Night and Day

 You've heard that old colloquialism "as different as night and day". Recently I began to believe that this may not be referring to presence or absence of the sun and more appropriately, at least for nurses, as the differences between our counterparts on the opposite shifts.  This has always been an issue I would assume. I have noticed long ago that a certain animosity exists between most shift workers. I feel like I'm just stating the obvious here and that you guys will read this and roll your eyes as if I've been naive up until now. The truth is I'm just now reaching the point where I want to vent about it in a public way.

Let me put a little disclaimer on this. I will be speaking in generalities about hospitals and RNs/CNAs of opposite shifts. It goes without saying that this is about my situation at my hospital and does not reflect the work and professionalism of all nurses at my hospital or in the profession at large.

I work day shift now. I have worked night shift, so you can't pull the wool over my eyes about how "Hard" night shift is. I'm going to be blunt... Night shift is easier in general. Night shift is where we start our new nurses and it's where we keep the ones that are a little bit off. Sometimes a nurse will stay on nights because it's all they've ever done and their sanity surely depends on keeping their circadian rhythm on track. On night shift you have the luxury of not having admin looming around. You don't have to deal with meals, and you have a lot less family hanging around. For the most part, your patients sleep at night. Of course there are exceptions, sun downers being the most obvious. The bulk of medications are given during the day too. At my hospital, which is not a teaching hospital, we do not have doctors around after 5ish with the exception of the OB if delivering, the ER and emergency surgeries. Rounds are done (primarily) between 7 and 9am the exception being new admits who come up after rounds. So, night shift will hardly ever have to interact with a doc in person. Some of our night nurses admit to not even knowing what some of our docs look like. We don't have a unit secretary, at least not the conventional kind. We have a CNA who sits and goes over IV charting and charges for half a shift. We, as day nurses, are responsible for all the orders the providers spew out during rounds. With all of the discharges occurring between the hours of 8 and 5 there are only a couple of night nurses that can even complete a discharge, including house supervisors.

Now for the venting.

On an almost daily basis, I walk in to find night shift sitting and shopping online or watching TV on their phones or some other kind of shenanigans, with food and drinks scattered about. I am then privileged with a half-ass, substandard report on Pts that, if I had worked the day before, sounds almost exactly like the report I gave them, as if they were reading mine back to me. After they leave, I must scour the patients charts to determine what was left out of report. What meds were left not given or were due at shift change and were not given. And I have to do it fast because the Dr is rounding and will no doubt catch these mistakes and I will be the target of his ire and the face he/she associates with utter incompetence. My shift and I have each other's backs. I will take the heat if my aid forgot to chart or even recheck a temp on a febrile pt. I'm always down to turn/reposition the heavies. And we will answer any call light. That's how we operate, that's our mentality. It is OUR shift and OUR patients. This sense of fellowship or camaraderie was not present when I worked night shift. It was more of an "Us against the world" attitude. Most of them carry some form of chip on their shoulder for the day shift. One reason for this may be because we are generally staffed with more people, but this is only due to the increased work load. Also, recently they implemented a new policy that made night shift responsible for pulling day shifts AM meds (0730-0900) with the exception of any controlled or refrigerated meds and place them in a locked alcove outside of the patients room. This was met with great resistance from both shifts. Nights, obviously, didn't want to have to do it, but the day shift didn't trust night shift to do it correctly and would rather have the extra workload. Admin countered by adding that Day shift must pull night's meds as well from the same time frame. That was met with more resistance. It now stands, at least in policy, not necessarily in practice, that nights pulls AM meds and Days doesn't pull Night's meds. As either a subconscious or passive aggressive form of rebellion it seems that our meds in the AM are almost always wrong. A few nurses absolutely protest doing this.

Most recently, yesterday in fact, I came in for report on 4 repeat patients from the day before and 2 new patients. I noticed in report that one of the repeat patients IV fluids had been stopped and saline locked. Knowing damn good and well that they didn't call the Dr to DC the fluids I asked why the patient was saline locked. I was told that while turning the patient another nurse told her that she thought the patient was saline locked on a previous shift she had worked. So, without checking orders, they simply saline locked the patient and left. WITHOUT CHECKING THE ORDER! Who does that? This is a hospital! This is a new day! Things change, orders are made, treatments are adjusted! This and the STATUS QUO dept! PAY ATTENTION! I know it is a small thing. Hey, it was only running maintenance fluids at 40/hr. But what if it were something else? What if it were vitally important. What if we were running 1/2 NS with 40meq of KCL at 125/hr to correct a low potassium level and they had shut it off and the next shift didn't catch it, then they reported that the patient was saline locked and lack luster noc shift accepted it without question. That's 36 hours at 125ml/hr which is 4500 mls with 40 meq per liter that's 180meq of KCL that the patient didn't get. One day they said, I don't know if the Pt is A/O they've been asleep all night. Turns out they weren't asleep they were unresponsive. THERE IS A FUCKING DIFFERENCE BETWEEN ASLEEP AND UNRESPONSIVE!

Last night after giving report to an eye-rolling, teeth-sucking, sighing, sarcastic, bitter nurse, I began to report off to another and I overheard the other saying that she "wasn't even going to go in a room tonight." ARE YOU SHITTING ME! It's like my whole shift of hard work is negated by their shift of laziness.

Again, I am venting, this is about my hospital, and even within my hospital it is primarily only a few nurses that are responsible for all of this rant.

But it can't be just me that is noticing something like this. I'm not just being negative, right? I feel better already having gotten that off my chest.

Thanks for reading,

As always follow me on twitter @MurseWisdom
Also follow @MurseMafia @That1Murse @JustSomeMurse

I'm back, Jack!

It's been a long time since I've posted a blog. It's been too long. So, I'm going to attempt to catch up.

I don't know if Ive mentioned it here before but my wife is also an RN. She graduated last May. Just before she graduated and at her behest, we moved out of our 100 year old apartment to a house in a very small town about 45 min away. She continued to commute to her last few days of classes and clinicals and I commuted to work while looking for a job some place closer to our new home. Wait, back up... I forgot to mention that she was 5 months pregnant when she graduated. So, she quit her job when we moved and being 5 months pregnant couldn't find work anywhere. Although they don't discriminate against pregnant women, she never seemed to get interviews. So, I took on all the bills and expenses of moving on my own. To make that worse we found out we were pregnant 1 week after I bought my new truck.

 So, naturally, cuts had to be made. I couldn't get rid of the truck or the gas needed to drive 45 min one way to work. I had to cut the internet and the cable. Well, I didn't cut it so much as I never started it at the new house. How exciting for my pregnant wife to sit at home with no cable and no internet in a town smaller than Mayberry with nothing to do. Thank God for Smartphones and 3G signal in the boonies. So, having no access to the internet on my computer, I couldn't write the blog anymore. I certainly wasn't going to try to type it out on my Droid.

My job search went well, interviews left and right, I finally landed on a small hospital about 30 mins away. Didn't improve my commute much, did I? But they really liked me and the CEO was so positive and energetic and likeable, the new Nurse Manager (who has an MBA to go with her BSN) was awesome too, and she told me all about the new ideas and plans she and the hospital had in store. I'll be honest, it sounded like I was getting in the door at the right time. I took that job but didn't quit my other job, figuring I'd have to make up for my wife's missed salary. Then I got a call from my former DoN asking me to come help her out as she had recently been hired as a regional director for a home health company that worked with Peds. She had been doing all the infusions herself on top of her administrative duties and wanted me to jump in and do some infusions. I said "Ok", and then I had 3 jobs! I really didn't have time for blogging then. I worked my tail off all summer until late August. I stopped scheduling myself at my original job and became extremely PRN. The infusions slowed to a crawl because eventually you worked yourself out of a job because your Pt's got better from the infusions, or they died. I know, that's a downer but it's true.

Sept 27th, my wife gave birth to my daughter

 

 A few days prior to that I had finally gotten cable and Internet and was all ready to get back in to blogging. Then I stopped sleeping! My God! Do people know how needy these babies can be? This has been a whirlwind of emotions and a physical strain. I will tell you that I have served in an active combat zone, I have stayed awake (my longest stretch) for 55hrs and finished it off with a convoy through a heavily populated area, and of course I have graduated Nursing school. NONE OF THESE THINGS PREPARED ME FOR FATHERHOOD!

That should catch y'all up for a while. I really enjoy my Twitter Anon shenanigans and I enjoy giving out advice and guidance. There is someone on twitter now that is almost a blatant copy of my account and I don't know whether to feel flattered or angry or threatened. I now that it's pissing me off so far and I'm refusing to follow him because if I see him tweet something that I've tweeted before I will lose my shit and probably hundreds of followers in the process.

I'm debating doing one of these Google Hangouts with the other Anons, I just recently bought a web cam so I can talk to my parents over Skype and they can see the baby. It would just be really awkward to jump on there and recognize someone.

Ok, I'm sorry that wasn't a comedic post. I'll be funny next time.

Until next time...

Follow me and my Murse buddies on Twitter

@MurseWisdom

@That1Murse

@JustSomeMurse

@MurseMafia

And leave a comment so I know you guys are reading this!

 

Gender Bias in Nursing??

@nurseofdoom wrote a research paper regarding gender bias in nursing.  It was so good, we wanted to share it with everyone.

Do you agree?  Disagree?  Comment - discuss

https://docs.google.com/open?id=0B6qm33---mv2MnpHaXhLZkNyNms

(I posted it on google docs as it was fairly lengthy)

Thanks
@that1murse

and follow the #MurseMafia - @MurseWisdom @JustSomeMurse and myself.

Reflections from the Joplin Tornado

As I start this off, I want to make one thing perfectly clear please.  I’m not a “Hero”.  I never have been.  Please don’t call me that.  I’m a man that did what anyone else in my role and my skillset would have done.  @MurseWisdom is a Veteran that served in a war zone.  @MurseWisdom is a hero.  Both of my parents proudly served in the military.  They are heroes.  

Dr. Kevin Kikta is a hero.  He wrote a story called 45 seconds about his night in the ER that night.  It’s a chilling read.  http://statemagazine.org/?p=531

Dr. James Smith is a hero.  He was doing surgery when the tornado hit and ran over 7 miles home to check on his family.  http://www.outpatientsurgery.net/news/2011/05/24-Operating-Through-the-Tornado

The countless, unnamed nurses, RTs, Rad techs, and all the medical personnel that covered both hospitals that night and continued to staff them until everyone was taken care of are the heroes as well.

Please save that prestigious title for them … they deserve it.

With that being said, here we go.  I’ve debated the last few days what exactly I wanted to say. I figured I would say, what I felt, what I did.

It was 5:41 p.m. and it was 32 seconds that would forever change the lives of people that lived anywhere near Joplin, MO.  I was watching the coverage on The Weather Channel.  There was discussion that Joplin and possibly a hospital had taken a direct hit; however, I knew this to be true well before it was confirmed on the air.  Facebook literally blew up.  I knew that St. John’s had taken a direct hit because of Facebook.  But when the weather channel cut live to a Mike Bettes standing in front of what used to be the hospital; my heart sank.  “I have friends and classmates that work there” I thought and then Mike came on the air and pleaded for doctors, nurses, medical personnel to please come to Joplin.  http://www.youtube.com/watch?v=r8kg2dEJo_Y&feature=related

It was all I could take, myself and several other nurses loaded up to make the drive to Joplin not knowing what the hell we would find but knowing that we had to do something.  We arrived about 4 hours post touchdown and went to Memorial Hall where the medical triage was.  Upon arrival there, we found them fully staffed and they suggested we go to another secondary site.  We got there and waited about an hour before I finally was able to get through to the Red Cross.  They basically said that if we were already in Joplin that we should go to Freeman hospital.  

Driving to Freeman hospital was problematic to say the least as we had to drive past what was St. John’s hospital.  We were stopped 3 different times at three different roadblocks, one being right next to St. John’s hospital.  I do have to say that this was one of the most amazing experiences as a nurse.  The police officers stopped us, I said “We’re nurses” and they screamed “nurses” and opened the roadblocks for us.  Once we got to St. Johns we had to drive around the back of the hospital. Pictures will NEVER do this justice.  I’ve heard it described as what pictures of the atomic bomb in Hiroshima looked like and I’d have to agree.  It was complete and utter devastation.  People were wandering around aimlessly obviously in shock of what had happened and the place smelled of strong, strong natural gas.  We arrived at Freeman hospital finally and walked into the ER lobby.  It was one of most surreal scenes I’ve ever seen.  The lobby was literally overflowing with people and I would estimate approximately 1,000 people waiting to be seen.  I found a friend of mine that worked there and he said they were out of most every supply except gauze and gloves mostly so if we could do some basic first aid and try to find the most ill patients to be seen first.  We walked around and spoke with people, treated and cleaned bumps and bruises, and found severely injured people to pull back the moment ER beds opened up.  On the ambulance side of the ER they had a convoy of over 100 ambulances and they were literally loading people up and dispatching them to hospitals in a 200 mile radius.  There were buses loading up less severely injured people and transporting them as well. 

The looks on the faces of the people in the lobby is something I will never forgot.  It was disheartening seeing the look of pure shock at what had happened and trying to make sense of it all.  How could 32 seconds completely change their lives like that.  While we treated the bumps, bruises, and lacerations; we were not able to treat the mental issues that were filling that hospital and that town.  We stayed until about 4 am and then went home knowing that as much as we felt we did we probably didn’t do enough.  Little did I know at the time, but my ex’s brother was frantically searching for his daughter who was working at a local restaurant at the time.  Unfortunately, while they found her; her injuries were too severe to survive.  However, she died a hero as well.  She was working to keep customers and other employees calm before the tornado hit the establishment… she wasn’t even 18 yet.  

I’ve talked to employees from both hospitals and some still have trouble sleeping or still have mental issues relating to that 32 seconds.  

So there are a few things that I learned from this event: 1.  Social Networking is a must.  As I said, I knew that Joplin and St. John’s was hit long before it was announced.  Facebook was also a lifeline for people looking for loved ones at that time because if you couldn’t make a phone call you could send texts a little easier and a text to a loved one or facebook was a welcome sight for families.  2.  If you don’t know how to text – learn.  And teach your parents, grandparents, anyone with a cell phone to text.  To put it into perspective, I tried over 100 times to call the Red Cross that night.. I got through once.  Text messages were going after only a few times of trying to send.  3.  NO HOSPITAL IS PREPARED FOR A DISASTER OF THIS MAGNITUDE.  Freeman was out of supplies initially within a few hours.  Our hospitals are trained to keep supplies on hand for anticipated need.  Not for 1,000 people showing up in your lobby to be treated in a few hours.  I have disaster training and used to work in that field.  This last one scares me the most because I used to think our hospital is ready, but I think we would run through supplies in a matter of hours as well and then would have to get inventive like Freeman staff did.

However, Joplin doesn’t want to be known for that.  They want to be known for their drive to rebuild and they have done an amazing job.  It should be an inspiration for everyone of how to overcome adversity.

@that1murse

Hypomania

So I mentioned in my post that I was a hypomaniac, which sounds funny but true. 
An ER doc one night said you are a hypomaniac and I laughed.. until I pulled up the DSM-IV criteria and met most if not all of them.  Anytime I walked in dragging ass he'd laugh and say you got too much sleep didn't you.  I truly function better on 4 hours of sleep than 8 hours of sleep.
So here are the DSM-IV criteria for hypomania:
DSM-IV-TR defines a hypomanic episode as including, over the course of at least four days, elevated mood plus three of the following symptoms OR irritable mood plus four of the following symptoms:

• pressured speech
• inflated self-esteem or grandiosity
• decreased need for sleep
• flight of ideas or the subjective experience that thoughts are racing
• easy distractibility and attention-deficit similar to attention deficit hyperactivity disorder
• increase in psychomotor agitation
• involvement in pleasurable activities that may have a high potential for negative psycho-social or physical consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, reckless driving, or foolish business investments)

Hypomania isn't a bad thing though usually.  Dr. John Gartner wrote a book about how hypomania actually is what drives America.   His book is called "The Hypomanic Edge" http://www.hypomanicedge.com/

There are advantages of hypomania as well:
For me personally, I've learned how to read people.  I've also learned the rules for work.  I was approached a few years ago and asked to take a semi-management position.... except I was told that I will befriend the current person, learn as much as I can, and then watch them take the fall.  It was that moment, that I realized administration is three steps in front of everyone and I vowed to be at least two from that point on.  I'll do what I have to do to succeed.  Callous... probably.  I don't fail.  I refuse to fail. 
I've also considered a career in politics.. because I have no doubt that I can do it.

"Some commentators believe that hypomania actually has an evolutionary advantage.^[5] People with hypomania are generally perceived as being energetic, euphoric, visionary, overflowing with new ideas, and sometimes over-confident and very charismatic, yet—unlike those with full-blown mania—are sufficiently capable of coherent thought and action to participate in everyday activities. Like mania, there seems to be a significant correlation between hypomania and creativity. A person in the state of hypomania might be immune to fear and doubt and have negligible social and sexual inhibition. People experiencing hypomania usually have very strong sex-drive. Hypomaniac people are often the "life of the party." They may talk to strangers easily, offer solutions to problems, and find pleasure in small activities. Such advantages may render them unwilling to submit to treatment, especially when disadvantages are minimal."

Disadvantages though means that I drag ass for a few days if I sleep too much and of course foolishness can be a double edge sword.  It can ruin relationships as well as ruin you financially (if you make a bad business move)... but that's a chance you take cause the payoff can be huge.

Defense Mechanisms

Sorry it's been a while.  You know how it is with finals and all.  

So I’ve posted some “#BeingAnERNurse means” and it got me thinking about ER nursing.  One of the things that came with working in a smaller community is that there is a better than average chance that I’ll know my patients, their families, or will see them out and about.  This can be a double edged sword. 

Every time that ambulance rolled through the doors, there’s a piece of me that wondered if it was someone I love.  I heard a story of a nurse working in an ER like mine and the ambulance rolled in with a severe trauma… It was her husband.  She literally went catatonic and woke up several weeks later in the hospital. 

With this fear comes the point of my blog post tonight, defense mechanisms.  One of the defense mechanisms that I have (and I only know this cause I can willing admit it) is that I don’t look at faces, unless the injury is specific to the face.  I know this sounds weird until I explain it. Hell, then it might still be weird.  If I don’t look at the face then I don’t know whether I know that person (yes, I know you literal people will say look at the name and to you I say shut up, LOL… Actually, traumas come in John Doe so it doesn’t help anyone).  I have literally taken care of people for 2 hours and when they get admitted to the hospital I realize that I know and recognize them.

This does make for two strange situations though: 

1. I’ve had people come up to me in Wal-Mart and say “Thanks for taking care of my husband so well”  and I look at the them and how no idea who they are.  But if they tell me what room they were in and a little about the case, I can tell them exactly what we ordered, the diagnosis, and the disposition… Strange I know
2.  I have a hard time recognizing faces outside of work.  I see people and think.. shit I know them from some place but I can’t pinpoint where.  It usually takes me seeing the person 5-6 times consistently before I can remember their face.

Again I have this defense mechanism in place to protect myself from the inevitability that I will probably work on someone that I know and love. 

So do you have any defense mechanisms in place? 

As always comment here or tweet me. 

And of course follow the me and the rest of the #MurseMafia on twitter.  

@that1murse

Kinky, Freaky Nurses

Get into the mind of a nurse and I’d say the majority are kinky, sexually uninhibited, or like to explore sexually… hell they could even be a closet freak and you have no idea.  Why is that?  Well my opinion on the matter is that nurses (and medical professionals in general) deal with death on a regular basis.  We stare death in the face on a regular basis.  Sometimes death wins and sometimes we give a big middle finger to death and save a life.  With all this death floating around, of course we are cognizant of our own mortality.  And with that knowledge comes that fact that we know we only get one trip around this world (unless you believe in reincarnation) and we want to make the most of it.  We take more risks, we drive a little faster, we have freaky, kinky sex.  Maybe you were a freak before you went to nursing school.  Maybe you became a freak while in nursing school.  Maybe it took a few years after you get out… but I truly think that in death we decide to try to live more.  

FYI – Sex is generally a highly pleasurable activity and we want to get the most out of it… and being nurses and having intimate knowledge of anatomy and physiology doesn’t hurt either ;)

The point of this post is if you are questioning why you like kinkier things then you used to blame nursing.  If you are freak already, then at least now you have something to blame it on… If you have kinky thoughts but are afraid to act on them… know that most of the time with nurses you are in mutual company.  So find a slurse or a murse and turn those thoughts into more than thoughts buried in the deep recesses of your mind.

You’d be amazed of the things that nurses at work have talked about doing or offered to do while at work.. Bad slurses ;)  I could talk about it here but it would go from R rated to X rated relatively quickly, LOL

And if you like “vanilla” sex and think you always will, hell at least enjoy it then.   

Agree?  Disagree?  Voice an opinion? Comment?

Follow me on twitter @That1Murse.  Follow my co-blogger, @MurseWisdom