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TriptoBountiful
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Name: Bountiful
Interests: Retro/Vintage Home Dec: Fire King jadeite, old aprons, painted furniture. Flower gardening, quilting, knitting.
Expertise: Re-wiring vintage light fixtures, sewing, singing, baking yeast bread, hand quilting, and passing nursing tests (so far).
Occupation: Graduate Nurse
Industry: Medical
Message: message me
Member Since:
5/25/2006
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| Of the 8 patients I cared for yesterday, 2 of them were actively dying. I was actually surprised that both of them made it to the end of my shift. I doubt that they both made it through the night.
I'm struck today by how differently people die. Each death, just like each person, is unique.
In one room, I had a pt surrounded by friends and loved ones. She lay very still and quiet as her breathing became more labored, yet her eyes frequently opened to look at us, and she opened her mouth to suck on the syringe of roxanol when offered. There was always someone sitting right next to her, their face close to hers, their hands clasping hers or stroking her face and arms. Overall, the mood was one of a quiet acceptance mixed with profound sadness.
In another room, my patient spent the morning alone. He hovered somewhere between consciousness and unconsciousness, his eyes rarely opening, his breathing fairly regular-until his family came. He then became quite agitated. I wondered if he was trying to "wake up" because he knew they were there, but at any rate, he began to thrash around in bed as he struggled to breathe. I held his hand and spoke to him, but he could not be consoled. I gave him morphine regularly throughout the latter end of the shift and raised the head of the bed to help ease his breathing. I encouraged his family to talk to him, but they just mainly sat or stood mutely by the bed and stared helplessly at him. I later found out that his decline in health had come on quite suddenly; the family was still dealing with the shock of such a rapid change in his condition. They kept asking questions like "How long will it be?" and "Why is he so unresponsive?" It was obvious that they were struggling to emotionally and mentally "catch up" with what their eyes were seeing.
I have to admit that I struggled a bit too. I struggled with the idea of giving frequent doses of morphine, wondering if I was somehow pushing someone closer to death. My supervisor and the other nurses on the floor acknowledged that this is something that every new nurse has to deal with. We believe and practice the idea of doing no harm. Yet, when death is approaching, is it more harmful to let someone die in agonizing pain rather than make them comfortable, even if it means hastening death? That's something I'm still thinking about today.
I'm also thinking about relationships and how it affects the way we face the loss of a loved one. When a patient is dying, the family also becomes my patient, in a way. I have found that I can almost always accurately guess the kind of relationship a person has had with another by the way they behave when faced with losing them. Unresolved issues bubble to the surface and emotions overflow and slosh all over unsuspecting health care workers. I've had my share of dealing with angry people who lash out and treat me with contempt while I'm trying to take care of their seriously ill or dying family member. I try to remind myself that whatever is going on inside of them has very little to do with me and a lot to do with the relationship that they now stand to lose. Sometimes I can get them to talk about the relationship with simple, non-confrontational questions like "Tell me about your dad". But, more often than not, when it's almost the end, there is too much anger and hurt inside, leaving little room for the clarity to heal a broken relationship.
I dreamed one recent night that I was permitted to travel back in time and warn a friend about an impending loss. If only that were possible. If I could, what I would tell them is this: Once someone is dying, there is no time left to make things right. You can't go back and be the person you should have been to them. You also can't go back and make them the parent/spouse/sibling you needed or wanted them to be. All you have, in the end, is what was. The time to change that (or find the healing to accept it) is not at the end, but now.
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| I'm still floating and still working as an aid more often than not. I really don't know how long I can keep this up. One of the other newbies on the floor has already asked for a transfer to the outpatient surgery unit. The hours are great, no early mornings, no evenings, no weekends, no holidays. I nearly applied for it myself and just may do so if another opening comes up in the next few months.
Turmoil at work continues. Some nurses on my unit are trying to demand float pay (it won't go anywhere), our manager is growing discouraged, and we all just really want to be back on our own floor.
I keep reminding myself that every day that I float represents a chance to see/do/learn something new. I keep telling myself that I just have to get through December, because surely we will reopen in January. I hope.
Today I'm off and have appointments at the hair stylist and then the spa for a relaxing facial. I'm going to come home after that and make chicken and dumplings and then I'm going to ignore my messy house and just knit. (House cleaning can wait until I have more than one day off in a row. One day off is just not enough to recuperate from the aid work otherwise.)
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| A lot has happened since that last post. They closed our floor for remodeling and didn't re-open it when it was done (which is what had been promised). Census is low, so our floor is staying closed indefinitely and all of the nurses from our unit are now being used as float nurses (without float pay!)
I'm tired of working on a different floor every day. I don't feel supported as a new nurse. I rarely see my own manager. I feel like I have NO ONE to go to sometimes.
The other nurses feel the same way, even the seasoned ones. We're being given crappy assignments and have had no orientation to these other units. I honestly feel like I've been thrown into the deep end and nobody is there to help me most days.
Yesterday they had me work as a nurse aid, which is a LOT more physically demanding than nursing. This morning I woke with a very sore lower back and guess what? They made me an aid again today. I honestly can't take much more of this.
And now they are starting to talk about floating us to the cardiac unit. I hope for the patients' sake we get some kind of orientation.
I was just getting used to being a new nurse and feeling like I could handle it. I want to love nursing, but right now, I feel like I'm just trying to survive it.
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| Wow. Over 2 months since my last entry here.
Things are still going pretty well at work. I have great days, then I have not so great days. Sometimes, what I thought was a great day turns out to have been a not so great one after I get home and remember things I forgot to do. Like call a Dr and tell him that I was discharging his patient. That was NOT a good day after all. It wasn't pretty, but I got through it and moved on. And I will NEVER forget to notify the Dr of a discharge again. I guarantee it.
None of my mistakes have been serious, thankfully. No one has called me on the carpet or anything like that. I most definitely am harder on myself than anyone else is. And I will tell on myself when I think I've made a mistake and my manager won't seem as concerned about it as I was. I spend too much time on my days off worrying about work. I need to work on that. I don't want to get to the point where I don't care, but I do want to be able to enjoy my life.
I love nursing. I'm just not so sure that I like floor nursing. I don't think I'll be doing 12 hour shifts on med surg for years, so I'm going to start working on my Bachelor's degree next semester so that I can move on to other, less physically demanding areas of nursing eventually. I still think I want to teach or work as an NP in some way. (I've noticed that a lot of Doctors have an NP on staff.) I'm also interested in earning certification in Holistic nursing or maybe even aesthetic nursing. I figure I'll just work on getting certified in the areas that interest me and see what kind of opportunities God brings to me.
My main issue with my new life as an RN is that my time off seems to pass too quickly and I feel like I'm not getting anything done or having much of a life outside of work. I think a lot of that is due to the fact that it's the time of year when my seasonal depression sets in, so when I'm off I tend to want to hibernate. I sleep too late, don't exercise, and waste a lot of time in front of the computer or t.v.
And my eating? I've developed some bad habits. Nothing as bad as when I used to drink 5 or so cokes with candy bars a day. I just find myself eating the same things over and over: peanut butter, Cheetoh's, cinnamon rolls (why did they have to hire a pastry chef at work?), and bread. Not a lot of veggie eating going on here, not a lot of cooking either.
I think the problem is that I get up at 5:00 or 5:30 on work days, but sleep in on my days off. To treat SAD, I have to sit in front of my light therapy box at the same time every day, which isn't happening because I'm not being consistent with my sleep and wake times. I am up earlier than usual today; I was in front of the light at about 6:40 this morning, which is way better than my usual 8:00 mornings on my days off. I'm going to try and aim for a 6:00 waking time on my days off and 5:30 on work days. Surely that half hour difference won't be significant.
I've also slacked off on working out since the SAD kicked in, so I've lost energy reserves due to that as well. I did do yoga twice this past week and will do so again today. I'm off work until Tuesday, in fact, so will have 3 days in a row to work on eating right, getting up at a consistent time, and working out.
And I have GOT to start cooking again. The peanut butter habit is largely a result of my laziness on my days off. I think I cooked one meal in the last month: a pot of split pea soup. I really need to have some good chicken breasts cooked and ready to go so that I can pack up good lunches on work days and stop eating the stuff in the cafeteria at the hospital (way too much meat loaf, fried chicken patties, and BLT's going on there ).
So, today I am going to plan a menu for next week. I want to cook at least 3 decent meals with extras for leftovers. And I want to have more produce in the house and less processed foods (bye bye Cheetohs, hello baby carrots).
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| Alright, I said I wasn't going to continue this blog because I didn't want to talk about work. I've changed my mind. At least for now.
I've been off of orientation and on my own as an RN for almost a month now. My first week off was a trial by fire (that is exactly what my manager called it), with people crashing right and left. On my first day I transferred a patient to ICU within less than an hour of taking report because we thought their brain was about to herniate (it didn't). I had a surgeon drawing fluid off of a pt's brain in the room and a neurologist giving me stat orders to push meds to try and save this person's life. I had a patient sat in the 50's on room air and was only able to get it up to the 70's on O2, which necessitated calling the rapid response team and paging the Dr and respiratory therapy for a stat treatment. I had a patient pull out their feeding tube right at change of shift and possibly aspirate some of it. It just goes on and on.
But you know what? I also had my manager running down the hall to draw up meds and a fellow nurse personally went to the pharmacy for other drugs that we needed "five minutes ago" (to quote the neuro doc). Fellow nurses paged Rapid Response and entered the orders I received from the Dr. They were right there with me, suctioning my patient and showing me how to insert a new feeding tube when it was already time for them to report off and go home. They have taken on tasks for me when I have been overwhelmed, rounded with the Dr when I've been tied up in another patient room, even done some discharges for me on a day when I received discharge orders for 6 of my 7 patients within an hour's time.
I did a lot of angsting over where I should specialize after graduation. I kind of felt like I wasn't pushing myself for greatness when my friends went into ICU or ER or OB. I thought maybe I was just settling, but I also knew that I wanted and needed a very broad foundation in nursing. Every day, even on hard ones, I go home thinking that I have learned something new and that, next time, I'll know better what to do. It's a very steep learning curve, but every new thing I learn adds to my foundation.
I am toying with ideas about what I want to end up doing. I'm still leaning towards teaching someday or doing some kind of family practice as Nurse Practitioner. I have no idea where I'll end up, but for now, I know that I'm in the right place.
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