Tuesday, September 2, 2014

This one is for the nurses

Mike said the kids were really good for him yesterday. His cold is hanging on and the stif neck he developed a couple of days ago is easing only slightly. It's hard to say if it's a cold or allergies. It it doesn't improve soon we'll be giving the doctor a call. I felt really bad going to work knowing he isn't 100%. 

James remains the same. His upper lip is all chapped from constant nose running. His tonsils are large and inflamed. No fevers though. He remains quite whiney with fluctuations I his Tiggerness. 

Sam is great. She had to wear her wide brimmed hat to school on the first. She said that the kids who didn't have a hat to wear had to sit in the shade instead of running and playing outside. As several family members have had melenoma I'm thankful for the enforcement of this precaution. 

Today I worked another evening shift. Prior to going to my assignment I stopped on another unit and was able to visit a friend from my time spent at Westminster. She explained that she got into nursing late (mid 30s). She always loved drama and is a classically trained opera singer. She has a gig this weekend and is auditioning for another. 

The ward I was assigned to specializes in stomach, bowel, liver and pancreas conditions and surgeries. The nurse I was paired up with also had a nursing student who will be done in November. There were eight patients between us and the pace was a bit more of what I'm used to. I was exposed to more charting and as-needed medications tonight. 

The med room is a place to hurry-up-and-wait, that is universal. The narcotics are kept in a locked metal cupboard. It opens with a skeleton key that I'm guessing has been in existence since the hospital was founded. There is one key per unit and the nurses are frequently seen quickly walking around the unit asking "Key? Key? Key?" Double checks are required for taking the narcotics out of the cupboard and tally is kept on designated sheets organized in a note book. 

Pain madication is given subq or orally, not in the IV line. When I asked about it I was told that pain medications were given IV only in the intensive care unit. For the patients requiring frequent subq injections, a small catheter similar to an IV was placed under the skin on the chest. This was a completely foreign concept to me. 

The IV antibiotics were mixed and drawn up by the nurses and given via IV push, not through an IV drip. Heparin drips are mixed my the nurses as well, not prefilled and stocked by pharmacy as I am accustomed. 

Yesterday none of my patients had IV fluids and today only one did. The patients I have self with so far, generally take an active role in their care such as getting to the bathroom, moving about in bed and simply acting more as if they would at home. Perhaps it is because they are not feathered to an IV pole or perhaps it is just the cultural expectation to take a more active role in ones own health. I'm just not sure. It'll be interesting to see if this is a fluke with my limited experience or not. 

There are no nursing assistants, instead there are Patient Service Atendants (PSAs). The PSA cleans the unit, delivers and gathers meal trays, and transports patients for procedures. I'm sure they do loads more, this is simply what I've observed so far. I'm still learning the different uniforms and what role is indicated by what uniform. 

Again I arrived early for my shift, not 1 1/2 hours early like yesterday, only a good 40 minutes early. As an agency nurse my pay is higher than the hospital employees. I've heard of some feelings of animosity from staff nurses because of this. Therefore, I aim to put the extra effort forward in being as prepared as I possibly can when the shift starts. It also means that I don't sit and idley chat, gather my belongings earlier than the exact end of shift and frequently ask what I can do. I hope to be a bit more self directing as I gain local experience  as for now I aim to be an extension of the nurse to whom I am paired with the intention of making the shift as smooth for her as possible. 

With the absence of nursing assistants I'm finding myself doin more of the hands on care. I love it!  I really missed being able to have that personal connection with my patients. It is nice being able to hear what a patien has to say while taking their blood pressure or while helping them get ready for bed. I think another contributing factor is that the paperwork less taxing; although, that may just be beginners naivety.   

I've asked several nurses about assessments. At my previous place of employment nurses were required to do a full head-to-toe assessment every eight hours. The replies I've gotten here is "That's for the doctors to do.", "Why would I do that?" And "No, you only have to focus on what they're currently being treated for."  I'm not quite comfortable with these responses and am eager to learn the protocol and expected standard of care. 

Because I work for an agency, my shift is six hours long instead of 8 like the staff nurses. I guess they figure I don't need to be there for the shift overlap. It does mean that I do need that extra time to get a quick verbal report so I can start off safely. 

For each shift I've worked I've brought in goodies to give the staff of the ward. Last night I brought in Arnott'a biscuits (cookies), tonight I brought in fun sized candy bars. What better way to break the ice than by asking "Where can I put these?"  A gesture of goodwill is a good start right?

An afternoon with the guys

This morning my wifi ran out or the date was up or something.  So we headed to the shops to look into a regular program, not a pay-as-you-go thing.  On our way I received conformation that James is under the weather.

I seriously can't remember the last time he fell asleep during the day. He was so out of it that I was able to get a few snuggles in.  He even stayed asleep when we transferred him to the stroller.

We did our errands at the shops and headed home. We intentionally passed our stop and visited a neighborhood cafe.  It wasn't until we were seated that I remembered that Sam really wanted to visit this cafe; however, she is at an overnighter with a friend.  The cafe is right by the beach and has a very relaxed atmosphere.  
James took this photo while keeping himself entertained waiting for our dinner to arrive. Gotta love the cricket bats.

It was a beautiful evening for the half mile walk home.  The sun was casting only a few rays our way after settling past the horizon.  The waves were quite loud as we walked along the coast. The moon was a small silver sliver and the stars kept us company the whole way.

And this one is for Robbie.  This is what I bought for Sam to share at her sleepover.  I haven't tried this flavor, it sure did look yummy though.

From August 29, for some reason it didn't publish. 

Monday, September 1, 2014

First day

Because I make the kids do it every school year...

I survived my first ever shift!  I'm sure Mike and the kids did fine. I am currently enroute to home. 

Lots of differences. Medications have different names, thankfully the generic name is the same and that is listed on the packaging as well. 

Today I was on a vascular ward. The patient profile is very similar to what I was used to on the medical unit. The nursing assignments were 6 patients to two nurses or four patients to one nurse. The patient acuity is determined and assignments are made accordingly. 

Day shift starts at 7 and goes until 1530. Evenings from 1330 to 2130 and nights from 2100 to 0730. Days and evenings have a two hour overlap as dayshift "can get pretty busy" and by doubling up on nursing it enables everything to get done. 

Today I worked with a very lovely RN who had trained in India, worked in Saudi Arabia, England, and here. The nursing community at first glance appears more culturally diverse than I've experienced previously. There were many times I had to ask things to be repeated either because the terminology was different and/or accents were a bit heavier or words pronounced differently. 

Our six patients were all on isolation. There were four with VRE in one room and the two with MRSA had private rooms. In the room with four beds, there were two beds to the left and two to the right. The women were in the beds nearest the door and the men were nearest the window. The dividing curtains I'd well wrapping around the different patient beds to ensure privacy. 

Each person had access to the tv, internet and phone via a very modern looking device attached to an arm that looked like something that would hold the light at the dentist office. This arm was connected to the wall at the head of the bed and allowed free range of movement all around the patient area withou being in the way. As the median age of my patients was around 86, not many of them utilized the technology. 

Although patients had access to very modern entertainment, the documentation was more old school than I've been exposed to during my time as a RN. Nurses made progress notes on the same sheets as doctors and other disciplines. This was nice as you could just peruse the pages rather than clicking from screen to screen. 

Medications were also documented on paper with a different paper for insulins and as-needed medications. It was a bit nerve wracking as I've been used to having a paper copy of medications for double checking at the bedside, or more reciently barcode scanning of medications. There are safety measures in place, all injectable medication require a double check, insulins, heparin, antibiotics, everything; if it gets injected it gets double checked. 

Medications were kept in a little cart. One drawer had bulk medications that were frequently used and another drawer had bins for patient specific medications. Needless to say, passing medications took me a bit longer than usual and this is to be expected when leaning a new system. In Bellingham we had a PIXIS machine that interfaced with the computers. We could only take out medications specific to the individual patient. 

Basins, bedpans and urinals are not disposable they way they have always been in my practice. They look similar and were made of heavier plastic. After each use, they were emptied and put into this fancy dishwasher-like stainless steel machine. In a way I think this is really good as each person gets a clean pan or "bottle" to use. Trust me, I've seen a few ripe ones as people  don't want to be wasteful throwing it away and getting a fresh one. 

The protective equipment was also a bit different as for the patients with VRE I was required to wear a long white plastic disposable apron. When I say long I mean long. Down to my ankles....

Well, I had been writing this on the bus, but needed to put it down to pay attention to get off in the right place.  It ends up that the last stop was my stop.  As the bus pulled in the train pulled out.  I asked the driver about the bus I'd need to catch home and would be stuck writing there for ages.  It's not the most savory stop, so I called a taxi.  The taxi people couldn't tell me when the next taxi would arrive and that it would be at least $26. So I figured I'd just stay close to the guard box and wait.  I called Jenny and asked her to message Mike that I'd later than planned. Instead her husband came and picked me up.  Thank you Andy and Jenny!!!

Oh Mom,  one of my patients said she was disappointed that the hospital did not have Horlick's for bedtime. She told me about three times that I have a "lovely face."  I took this photo for you.  I thought you'd appreciate the verbiage.

Just about ready to head to bed. I'm exhausted when this incredible noise came from all around.  I've heard it onece before here, long ago, standing in a tin roofed gym.  That's right, it was hail.  70+ degrees a couple of days ago and hail tonight.