skillzzzzzzzzzzzzz

there is a certain feeling of accomplishment that comes from doing a job well. like when you have had to use all your critical thinking skills, maybe caught something about a patient that was a little bit off that ended up making a difference or saving a life. or making a connection with a family member having a hard time letting go of grandma or grandpa. or running all night transfusing units of blood trying to stay ahead of a bleed, and successfully 'reminding' the physician to order lasix in between units of PRBC's. sometimes the night is such a high i have a hard time winding down in the car on the way home. not a high like.....a good high sometimes, like you just finished a great endorphin-releasing run or a really amped up concert. but more like you just fought a good fight....or, i dunno, it's hard to explain.
on the other hand, i hate the nights when i get my ass handed to me. when your A game just isn't there and you miss stuff......as exhilarating as it can be to Find the Big Thing or Prevent the Tragic Mistake, that's equally how bad it can suck to MISS the Thing that Kills Your Patient. for the record, i haven't yet Missed the Thing that Kills my patient, but i've def come close a few times. what i have done a few times is not Miss the Thing that Kills my patient, but had my patient die or end badly anyway. that sucks. i'm not sure what this piece has to do with skills, (i think i had a different post in mind when i started), but there you go.

things you can't say to your patients #2

to the sweet sweet 60 some-odd year old lady with the silicone breasts of a 20 something year old hollywood starlet, 'wow, these are some very nice boobs. very symetrical, perky and firm. in fact, they are so firm, i can't even listen to your lung sounds to assess your pnemonia like i'd like to because they aren't sagging down under your armpits as your-age appropriate boobs should and would be.' what i can't help thinking about everytime i encounter a set is that someday, all that will be left will be a bunch of bones and two perfectly shaped, symetrical bags of silicone sitting in a fancy wooden box. that would make a fun halloween costume though, huh? i'd have to explain it to everybody however, and that would get old fast.

things you can't say to your patients #1

.......when you are placing a foley in someone's penis. 'hey man, you have a REALLY large penis. way to go. does it get even bigger when it's erect?' or to the girlfriend, 'wow, looks like you are one lucky lady.'  it wouldn't have mattered anyway, the kid was only 18 and probably a virgin anyway. that probably means he wasn't even done growing......geez, imagin that.

Maximus, Brutus, Octavius

i have three boys. if you can remember far back enough, i used to only have the one boy. here's what happened. we got pregnant very easily with Max. like, first time we tried, boom goes the dynamite. so we think to ourselves, well, we must be very fertile. awesome. years go by, we think we can handle another, so we try for bebe number 2. and try again. and again. and next month, we try again. no dice. what?!?!? finally, after a YEAR, we got Brutus. so..............now we're like, well, we must not be that fertile. and maybe we weren't as careful, you know, as we should have been. sooooooooooo, some how, when Brutus was only 6 months old, surprise! we're pregnant again. oh joy! right, honey? those are tears of joy, right? honey?
oy vey. that is hard. this is hard.  two boy bebes, 15 months apart, not so much fun. someday it will be worth it, i hope. man, it is hard now. hey, at least i got a cool minivan out of the whole thing.

ketchup

having two bebes in two years is HARD. seriously. I wouldn't recommend it to anyone. also, not having a fully functioning laptop kills your blogging career, but mostly it was the two bebes in two years thing. anyways, i'm back. did i miss anything?
i have missed blogging. i have a lot of catching up to do. i have really missed grumpy, nurse k, head nurse, new nurse in the hood, and scores of others. i have missed having a creative outlet to unwind and spew my emotions about nursing. hopefully i really am back.
where do i begin again? who am i now?
i guess i am a more experienced nurse. three years in an icu will do that to you, i guess. there is very little that comes my way now that i don't have an answer for, and when i do get something new, i relish it as a treat and an opportunity to learn something new.
just the other day i had a patient had a strain of H1N1. no big deal, right? yeah, except it was summer. and it was a strain from 2010. what?!?!?! seriously. and she was young. 40's right, not in the greatest of health, a few comorbidities, but nothing that would make me think, yeah, this one's a goner. so, of course, i took care of the patient for a coupla days, on BiPAP, without precautions. always seems to happen, right? then, oh yeah, H1N1 guys, make you sure you do precautions. thanks. gal keeps getting worse, buys a tube, and eventually a rotoprone bed. some serious Star Trekian stuff. no dice, dead with a week. weird. never saw that coming.

For Shame

i am a dood nurse. most nurses are females still, and have been for some time.

the recent influx of males into the profession of nursing may be a good thing. on the one hand, having more males in the profession is probably doing more to elevate nursing in status from being doctors handmaidens to, you know, an actual profession.

pro

case in point. our manager decided to try out a new thing. something about having the charge nurses introduce themselves to the patients every shift, or some such nonsense like that.

anyway, my manager is not the best communicator. he's this sooper non-confrontational guy, for one thing, and he's super old and kinda close to retiring. but, he has forgotten more about nursing than most of us will ever know, and he's sorta considered a saint around my hospital. for instance, he got grandfathered in and didn't have to get a BSN. like i said, he's an absolute saint.

so. with his new have-the-charge-nurses-introduce-themselves thing only sort of officially rolled out, chaos ensued. some charge nurses were like, so, are we supposed to do this every shift? and other nurses were super gung-ho about it, charging in and whatever.

now, i know that there are some hospital and floors that do this sort of thing already. the mom-baby floor were we delivered our kiddle-diddles did this, for example. it was perfect, the charge nurse came in, introduced herself in a non-threatening way, said she would be available, blah blah blah.

in an ICU, it is a little different. okay, it's really different. mom-baby, healthy people (mostly) having babies, flowers and sunshine and puppies and rainbows coming outta orifices and whatever.

ICU, hover between life and death.

so, when our sainted fearless leader didn't provide a script or guideline or anything for the charge nurses, many things were said. sometimes, what the charge nurses said caused the patients families to ask and wonder, 'why are you checking up on my nurse? is there something wrong? and then gung-ho charge nurse would have to back-track.

what needed to happen was a script needed to have been provided that took into consideration what patient families might think, and say things in a way that, oh whatever. it needed to have been done better.

one of charge nurses got asked by a patient for some dilaudid, and the charge nurse was all like, sure, i'll get right on that. the she sailed out of the room. well, turns out the dilaudid was discontinued, and the primary RN was left to pick of the pieces.

a lot of other stuff happened too, and most of it involved female charge nurse and female nursing staff. there were a lot of hurt feelings, and nobody said anything to Female Gung-Ho Charge Nurse. there was a lot of back talking and gossip though.

everytime somebody mentioned this, i always asked, okay, who is going to fix this? who is going to approach Female Gung-Ho Charge nurse? now, this may be stereotypical, but, this chatty bunch of women did nothing.

we have only two male charge nurses. and one of them did the gung-ho thing once, and he happened to do it a patient that was assigned to a male nurse that was friend of his.

scene 1: male charge nurse in the room, speaking with family and patient.

primary nurse walks in. 'whats going on?'

charge nurse, 'oh, you know, checking up on you. it's okay, the family says you're doing a good job.'

scene 2: right outside the room, right after scene 1, charge nurse and primary nurse.

primary nurse, 'what the HELL do you think you're doing in there, calling MY nursing into question with that family?'

(heating discussion follows, almost coming to physical blows, by some reports.)

and those two were friends!

afterwards, the to made up and it never happened again.

see, if i was being stereotypical, this would be the breakdown: female offends females, there is no confrontation, stuff gets dragged on, blah. dood offends dood, they immediately hash it out, problem solved, problem over.

okay, nuff of that. here's the con.

scene: an ICU, a LARGE female patient on a rotobed.

male ICU nurse (in a room full of other male nurses), 'okay, everybody grab something, and lets get this patient scooted up in bed. oh hey, be careful of her gunt.'

nurse j, ' whats a gunt?'

male ICU nurse, ' you know man, not quite a gut, not quite a ........'

nurse j, 'oh okay, i get it.'

awesome. 'gunt,' huh?

for shame. the darker side of male nursing.

Do you Speak Penis?

i wrote a while ago about my co-worker friend who has a way, shall we say, with catheters, in The Penis Whisperer.

i had a chance to put in a catheter with a urologist. it was pretty funny. i told him about my coworker. the urologist said he wasn't so much a whisperer as much as a 'penis shouter.' it was pretty funny.