Monday, April 30, 2007

Work, work, work, work

Saturday night I got called off, here that means you are on call for free all night. Cannot drink a beer, cannot take a Lunesta to sleep, must be ready for that freaking phone to ring all night...lucky for it and my migraine it did not ring...but shit...not like having a night off, right.

Then you come into work on Sunday and everyone is pissed you didn't come in on Saturday and take your regular you had a choice, and you opted out on getting paid or something....jesus.

Then your "not your patient" guy who is confused and in room 26...not your patient, but your very familiar with him as he is a frequent flyer...there every week with chest pain, anxiety. Last week he was there (too funny), he didn't want the foley cath even though he was on Lasix and bedrest....Oh did I mention he was a Mayor in a Local town...and has demential...and thinks everyone is his employee...and OH MY GOD...he must HAVE been a TYPE A personality...because EVERYTHING has to be done NOW....this second? Ok, back to last week and the foley problem...well.... he (thank god was not my patient that day) climbed over the bedrail and DISCONNECTED the foley FROM the collection bag and strolled down the very public hall way, penis swinging, piss aflying...happy as a lark...until somebody chased him down, reconnected him to his happy bag and called for "clean up on aisle 3"!!!!! Shortly thereafter he made Hospial History for begging to be allowed to go and pee in the hallway...."please disconnect this bag so I can go and pee in the hallway,,,,, please!"

Please....somebody stop the home, if he doesn't get his way...immediately...he has *chest pain* *abdominal pain* *nausea*...and his "heart palpations" which earns him the RIGHT to be taken the EMERGENCY room of his FAVORITE facility...where is is always admitted...always goes though a battery of tests which .....dat dat da! SHOW NOTHING EXCEPT HE has a normal heart rate, normal enzymes...and IS JUST experiencing demential...

Last night, the MD's in all their wisdom decided to d/c any and all anti-anxiety order to NOT mask the symptoms for the psych
MD when HE DECIDES TO VISIT.>>> remember this is Sunday and we won't see the smiling face of the pleasant pysch MD until at least Mr. Anxiety was on the button every 5 minutes and calling "GIRL COME HERE" ....."BOY COME HERE NOW" all night long. I was not his nurse...but he could see me....his pee must be emptied before it is allowed to cool, his commode must be scoured everytime he looks at it. clean his table, move his trash, open his door, close his door, light on, light off, blanket on, blanket off....come on....arn't you his personal servent...mercy of light????

His nurse sat at the other station...she left on time...following her shift...ME...I worked 1 1/2 after my shift charting on the work I managed to accomplish on my own assigned new admit, my NGT going to surgury w/ small bowel obstruction, my patient going for Greenfield filter (with consent, med reconciliation, and checklist all completed and prep done) ....

I'm tired. I hope the Mayor goes home before my next assigned shift...maybe I should have stayed a secretary after all. *sigh*

Sunday, April 8, 2007

Is that an Artery??

Well, this happened about two weeks ago...but I haven't forgotten it yet.

We had a repeat customer...a 90 year old female, readmitted for Sepcemia...high fever, UTI, ect. ect. ect. The family had made DNR decisions...but had her dragged to the ER because she was sick. She had just went back to the nursing facility...can we say for 1 day!!!! She had a handy dandy PICC line in her right upper arm....can we say infiltrated to the max...hard, hot, swollen...but somebody had infused IV antibiotics into it regardless.

We got an order for Anesthesia to come and check the line (Xray showed it was out of the vessell....gee...lack of blood, hard, swollen...that could have been a couple of cheaper alternatives to the Xray). The Dr. wanted another one in. The RN Anesthesic person had to go to an ER C-Sec, so we get the ACTUAL Anesthesia did the DNR pt rate that.

Doc is pissed, called out on a weekend, for a DNR patient to place a PICC line when she is SEPTIC already! Call me callused, but I still thought the Doc should have used Sterile Technique...and when she couldn't get the about a new needle?? No exageration. She stuck that poor woman over 20 times with the same contaminated needle, she finally got blood return. Spurt, Spurt, Spurt....NURSE, DO YOU THINK THAT IS AN ARTERY??? Yes, Highly Trained MD, I do Believe that is an Artery! NURSE, I THINK THIS IS A VEIN! Sorry Highly Trained MD, but I think Arteries Spurt and Pump Blood in time to the Heart Beat....PUMP, PUMP, SPURT, SPURT! NURSE....ARE YOU SURE THIS ISN'T A VEIN, the Highly Trained MD asks, as she drags the INNER cannula (blue) part of the STERILE PICC line set up over my UNSTERILE arm (she didn't set up a sterile field before she started. No ALMIGHTY HIGHLY TRAINED MD, that is obviously an ARTERY...and you just contaminated the sterile cannula....let me go and locate another sterile kit.

I had to leave the room, get a breath. I left the nurse aide in the room and Paged the Nursing Supervisor. I gave a brief...accurate description of the problem to the House Supv, who went to locate another kit....(she also was in the ER C-SEC.) When I get back the Nurse Aide states...I'm leaving...and walks out. Now I know I'm no rocket scientist...but if the Nurse Aide is I am stuck alone with pissed off Highly Trained MD. WHO FINALLY FINDS A VIEN WITH THE multi-used *sterile* needle and starts feeding the *sterile* cannula in.

STOP....THAT IS A CONTAMINATED CANNULA....STOP THAT IS CONTAMINATED. Her reply...I finally got a vein, why didn't you tell me before this is was did not tell me.

What part of me leaving to get a new kit did you not stupid BI***?? Well she wasn't leaving the vein...or getting a new kit, so she settled for *leaving the contaminated part out* and suturing it down and covering it up. "What difference does it make, she is septic, a DNR, and a drain on our medical doesn't matter."

All of which was reported management.

The doc still works here.

Now I know why she wasn't in the ER C-Sec.

If I'm every gonna be knocked out for surgury, guess who I don't want starting a line on me