I have a new favorite quote...." Many of life's failures are people who did not realize how close they were to success when they gave up."
This is the story of my Life.
I really need to get back on the horse
Tuesday, February 21, 2012
Monday, February 20, 2012
My Upside Down Life
For years I have worked the Night Shift. I have pulled off 12 hour shifts, 8 hour shifts. These shifts have started many different times, my favorite would have to be those 12 hours 1900 to -730 North Vista Hospital. Sweet! only three required. Working Three shifts would allow me 4 WONDERFUL days off with Family. These days I work the 2330 to 0800 shift. I enjoy a fast shift believe me 8 hours is nothing compared to 12, Oh and the patient load at North Vista, although Done well and effective, these days with my SBAR I am on easy street. I enjoy my random float to the Med/Surg unit, this gives me a sense of clinical importance LOL. I really like the on-going monitoring of an IV and the fluids infusing. I enjoy the patient that just needs a hand and listen moment. I like the ability to know the drugs that are to given and what to look for as the effect of the drug. I like understanding side effects and adverse reactions and working with the physician with the report of ether. I feel good knowing what I am watching for and not being afraid to call my physician on call.
With this new appointment I am seeking in the VA southern Nevada, I know the knowledge I have from the years of health care experience I have. I will contribute a wide base of skill in total patient care from every area of the Hospital, physician and mental health setting. I am Amazing and I really enjoy my career.
With this new appointment I am seeking in the VA southern Nevada, I know the knowledge I have from the years of health care experience I have. I will contribute a wide base of skill in total patient care from every area of the Hospital, physician and mental health setting. I am Amazing and I really enjoy my career.
Saturday, February 04, 2012
Nursing and Being Floated
Working as a nurse being floated is just something that happens from time to time. Last night I was sent to the medical surgical floor. I don't mind because this allows me to keep up with my clinical skills, it also looks good on a resume.
Unfortunately when you are the float you seem to get the patients everyone else had that no one else wants. Let me explain,
I was given report on a patient with major wound care issues where dressing changes are necessary. (this entails following a treatment plan, with seriously detailed description of each wound). Document the type of wound and location, is it a partial or full thickness wound. One of hers included a thin blister over a dark wound bed. This wound is covered by thin eschar. Next was a Stage I intact skin with non-blanchable redness of a localized area we call it bony prominence.her Stage III aka, (Full thickness tissue loss). Subcutaneous fat was visible but her bone, tendon,and muscle were not exposed. Slough was present.Amazingly so No undermining and tunneling.well all in all No camera too bad, measuring each wound and depth is completely necessary.
Another favorite is the patient with pain control problems. (The Opioid Dilemma) you will spend about every hour in that room.The use of opiates (or for that matter any treatment) makes sense when the benefits outweigh the risks and negative side effects. Benefit is suggested when there is a significant increase in the person’s level of functioning, a reduction or elimination of pain complaints, a more positive and hopeful attitude, and when side effects are minimal or controllable.
Opiates are not harmless drugs. The dilemma with the long-term use of opiates are so bad that the hospital opened a whole new wing in the hospital called SATS (substance abuse treatment program). The treatment team, along with the person in treatment, develops a treatment plan based on the assessment. A treatment plan is a written guide to treatment that includes the person’s goals, treatment activities designed to help him or her meet those goals, ways to tell whether a goal has been met, and a time frame for meeting goals.The treatment plan helps both the person in treatment and treatment program staff stay focused and on track.
The treatment plan is adjusted over time to meet changing needs and ensure that it stays relevant.
But before all that goes on, we as nursing staff feel pain is a vital sign, and what ever the patient says their pain is, it is what it is... we ask, "What is your pain scale on a scale of 1 to 10, 10 being the worst most imaginable pain?" and of course they say 10 or my favorite 20. SURE okay who am I to judge, so going over the patients PRN and Scheduled pain medication and anxiety meds I find that he has Maxed out his 3g acetaminophen allowed in a 24 hour period so giving him another percocet ( his break through pain drug) is out of the question now explaining to him that all he has left is an IV push Dilated in 1 hour. Now don't let me fool you, these patient know every pill they have available to them and when they are due. But they push their agitation to the limits in hopes they get the new grad or unseasoned nurse will call the doc and just maybe the doc will grant a added dose or 1 x Now dosage of an amazing wonderful drug (like dilated IV Push) because they desire to reach that euphoria feeling, aka, (chasing the silver dragon) seeking the High of Highs.
On top of that the agitated highly animated post surgical procedure patient. See anesthesia sometimes hands you back a patient with altered mental status, coordination and balance problems, and changes in mood or behavior, among other ...Oh and when handed that patient you would most likely want him on a 1:1, but the NOD says, "sorry not enough staff". Oh! and did I mention the family of the post surgical patient, ha ha ha.
But Wait!!! There's More!!! I also got four low acuity patients, yea right, what ever...
Time management, yes this is an important ability over all nursing talents. juggling 7 and I am Sorry but you Family members are like extra patients.so 8 I don't mind patient and family education, it improve family comfort and sometimes you can get the family to help out. I really think it takes about an hour to educate a family on what is going on with their Dad, but after they get it they are full of heavy emotions and that is what continues through the tour. some members really want to help. Only problem is the redirection and time spent explaining why the surgery went well but the anesthesia altered the brain and Daddy is no longer himself. This is one of the hard parts of nursing. See the doctor gets to tell them, "The Surgery went well, but he is not fully out of anesthesia" The family has no idea what that means so they ask the doc, and of course, he says, " these things are unknown, sometimes it wears off" What turds, they really need to sit down and spend time explaining the whole picture and NOT in five minutes. So the real education starts when the patient arrives to the floor, aka Med/Surg.
DON'T forget I did have 4 other patients with their own serious situation, and an extra long list of medications. Please remember in doing all this amazing nursing I had IV to start, fluids to hang and meds to give at specific times see a hour before and hour after any more you are derelic of duty
I can say no more, I get to go back tonight...
Unfortunately when you are the float you seem to get the patients everyone else had that no one else wants. Let me explain,
I was given report on a patient with major wound care issues where dressing changes are necessary. (this entails following a treatment plan, with seriously detailed description of each wound). Document the type of wound and location, is it a partial or full thickness wound. One of hers included a thin blister over a dark wound bed. This wound is covered by thin eschar. Next was a Stage I intact skin with non-blanchable redness of a localized area we call it bony prominence.her Stage III aka, (Full thickness tissue loss). Subcutaneous fat was visible but her bone, tendon,and muscle were not exposed. Slough was present.Amazingly so No undermining and tunneling.well all in all No camera too bad, measuring each wound and depth is completely necessary.
Another favorite is the patient with pain control problems. (The Opioid Dilemma) you will spend about every hour in that room.The use of opiates (or for that matter any treatment) makes sense when the benefits outweigh the risks and negative side effects. Benefit is suggested when there is a significant increase in the person’s level of functioning, a reduction or elimination of pain complaints, a more positive and hopeful attitude, and when side effects are minimal or controllable.
Opiates are not harmless drugs. The dilemma with the long-term use of opiates are so bad that the hospital opened a whole new wing in the hospital called SATS (substance abuse treatment program). The treatment team, along with the person in treatment, develops a treatment plan based on the assessment. A treatment plan is a written guide to treatment that includes the person’s goals, treatment activities designed to help him or her meet those goals, ways to tell whether a goal has been met, and a time frame for meeting goals.The treatment plan helps both the person in treatment and treatment program staff stay focused and on track.
The treatment plan is adjusted over time to meet changing needs and ensure that it stays relevant.
But before all that goes on, we as nursing staff feel pain is a vital sign, and what ever the patient says their pain is, it is what it is... we ask, "What is your pain scale on a scale of 1 to 10, 10 being the worst most imaginable pain?" and of course they say 10 or my favorite 20. SURE okay who am I to judge, so going over the patients PRN and Scheduled pain medication and anxiety meds I find that he has Maxed out his 3g acetaminophen allowed in a 24 hour period so giving him another percocet ( his break through pain drug) is out of the question now explaining to him that all he has left is an IV push Dilated in 1 hour. Now don't let me fool you, these patient know every pill they have available to them and when they are due. But they push their agitation to the limits in hopes they get the new grad or unseasoned nurse will call the doc and just maybe the doc will grant a added dose or 1 x Now dosage of an amazing wonderful drug (like dilated IV Push) because they desire to reach that euphoria feeling, aka, (chasing the silver dragon) seeking the High of Highs.
On top of that the agitated highly animated post surgical procedure patient. See anesthesia sometimes hands you back a patient with altered mental status, coordination and balance problems, and changes in mood or behavior, among other ...Oh and when handed that patient you would most likely want him on a 1:1, but the NOD says, "sorry not enough staff". Oh! and did I mention the family of the post surgical patient, ha ha ha.
But Wait!!! There's More!!! I also got four low acuity patients, yea right, what ever...
Time management, yes this is an important ability over all nursing talents. juggling 7 and I am Sorry but you Family members are like extra patients.so 8 I don't mind patient and family education, it improve family comfort and sometimes you can get the family to help out. I really think it takes about an hour to educate a family on what is going on with their Dad, but after they get it they are full of heavy emotions and that is what continues through the tour. some members really want to help. Only problem is the redirection and time spent explaining why the surgery went well but the anesthesia altered the brain and Daddy is no longer himself. This is one of the hard parts of nursing. See the doctor gets to tell them, "The Surgery went well, but he is not fully out of anesthesia" The family has no idea what that means so they ask the doc, and of course, he says, " these things are unknown, sometimes it wears off" What turds, they really need to sit down and spend time explaining the whole picture and NOT in five minutes. So the real education starts when the patient arrives to the floor, aka Med/Surg.
DON'T forget I did have 4 other patients with their own serious situation, and an extra long list of medications. Please remember in doing all this amazing nursing I had IV to start, fluids to hang and meds to give at specific times see a hour before and hour after any more you are derelic of duty
I can say no more, I get to go back tonight...
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