Last quarter ended on an awkward note, as I stayed after my final to speak to my A&P instructor about his inappropriate comments throughout the quarter - see my last post for more info. So imagine my unpleasant shock when, the Friday before classes were due to begin on Monday, I got a letter telling my I hadn't paid my spring quarter tuition and was therefore DROPPED FROM ALL MY CLASSES. WTF. That's a horrible way to let me know that. Wouldn't logic tell you that if someone owes you money, you should give them notice of that BEFORE it becomes a problem?
Nope. That was the first I'd heard of it, because up until now my financial aid has covered all of my tuition with no problems.
So now I was faced with the possibility that once I paid the extra money financial aid didn't cover, I might have to try to get into whatever A&P 2 class is available. Which includes the one taught by my last instructor. And both he and I would probably rather eat some glass than have that happen. Awesome.
Long story short, it all worked out and I'm deleriously happy to be enrolled in my (female) teacher's A&P 2 class. Today was the first lecture, and she's organized, clear, and seems to be an excellent instructor. And hasn't mentioned her genitals once!
I love her. I'm so, so, so relieved to be taking her class! This is going to be a good quarter.
Tuesday, April 3, 2012
Wednesday, March 21, 2012
Spring Break!
I made it through my finals and am now officially on spring break! Who would have thought that only working full-time could feel so easy?
This last week at work was extra stressful too, with a barrage of needy/cranky/drug seeking/on isolation precautions patients who made sure that at least one of them was pushing their call light every 3 minutes throughout my entire 8 hour shifts. I got home cranky after those, let me tell you.
After my final today, I stayed after class to have an uncomfortable talk with my instructor that went a little something like this:
"Hello teacher, I want to talk to you about your behavior and how you might improve it in the future. You seem like a good person who ultimately wants his students to be successful in this class, right?"
"Right"
"Well then let me tell you something, when you talk during class about 'Which head do I think with' [meaning brain or penis] or about pornography, or about who might have a 'thing' for urine it is offputting to your students and makes you much less approachable. I took late points on an assignment rather than speak with you one-on-one earlier in the quarter before I'd observed you enough to decide you were actually all right."
"Oh, that's strange, no one's ever told me that before"
"Really?? No one? Not in your anonymous performance reviews, not face to face, not via email?"
"Oh only 2 or 3 students in all the years I've been doing this. I don't get performance reviews much anymore, I'm tenured you know."
"Yes,I know. Well, think about it - if you intimidate and make people uncomfortable, they're not going to come to you and tell you you're doing that. So assume that I'm speaking for any number of students when I tell you this is not appropriate workplace behavior."
"I like to joke around, it makes me approachable. Most people like it, that's good enough for me."
"It doesn't make you approachable, it makes you inappropriate. There are ways to joke around that are great, do those."
"No, I don't think so. Thanks for the chat, bye. Oh by the way how are you going to handle me next quarter?"
"I'm taking a different teacher next quarter, of course. Goodbye."
ARRRRGHHHH! I want to rip my/his hair out in frustration.
Seriously, who does that? Who in their right mind wouldn't say "Oh, I see, perhaps you have a point, I'll think about it. Or tone it down. Sorry about that."
What a jackass, right?
So then I went home for my much-anticipated post-final nap and had a nightmare that I'd been demoted from working at the hospital to working at our sister facility nursing home. Only problem is, it was full of very acute patients, including pediatric ones! In my dream, the CNA that was orienting me suddenly had a little girl start coding and casually gave her a sternum rub and then some compressions until she revived and told the CNA to stop because it hurt. Then a doc came by and said "Oh, it was probably just postural, her vitals drop when she's supine. Turn her over and carry on." I was horrified that I'd be expected to be saving children's lives one-handed and that they all took it so casually, and was tangled up in a bunch of IV tubing and suction tubing trying to get my butt out the door before I killed someone.
Stress dream, much?
Stupid tenured teacher.
Good news: quarter is over, no more teacher, and I'm NOT demoted in any way at the hospital, and I will never have to be responsible for critically ill children unless for some ungodly reason I decide I want to be, which seems very, very unlikely. Old people, sure. Kiddos, no way. Can't handle that population; the very idea makes me shake.
This last week at work was extra stressful too, with a barrage of needy/cranky/drug seeking/on isolation precautions patients who made sure that at least one of them was pushing their call light every 3 minutes throughout my entire 8 hour shifts. I got home cranky after those, let me tell you.
After my final today, I stayed after class to have an uncomfortable talk with my instructor that went a little something like this:
"Hello teacher, I want to talk to you about your behavior and how you might improve it in the future. You seem like a good person who ultimately wants his students to be successful in this class, right?"
"Right"
"Well then let me tell you something, when you talk during class about 'Which head do I think with' [meaning brain or penis] or about pornography, or about who might have a 'thing' for urine it is offputting to your students and makes you much less approachable. I took late points on an assignment rather than speak with you one-on-one earlier in the quarter before I'd observed you enough to decide you were actually all right."
"Oh, that's strange, no one's ever told me that before"
"Really?? No one? Not in your anonymous performance reviews, not face to face, not via email?"
"Oh only 2 or 3 students in all the years I've been doing this. I don't get performance reviews much anymore, I'm tenured you know."
"Yes,I know. Well, think about it - if you intimidate and make people uncomfortable, they're not going to come to you and tell you you're doing that. So assume that I'm speaking for any number of students when I tell you this is not appropriate workplace behavior."
"I like to joke around, it makes me approachable. Most people like it, that's good enough for me."
"It doesn't make you approachable, it makes you inappropriate. There are ways to joke around that are great, do those."
"No, I don't think so. Thanks for the chat, bye. Oh by the way how are you going to handle me next quarter?"
"I'm taking a different teacher next quarter, of course. Goodbye."
ARRRRGHHHH! I want to rip my/his hair out in frustration.
Seriously, who does that? Who in their right mind wouldn't say "Oh, I see, perhaps you have a point, I'll think about it. Or tone it down. Sorry about that."
What a jackass, right?
So then I went home for my much-anticipated post-final nap and had a nightmare that I'd been demoted from working at the hospital to working at our sister facility nursing home. Only problem is, it was full of very acute patients, including pediatric ones! In my dream, the CNA that was orienting me suddenly had a little girl start coding and casually gave her a sternum rub and then some compressions until she revived and told the CNA to stop because it hurt. Then a doc came by and said "Oh, it was probably just postural, her vitals drop when she's supine. Turn her over and carry on." I was horrified that I'd be expected to be saving children's lives one-handed and that they all took it so casually, and was tangled up in a bunch of IV tubing and suction tubing trying to get my butt out the door before I killed someone.
Stress dream, much?
Stupid tenured teacher.
Good news: quarter is over, no more teacher, and I'm NOT demoted in any way at the hospital, and I will never have to be responsible for critically ill children unless for some ungodly reason I decide I want to be, which seems very, very unlikely. Old people, sure. Kiddos, no way. Can't handle that population; the very idea makes me shake.
Friday, March 9, 2012
Little Old Ladies from Little Old Towns
I worked at the GreatRep today, where I was unsurprised to find out that one of my residents is in the process of dying. This is a woman who's lived at the GreatRep for about half of my life. When I was in high school, she moved in. She's been there longer than any other resident, longer than the current Director of Nursing, longer than anyone else who's worked there. Pretty amazing.
The entire time I've known her, she's been almost like a living doll. She doesn't speak, rarely makes noises, and doesn't initiate movement barely ever. We move her from chair, to wheelchair, to bed. We feed her with a spoon and hold a cup up to her lips to drink. We use a mechanical lift to put her on the toilet and change her briefs.
I've heard she used to be quite a spitfire back in the day, and would scream at people. There was one caregiver whose voice she just hated and this woman would have a cataclysmic reaction if that caregiver attempted to do anything for her.
Now this woman is ready to go, and she let us know that the way most of them do; by stopping to eat or drink. She'd simply hold it in her mouth or let it roll back out, whatever you put in there.
Her sister stopped by to say goodbye to her today, brought by a younger and more oriented family member. I never would have thought I'd laugh about what someone said to a loved one on their death bed, but this is the cutest and silliest little thing; you would have had to excuse yourself from the room too!
Little Miss Clara marched right up to her dying sister, telling us "I have to go see Sister! We had a violent disagreement a few days ago, and I've just got to make things right!"
Rememeber, Sister hasn't said so much as a word in years.
Miss Clara whipped out a sheet of paper where she had painstakingly written out her speech to Sister. She stepped right up, and gave Sister's arm a good shake, saying "Sister, wake up! It's me, Clara! Nurse, don't you think she oughta wake up?"
The nurse gently replied that no, sister would probably not be waking up and that Miss Clara might want to say her goodbyes.
"Oh, then. All right."
Miss Clara began to read from her paper.
"Sister, first of all, you were always prettier than me."
I wish mightily I could have known what all was on that paper, but it's hard to beat an opening like that!
The entire time I've known her, she's been almost like a living doll. She doesn't speak, rarely makes noises, and doesn't initiate movement barely ever. We move her from chair, to wheelchair, to bed. We feed her with a spoon and hold a cup up to her lips to drink. We use a mechanical lift to put her on the toilet and change her briefs.
I've heard she used to be quite a spitfire back in the day, and would scream at people. There was one caregiver whose voice she just hated and this woman would have a cataclysmic reaction if that caregiver attempted to do anything for her.
Now this woman is ready to go, and she let us know that the way most of them do; by stopping to eat or drink. She'd simply hold it in her mouth or let it roll back out, whatever you put in there.
Her sister stopped by to say goodbye to her today, brought by a younger and more oriented family member. I never would have thought I'd laugh about what someone said to a loved one on their death bed, but this is the cutest and silliest little thing; you would have had to excuse yourself from the room too!
Little Miss Clara marched right up to her dying sister, telling us "I have to go see Sister! We had a violent disagreement a few days ago, and I've just got to make things right!"
Rememeber, Sister hasn't said so much as a word in years.
Miss Clara whipped out a sheet of paper where she had painstakingly written out her speech to Sister. She stepped right up, and gave Sister's arm a good shake, saying "Sister, wake up! It's me, Clara! Nurse, don't you think she oughta wake up?"
The nurse gently replied that no, sister would probably not be waking up and that Miss Clara might want to say her goodbyes.
"Oh, then. All right."
Miss Clara began to read from her paper.
"Sister, first of all, you were always prettier than me."
I wish mightily I could have known what all was on that paper, but it's hard to beat an opening like that!
Monday, March 5, 2012
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!
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!
Wednesday, February 29, 2012
The Four Things About Me
Four Jobs I have Had
* jewelry counter at a department store
* nanny
* residential counselor
* nursing assistant
Four Places I Have Lived:
* my hometown
* the town I live in now, the best town in the world!
* Seattle, WA
* bumming around
Four Movies I Could Watch Again and Again:
* The Princess Diaries
* Center Stage
* Point Break
* Blue Crush
Four Television Shows I Love:
* Bones
* 2 Broke Girls
* Parks and Recreation
* Top Chef
Four Authors I Enjoy:
* Mary Roach
* Poppy Z. Brite
* Jen Lancaster
* Meg Cabot
Four Places I Have Travelled To:
* San Diego, CA
* Whistler, BC
* Bend, OR
* Austin, TX
Four Website I Visit Daily:
* http://tumblr.com
* http://www.allnurses.com
* http://www.facebook.com
* http://www.pandora.com
Four Blogs I Visit Weekly:
* Cake Wrecks www.cakewrecks.com/
* The Bloggess www.thebloggess.com
* Clinical Psychology and Psychiatry http://clinpsyc.blogspot.com/
* Head Nurse http://head-nurse.blogspot.com/
Four of My Favorite Foods:
* Rice
* smoothies with fruit and vanilla soymilk
* peanut butter
* miso soup
Four Places I'd Rather Be:
* at a beach
* Los Angeles
* camping with Mr. Polly
* in nursing school for my BSN
Four People I Want to Tag:
* Zazzy http://frazzledrazzlern.blogspot.com/
* Estelle Darling www.estelledarling.blogspot.com/
* Annie http://arkansasisyourkansas.blogspot.com/
* Jess http://icosmeticrn.blogspot.com/
* jewelry counter at a department store
* nanny
* residential counselor
* nursing assistant
Four Places I Have Lived:
* my hometown
* the town I live in now, the best town in the world!
* Seattle, WA
* bumming around
Four Movies I Could Watch Again and Again:
* The Princess Diaries
* Center Stage
* Point Break
* Blue Crush
Four Television Shows I Love:
* Bones
* 2 Broke Girls
* Parks and Recreation
* Top Chef
Four Authors I Enjoy:
* Mary Roach
* Poppy Z. Brite
* Jen Lancaster
* Meg Cabot
Four Places I Have Travelled To:
* San Diego, CA
* Whistler, BC
* Bend, OR
* Austin, TX
Four Website I Visit Daily:
* http://tumblr.com
* http://www.allnurses.com
* http://www.facebook.com
* http://www.pandora.com
Four Blogs I Visit Weekly:
* Cake Wrecks www.cakewrecks.com/
* The Bloggess www.thebloggess.com
* Clinical Psychology and Psychiatry http://clinpsyc.blogspot.com/
* Head Nurse http://head-nurse.blogspot.com/
Four of My Favorite Foods:
* Rice
* smoothies with fruit and vanilla soymilk
* peanut butter
* miso soup
Four Places I'd Rather Be:
* at a beach
* Los Angeles
* camping with Mr. Polly
* in nursing school for my BSN
Four People I Want to Tag:
* Zazzy http://frazzledrazzlern.blogspot.com/
* Estelle Darling www.estelledarling.blogspot.com/
* Annie http://arkansasisyourkansas.blogspot.com/
* Jess http://icosmeticrn.blogspot.com/
Tuesday, February 28, 2012
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?
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?
Wednesday, February 22, 2012
Suicide watch
The other night at the hospital, I got sent to a different floor than my usual one to do a one-on-one suicide watch for a patient waiting for a transfer to our psych unit.
My patient was very pleasant, and very very sad, and rather nuts.
And that experience clinched it for me - no psych nursing for me, thanks. Geropsych, possibly (I just love old people enough to overcome my aversion to the wild behavior). But regular psych, where someone is sharing their terrible childhood and depression and I just want to cry and cry for them? No thanks.
On the plus side, I learned to play Yahtzee and it's so fun!
Also, I like that we live in a world where someone very poor with no family to speak of will get round-the-clock care to keep that individual alive and stable with a goal of recovery ahead of them. And there's no profit in doing so. We just do it because it's the right thing to do.
That's a good thought to hold on to.
My patient was very pleasant, and very very sad, and rather nuts.
And that experience clinched it for me - no psych nursing for me, thanks. Geropsych, possibly (I just love old people enough to overcome my aversion to the wild behavior). But regular psych, where someone is sharing their terrible childhood and depression and I just want to cry and cry for them? No thanks.
On the plus side, I learned to play Yahtzee and it's so fun!
Also, I like that we live in a world where someone very poor with no family to speak of will get round-the-clock care to keep that individual alive and stable with a goal of recovery ahead of them. And there's no profit in doing so. We just do it because it's the right thing to do.
That's a good thought to hold on to.
Subscribe to:
Posts (Atom)