apparently

So I was at work one night and around 540 in the morning I started feeling well off. Took the blood sugar 256, not great but not the worst I've seen lately (maybe it's time to think about some rapid insulin...hint hint to the endo?) So I check my temp 99.4 well perfect...(not really) so I put on a little mask, might as well keep my germs to myself, I am working in a hospital after all, and go tell the charge nurse I won't be back in after this shift is over cause I have a fever and I'm going to the doctor. All is well. I go home, go to the doctor, get antibiotics and a work excuse, go back home and try to sleep. (Which trust me is hard to do when you're feeling super warm and can't breathe) My manager calls, says other people are feeling sick and do I think I've recovered enough to come into work after all (seriously) I told her I still had a fever and the doctor told me to sleep and do nothing for 2 days. All I can say is SERIOUSLY?

Sorry All

I've been off the net for awhile. Mostly due to picking up extra shifts at work, secondarily being hurt and then trying to recover to go back to work. Why is it if you work 4 12 hour shifts a week people think it's no big deal to pick up a 5th. That fifth set of 12 hours can actually kill you. I should know, I used to work 5 12 hour shift every week. No one, not even my parents would talk to me after 3 months, I was that cranky ALL the time. I think it's the lack of sleep you get, because of course most of those shifts are back to back to back to back to back. it's not good for the whole getting enough sleep thing. On another note exercise does help with the stress, but it cuts into your sleep, so with 4 I can go run after each shift (though after the injury it's less run and more speed walk) and not be cranky, I actually sleep better if I run. (Go figure) However with five I get a little weird. But maybe it's just me?

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?