Tweet round-up

Real bloggers do this, sometimes, don't they? I think the Bloggess does. She calls it phoning it in. Anyway, here are some of my most recent tweets for those of you who don't have the pleasure of subscribing to my brilliance there.

• March 25th: I feel genuinely excited to be about to clean my bathroom with lemon comet while I listen to an EMT podcast. 30 isn't too different from 29.
• March 26th: PT [physical therapy]asked me to come help push a guy's leg and then when I did it went kablooey and sprayed blood. And I didn't faint!
• April 7th: My shift is half over and very boring, I'm watching an old man watch baseball.
• April 8th: My confused elderly patient told me our relationship won't work if I don't stop lying to him & pretending we're at the hospital.
• April 15th: Hospital riddle: you're working a double and get a 1:1 for a confused impulsive fall risk old man. What word do you least want to hear him say when you walk into the room? ...My real answer (and what he said) = Vietnam. Other contenders?
• April 27th: What should I watch on VHS, crossroads or 3 men and a baby?
• April 29th: I'm still sick. Wheen I finally get better I have a new life goal: pinup girl gator wrestling queen. Seriously, I like Louisiana, waterproof makeup, alligators and crocodiles in general and I could dust off the fisticuffs.
• today: OMG I just got to cut off a patient's undies for the first time: today is AWESOME!!

Watch out for WOLFS

It's been another weird weekend over at the hospital, y'all. As I've probably mentioned on here before, weekends are the time when all my nice, normal, elective joint replacement patients are not there. So weekends are when I am either floated to another unit or I stay on my own unit but we get atypical patients there (OB-GYN issues, medical problems that don't involve bones, etc.)

Last night I got sent to another unit to do a one-on-one with a very large, schizophrenic patient with a history of methamphetamine use. I'll just let that sink in for a few minutes, shall I?

I spent 8 hours in a hospital room alone with someone who, on paper at least, I would normally sprint away from.

And boy, was it an unusual night.

As I soon discovered, my patient had quite a fascination with "wild animals". Since my patient was a little edgy, I took this person on about eighteen million walks around the floor to try to burn off some nervous energy, toting along the IV pole with us each time. On one of these jaunts, a framed poster of a baby animal that looked like some sort of canine caught my new friend's eye.

"Oh, is that a hyena? Look at him! He's so nice and symmetrical. I've never seen a hyena. One time I saw a wild animal that was like a bobcat or a wildcat or a mountain cat. I saw it walk by the window here too [note; we were NOT on a ground floor level]. One time I saw an Orca whale in a lake. They don't usually live in lakes, so I took a picture of it."

This proved to be a fruitful topic, so my patient thoughtfully provided me with more tidbits throughout the evening:
"If you were by the woods you might get picked off by a wild animal. Like some wolfs. Or mountain bobcats. You should really be careful. If a wild wolf comes out of the woods, you give it a cookie. If it takes the cookie, it'll just, like, go back into the woods. If it doesn't take the cookie, point to the lake. It'll go jump in the lake. I saw that happen but then the bobcat got eaten by an orca whale. In the lake. The whale just ate it all up. It was weird."

My patient had the flattest affect during all this, and consistently called wolves "wolfs" very clearly. I checked in with a nurse at one point to find out if perhaps this person was messing with me, and nope, the nurse said this patient was a bit of a 'frequent flyer' and advised me not to laugh at any advice or stories the patient told me.

We made it all through my shift just fine. Then tonight, in the cafeteria, I saw another CNA who works that unit. She said that my wild-animal-expert patient was pacing the floor, ranting, and attempting to get dressed in all sorts of things because the patient believed it was time to leave.

WHEW! I dodged a bullet there, didn't I? So glad I got floated last night instead of tonight!

Fall Risks and restraints

The culture of nursing homes and assisted living facilities has shifted far away from the use of restraints; most places are restraint-free by law these days. The hospital is one of the only places I can imagine restraints remaining in use, and that is simply because of the acuity (how sick) our patients there are. They cannot afford to be pulling out the lines that are giving them IV antibiotics and blood transfusions, because without those things, they will die.

Even at the hospital, restraints are considered a last resort. They frequently utilize one-to-one 'sitters' to watch and maintain safety of very difficult patients. I was pulled from my regular duties to act as one last night, for a confused elderly person who would not stop climbing out of bed (and was a fall risk), pulling out lines, and removing their much-needed supplementary oxygen tubing. Even with me there, the patient was very agitated, and trying to literally climb over the furniture to get out of the bed. I was willing to let her get up, but she was so damn fast she was apt to get away before I could gather up all the things that were attached to her so I could ferry them along after her to prevent them from ripping out.

Finally the MD returned the page from the nurse, and ordered a small dose of an antipsychotic. It didn't stop the patient from trying to get up, it just calmed the patient down enough to stop physically shoving me out of the way, which was good enough.

This was one of those situations where I think that chemical restraints would be so much more effective than physical. My patient has such poor short-term memory that s/he would forget what I had said literally 20 seconds before. Putting someone like that in physical restraints is going to be a huge safety risk because they're still anxious and panicky and energetic, and will focus all of that onto getting out of the restraints one way or another.

Whereas a strong sedative seems highly appropriate and could allow this person the time to absorb their antibiotics, fluids, and oxygen in order to begin healing.

Unfortunately, I don't think we have a specific policy and protocol for chemical restraints the way we do for physical ones. I understand they're risky in terms of oversedation; you don't want to accidentally kill someone! But I wonder, if I were the physician getting paged in the middle of the night, whether I'd view the sedatives I'm prescribing as restraints or 'sleep aids' or what?

Studying: it works!

I think I mentioned recently that after finding out that my employment at Father Sainty's is no longer such a gigantic helping factor in getting me into nursing school, I decided I needed to pull my grades up. I was getting a B in Anatomy and Physiology and an A- in Bio. That B in A&P was sort of tenouous, though, since I'd gotten a B- on my most recent exam.

I studied like crazy for my most recent exam on bones, and got a 90% on it! If I continue to study this hard and do that well on my remaining exams this quarter, I should be able to get my grade up to an A-, I think. So that's my plan.

Too bad I don't love muscles the way I love bones. I even had dreams regarding specific bones (I was in a butterfly garden but the butterflies were sphenoid bones that were flying around, and I was delighted!).

So while it may be tempting to put work first, I need to remember to put school first. That means if I have to sleep less to study more, that's what will happen. If it means showing up at work exhausted rather than after napping, then that's the deal. If it means eating dinner in the cafeteria instead of cooking and packing my meals, that's okay too.

After this quarter I only have to do A&P II and microbiology. I think I can technically apply to nursing school even with one class left to finish up, so maybe I can apply for admittance next Winter quarter and take microbiology in the fall before it begins?

Either way, I plan to stop working at the GreatRep once I'm in nursing school. That 10-hour workday is just too much time lost. If I can take out loans, i'll do that to compensate for the lost income. I know how incredibly lucky I am to be going to school for free right now, and I know that won't continue forever.

More and more the idea of goign for my LPN and working in a skilled nursing facility or inpatient rehab sounds appealing to me. If I'm going to work and go to school, part of me thinks that work should be the best-paying I'm able to get.

Either way, I'm back on board with school!

And here's a visual for anyone wondering about my dreams: they're a cross between this



and this

Best of Both?

I had a rough, rough shift at work last night. Was working with a nurse that is new to our floor, and coming from a floor that's notorious for having RN/CNA conflicts up the wazzoo. So I made time to sit and catch up with NewNurse when he came on shift halfway through mine. I already had 13-14 patients of my own, and the way we have it set up, all the call lights come to the CNA's first. If we don't answer, then they are forwarded on to that patient's nurse. So you can imagine how busy I am on these nights. Of my 13-14 patients, I'm likely to have at least 5 diabetics who need their blood sugar checked before meals and at bedtime. Another 2-3 who are confused/fall risk/non-English speaking. And 4 or 5 who are fresh post-ops, which means they're in a lot of pain, bed bound, and possibly needing to be strapped in and out of devices to move or steady their joints.

NewNurse got pissed at me for two things, one of which I think was valid (although I had no way of knowing about it) and the other which was absolutely not; one of our regular floor nurses scoffed at NewNurse when she heard him getting angry at me about it in the nurses' station.

Anyway, everything turned out fine, all my patients were okay (although one did give me a terrible scare, then when it became clear that my fear had been because of one of the machines giving a wrong reading the first time, the patient asked "Are we in trouble? I'll cover for us. What should I say?" which made me laugh despite how upset I'd been).

But I'm now mentally comparing that to my shift last week when I filled in over at the inpatient rehab unit (physical rehabilitation, not drug or alcohol rehab). I had such a mellow night, I was able to cover most of the unit by myself. And if I got tied up with something, the nurses were aware of it and went and did things for their patients themselves. I even had time to help a very sweet older lady get her Kindle working again, which delighted her!

It was more like a nursing home, in that it's lower acuity and the patients are there for longer periods of time. But it's a smaller unit, so that makes teamwork easier. And it pays at the rate of the hospital, not at the rate of a nursing home.

Is inpatient rehab the best of both worlds? Less stress, more time with patients, and the same pay and benefits?

Could be...

Oh, Gross! Again.

Now that I'm working in the hospital, I see waaaaaaaay more disgusting things than I did in assisted living. I won't say that hospital is definitely more disgusting than home care because sometimes people's homes are just beyond nasty. But assisted living tends to be pretty decent.

So now that I've been exposed to more things, I figured you all would be delighted to know what I find the most icky.

1. The Worst Smell Ever; when someone keeps vomiting blood and poo. It's just so, so bad. I mean it's three unpleasant things all mixed together. And it smells ungodly.

2. Trach suctioning. I know, not nice. It's necessary. Sometimes people need that tracheostomy (a hole at the base of their throat in front) to help them breathe. And sometimes that hole gets plugged up with mucous. And then that mucous must be suctioned out. And yep, it's exactly as oogy as it sounds. Especially if they're coughing and end up with puddles of phlegm pooling on their chest, which then also must be cleaned up.

3. Pulling out lines. This is more of an "I feel phantom pain imagining this" reaction on my part. The people who do this aren't with it enough to be as bothered by it as a normal, alert person would be. But the sight of someone ripping out their own IV, or (God help them) other lines or tubes just makes me shudder. Doesn't matter what the line is or what it's putting in or out of the body, the idea of them ripping out really grosses me out.

...and lastly, one that I'm surprised is not that bad to me? Wound packing and unpacking. When someone has MRSA or whatever and it eats a hole into them, that wound must then be frequently packed full of stringlike bandaging, then have that removed, and replaced with clean packing. It sounds awful, but it's actually pretty cool. It's what allows people to heal from the inside out, rather than the outside in. You wouldn't want your skin to close up over a big empty pocket in your body, because that wouldn't be structurally sound. So instead this way it heals properly. But it does look pretty weird.

Code: Disaster

Winter kicked my little town's ass this last few weeks. I know, everyone jokes about how we are such wusses about snow in the Pacific Northwest, but the thing is, we are never ever prepared for it. We don't have the infrastructure in place to handle it well. It's not just the snow, or the unplowed roads, but the fact that we have approximately 8 trees per square foot* and a lot of them fall down during storms and knock out our power.

So this last week was a special week at the hospital, as a disaster code was called. That meant all staff on premesis was not allowed to leave. People were mandated there for 30+ hours, sleeping on the floor wherever there was room for a short respite after 12-16 hours of work.

AWFUL.

I wasn't there during this, and had no way of getting there, which suited me just fine except that I felt so badly for my coworkers who were carrying all that load understaffed. In spite of this, they made it, and did well.

The thing that I found most touching was that we all got these desperate emails begging us to come and donate blood, because obviously all the regular blood drives out in the community weren't able to happen. Much as I hate needles in me, I wanted to go and do this, but again, had no way of getting to the hospital.

The other day I got an email from some muckety-muck about how that turned out - the big hospitals from the nearest Big City had some donors (3-10), one of the local Big Companies, had around 20 donors, and our hospital had 70+!! By far the most of any facility that did the emergency blood drives. And this was all from employees that couldn't leave. The email referred to us as "the little hospital that could".

And with that, my heart grew three sizes and I vowed to donate the next time the van is on campus at my school.



*scientific and accurate. Totally.

I'm on it.

I'm off training and working on my hospital's orthopaedics floor regularly now, and I LOVE IT. Love, love, love it. I love that no matter what the problem is, there's always someone there for backup. Not sure how to use that whatchamacallit? Ask someone. Need a bariatric-sized something or another? Ask the unit secretary to call for one. Patient getting combative? You can always call security. We never run out of the basic stuff I use to care for patients (gloves, linens, hygiene supplies) and I'm never left completely on my own to just deal with a situation. It's great. That's the benefit of being at a facility many times over the size of the GreatRep, with all different sorts of staff available.

I've also gotten to see some pretty amazingly gross stuff, like the patient who came in with the complaint of "My toe is missing. I think maybe the dog bit it off". Sure enough, the whole thing was missing, and I could see the bone right in the middle of that toe stump. I get a lot of darling little old ladies who are getting hips repaired or replaced and who are just delighted to have a young lady being the one who helps them to the bathroom. We don't get all that many amputations, which is kind of too bad because I think those are really neat and I want to see how people get back to their regular activities after one (but that's more of physical therapy/rehab deal).

All in all, I'm being exposed to a lot of new conditions/procedures/equipment and the nurses on my floor are quite nice and pleasant to work with. I feel so lucky that I happened into a floor where patients (usually) go home happier and healthier than when they came in - it makes for such a different dynamic than I've experienced before. And I have health insurance! For myself and Mr. Polly both!

NKOTB

I've started training on my actual floor of the hospital, caring for real live patients. I've learned how to use (most of) the equipment there, including my first ever go-around with electronic charting and fancy-schmancy vitals-taking machines. I have yet to have a patient accept my offer of a bed bath or a shower, so maybe these people just like to be dirty or maybe they're too high to move or maybe they just don't wanna get even a little naked in front of me? Hard to say.

Tomorrow I'll have 8 patients to care for, then for my last day of training I'll have the full 10 (my normal load).

And so far, no more fainting. Not at the blood bank, not after chugging up all the flights of stairs in the "tower", not when someone was admitted with their toe already missing, not any fainting at all. Yay me!

Now if I can just navigate the whole time-management aspect and deal with nurses who are unused to delegating anything at all, I'll be golden.

Whew!

First week of hospital orientation

I finished my first week of hospital orientation, which translated into multiple 8-hour days of class, basically. Seriously, I finally got a tour of my unit the last day, AFTER everything else (except restraints) had been covered.

And how was all this class, you wonder?

Pretty cool, for the most part. We're the pilot program of them implementing CNA's at Father Sainty's, so every single one of the CNA's for my floor was hired and trained all together. So it feels like we're a graduating class together after all these days of orientation classes together, which is neat. Dayshift, swing shift, and noc shift all got trained and oriented together for the pre-floor stuff. We learned new things (bladder scans!) and slung each other around using the overhead lifts in the patient rooms. Good times!

Now for the humiliating news: I passed out. Cold. In front of every single other CNA on my floor, two nurse educators, and one of my managers. It was AWFUL. We were in the classroom and I have a needle phobia.

I do okay when someone is actually in front of me bleeding or has an IV inserted or whatever, but that's because I can move around to keep my BP up, and because I know I'm responsible for them and cannot faint. I've cared for someone through a compound fracture and been okay. But when it comes to the classroom setting, when someone verbally starts describing blood draws or the like, I get woozy. Even if I'm listening to a nursing podcast and they get too graphic, I have to change it or I'd be a danger on the road.

So not only do I have a crazy phobia, it's ridiculously specialized; a DESCRIPTION of blood and needles phobia.

So our nurse educator is merrily telling us how to do glucose checks, and going on and on about it, and about how we may not "milk" their fingertips to get more blood, and I was getting woozier by the second. I trying to hang on as long as I could, then I figured I'd better get out in the hallway where I can put my head down without anyone seeing me. So I stood up and started walking towards the door.

Who can guess how that turned out?


Yep, I woke up flat on my back on the floor, with people over me going "Are you okay Polly? Are you okay???".

So. Freaking. Unbelievably. Embarrassing.

So now one of my managers thinks I'm going to do this while working the floor, and the rest seem undecided. All I can do is prove them wrong. And once I do, hopefully this will become a funny story about way back when I first started working at Father Sainty's.

Oy.

Coming soon, Hospital CNA Polly!

I got the job!!!

I start on the 24th, it's about a 30% pay increase, and I get health insurance for myself and Mr. Polly.

For now I'm tentatively planning to still work at the GreatRep one day a week until I get busy taking more classes next semester. I'm very, very excited and nervous.

Coming soon: orthopedics floor Polly!

Interviews

I just finished my phone screening (pre-interview) for a part-time job at Father Sainty's. I feel like it went really well, and should find out soon if I'll be called for a face-to-face interview or not.

I'm applying for a part time 2nd shift position on the orthopedic floor. The base pay over at Father Sainty's is almost $4 more per hour than my CNA pay at the Great Rep (and $2 more than I make as a Med Aide there) PLUS they have shift differentials for evenings and weekends, which is what I'd primarily be doing.

The lady I spoke to was cool, and we built enough rapport during the phone interview that I felt comfortable asking her my big question:

Since Father Sainty's just implemented CNA's, were any nurses let go in the process? What about LPN's?
I wanted to be sure I'm not walking into a situation where they've fired 3 RN's and hired 10 CNA's. The remaining RN's would start off hating me and all CNA's. Which is not good news, because they're going to be my direct supervisors. Or if they used to have LPN's and decided to do away with them in favor of all RN's supervising CNA's; that would be sticky too.

But they're actually going from an all-RN model to adding some CNA's. They never did use LPN's. And had they fired any RN's for this change?

She said no, that wasn't the case, and that while they had let some people's contracts expire without renewing them, they mainly freed up the budget by letting nurses retire. I hope that's the truth. I should try to get the scoop from my next door neighbor, because she's an RN over there.

Anyway, she didn't seem to be put off by my asking that, and answered as though it were a very reasonable question, which I think it is.

Now I just have to hold my breath for a couple of days to find out if I go get interviewed by a panel (!!!) at Father Sainty's. If I'm offered the job, I need to get details about their health insurance and how much it costs for employees, and then tally up whether I can afford to work part time there with benefits or if I need to stay full time at the Great Rep without benefits (which I'm currently paying the entire premium on).

Wish me luck!

Why Not?

Things have been about the same at work; there's a restraining order against the husband of one of my little old ladies, because the husband has been threatening to come to our facility and kill his wife and then himself. He states that he has a gun and is ready to do so. He lives within walking distance of our facility.

It's been stressful.

The new admit, the very combative one, continues to be that way. Some of it is kind of funny, like how he walked around with his underwear outside his pants for hours the other day. But it wasn't funny that he started shoving away anyone who tried to talk to him or help him change them to inside his clothes. And it's not funny that it takes 3 or more people leaping on him in order to complete any sort of care.

My classes start very soon, the week after next! I can't wait. I'm still waitlisted for one of them, but I'm #2 on the waitlist so it should be fine. I'm just nervous about the delay screwing up my financial aid, but I've been in touch with the financial aid office and they say it should be all right.

The biggest news is that I've applied for some jobs at our local hospital. We'll call it Father Sainty's. Over at Father Sainty's, they'd cut pretty much all CNA positions in an effort to save money, which has been a common trend among hospitals these days.

I don't understand it, because why would you pay a nurse much more money per hour to do something an unlicensed person like myself can do - take vitals, reposition, toilet, check blood sugars, etc.? Maybe it's because administrators assume (wrongly) that nurses can do all that AND do the jobs that only they are allowed to do at the same time. Crazy.

At any rate, Father Sainty's must have figured out that if you expect nurses to do everything, everything doesn't get done or at least not very promptly. And I'd expect that patients were unhappy with that. So they're adding back a LOT of CNA positions, and I've applied for every single part-time benefits eligible job they've got.

I have no idea what my chances of even being interviewed are, but I figured it's worth a shot. It'd be great experience, better pay, and include benefits. Which I don't have now.

I know, I know, all CNA's seem to think they should work in a hospital, as if the change in the type of facility is somehow magical and going to get rid of the worst parts of our jobs. I don't think that. I know it'll be at least as hard as what I do now, probably more so. But I've got a couple of years experience under my belt now, so I may as well try to be paid as much as possible at this while I go to school. And I won't be shocked if a patient tries to take a swing at me, or eats their own poop, or does any of the million disgusting things that I've gotten used to working with my current population. I'd miss the consistency of working with the same residents all the time, for sure, and I do still genuinely enjoy and get a kick out of people with dementia. But feeling actually in danger at work has taken away a lot of my daily happiness at the GreatRep. So leaving there wouldn't feel like as much of a loss as it would have in the past.

So, yep, I'm not holding my breath, but wish me luck anyway!