Well, I applied for a new position within CCU and got it. At first glance, it sounded awesome, but there are a couple of reservations that I have. The absolute most bestest part is that it's 11am-7pm. This is an awesome shift; it's earlier than 3pm (but not too early) and I'll be home by 7:30-8:00 every night. It'll be really nice being home in the evenings; there are plenty of days every week that I don't see Dave all day. The sorta icky part is that it's full time, Monday-Friday. No weekends. I don't really mind working weekends, but it will be nice to plan things without having to worry about if I'm working or not.

I'm sure a lot of you are thinking, "Well, I work full time M-F! Nothin' wrong with that!" But I'm also sure a lot of you don't really deal with illness, family dynamics, death, tragedy, or doctors full-time, now do you? :-) I had been hoping for 11a-7p 4 days a week, every other weekend... like I have now with 3-11. But that is not to be, at least not for now. So I'll enjoy my evenings and weekends off. It's definitely worth it... 9pm-11:30pm is usually the worst time for me at work. I just want to get out of there soooo bad. The lights are down and things are usually calm (usually) and it gets boring.

So as far as the calendar is concerned, I did January, but won't fill out the rest of it. Things will be quite predictable from here on out for awhile. I hope I like it.

codeblog!

I've taken "Tales from the CCU" to whole new levels. Unfortunately, I wasn't able to transfer the comments over, so everyone who commented on those entries before, go back and post them again on codeblog.

I'm only half-kidding :-)

Take me to it, baby!

This happened at work quite awhile ago. We had a guy come in for abdominal pain. Very vague. He apparently needed CCU because his blood pressure was labile ... it was prone to change fairly drastically for no reason. A general surgeon was consulted to see him, and when she came in, she started pressing on his abdomen, like they all do.

I have to admit that I only know these details second-hand...

keep reading...

Tuesday was my first day being charge nurse on my very own. I was greeted with only 2 open beds, 2 patients to come from ER, and 4 patients that were so sick or busy that they needed a nurse all their own (these are called 1:1's; our usual ratio is 1 nurse to 2 patients. Typically we only have one 1:1 patient at a time, sometimes two). Not only that, but the 1:1's required special RN's... those that were specifically trained to take fresh open hearts, balloon pumps, continuous dialysis (CVVH), and take out femoral artery catheters. Not every RN is trained to do everything. For example, I do CVVH, but I don't do balloon pumps. Other RN's can do open hearts, but they don't do CVVH. It's actually really nice to have the choice... if I wanted to take open hearts and balloons, all I'd have to do is say the word and my boss would train me in a second. It just so happens that I'm not especially fond of cardiac patients, but I really like renal patients...so it is not required of me at this point to learn to do specialized cardiac stuff (although I did do fresh open hearts and balloons in Illinois, and I do take routine cardiac patients here).

Anyway, I was given the option of saying that the circumstances were beyond me and letting someone else be charge, but I opted to do it and take my lumps as they came. Right off the bat, cath lab called and said they had another patient for me and that they were coming over "now." Usually charge does not take a patient, but in this case I had to. So now it's my very first night in charge on my own with 14 patients (our usual census is 8-10), 2 coming, 4 1:1's, and now I have to admit one of my own on top of it all. At one point, it crossed my mind that I was simply too stupid/inexperienced to know if I was in over my head. :)

Yet I survived. And did a pretty good job, if I do say so myself. Luckily mine was a very easy patient, I had excellent support from other RN's who are routinely in charge, and 1 patient that was supposed to come was diverted to another floor.

Tonight was the same ... right at the beginning I had to take a patient, but I was blessed with plenty of staff at 7pm and was able to give her up and be available to give breaks to everyone else, help out, etc. There's a lot of info I've left out, but suffice it to say that we are extraordinarily busy and I am really glad and quite proud that I didn't try to back out of it. At one point, I found myself sitting there thinking, "Wow. Here I am, in this busy CCU with lots of sick patients, and it is up to *me* to keep this place running smoothly, solve problems, be a resource, make sure everyone gets to go eat dinner, make sure there is adequate staff with an appropriate skill mix, and I am doing a good job!! I honestly hadn't thought that I was capable.

Don't tell my boss, but I think I might actually like this charge thing. :-)

The first thing I've learned while being in charge is that the best laid plans can be shattered in a mere instant. You can have all your staffing numbers planned out and jivin', life is good, and then it can all go to hell the next time the phone rings (RN sick calls, calls from ER telling me they have a patient for us, ER calling back to tell us that aforementioned patient is REALLY sick, supervisor calling back to tell me that said patient is SO sick that they have decided to chuck all the heroic efforts, make him comfy and send him to the medical floor, O.R. calling at 7pm to tell me that the patient they have for us won't be back until midnight, then O.R. calling an hour later to tell me that the patient will be here in 20 minutes.) All of those scenarios involved me making a decision about the number of nurses I needed. When OR told me that the patient wouldn't be back until midnight, I sent a nurse home. When they called an hour later to tell me they were coming in 20 minutes, I had to rearrange the assignments, which is fun for, oh, NO ONE! It was all well and good yesterday because I was still being precepted, which means that I always had someone right next to me telling me whether I made a good decision or not.

I've also learned that you have to hold an unbelievable amount of information in your head. I'm good at that, though. My short term memory is excellent, and thank goodness.

I've learned that when your coworkers find out that you are training to be in charge, they will tease you mercilessly, right down to my stupid new shoes becoming my new "charge shoes." (Never mind that the old ones are in tatters.)

Lastly, I've learned that I may actually be capable of being competent at it. We'll see. In about a year :-)

Whoa. I got some really unexpected news tonight at work. My boss informed me that I am to start training to be charge nurse. She didn't ask if I wanted to, just told me. Then said that I was already on the schedule to start January 1st. I'll have 3 shifts precepting with that day's charge nurse. In some ways, it's cool... a bit more money, don't have to take patients. In others, not so cool... having to make sure staffing is adequate, crunching numbers, fixing problems. I'm most scared of being confronted with a problem that I can't deal with. Or doing the numbers wrong and leaving us short for the next shift. I'm most worried about coding patients on other floors.... Coding patients in CCU is stressful, but at least I know where everything is and who I'm working with. If a code is called on another floor, I have to run up there and hope that I can do a good job. Or at least hope that the ER doc has beat me up there, thereby freeing me from having to "run" it :-) I should mention that I wouldn't be in charge every time I go to work. I don't actually know how often I would be... once or twice a week?

So that should be interesting. Tonight, I was flex RN. I carried a beeper and all the floors paged me for various reasons... IV's to be started, NG's to be put in, accompanying monitored patients to be transferred, admit notes to be done, preparing patients for surgery, answering general questions. It's typically a neat thing to do, but it is a LOT of walking. Dave reminded me to put on my Sportbrain today, but I didn't feel like it... but now wish I had. I walked A LOT!! My legs are quite sore. Anyway, I got called to start an IV on a patient and was told that she pulled out her previous IV because she was "confused." Okay, I say and walk in, only to be told by said patient to get the hell out, go home and go to bed. Ha. Needless to say, despite my most manipulative charms, she was not in the least bit interested in having an IV started (and kept thinking I was saying that I wanted to start "an idea." "Where can you possibly put an idea into me?" she'd say.) The hapless RN taking care of her gave me an exasperated look when I told him that I couldn't start her IV, because confused or not, she was refusing. It's just a feeling you get from people, and I guess circumstance plays into it as well. Sometimes confused patients tell you they don't want you to do this or that, but you HAVE to... even to the point of having other RN's physically restrain them. But she was lucid enough that I thought doing that would be a bit excessive. She was VERY adamant. About an hour later, I get a call to start an IV on that floor again, only to be told that it was the same patient! I patiently reminded them that I'd already been down that road and wasn't planning on going back... she said no, she didn't want it, it's her choice, end of story. No, they say ... now her husband's in there and says she'll cooperate. So I go back in and she's indeed all smiles and after explaining what I was about to do, she looked to her husband, who confirmed that I was not in fact some wacko off the street looking to find a pincushion. As soon as I started to take her arm to put the tourniquet on, she pulled away abruptly and firmly informed me that she was not actually going to have anything to do with this IV starting stuff. Go ahead and start one, missy, but not on me. I inwardly groaned again, but her husband said something or other to her, and she calmed right down and let me do my thing. Pretty soon, she was being as cooperative as could be and I started the IV with no problem. When I was done, she held out her other arm and asked if I needed that one too. When I said no, she looked at her husband and asked if he was going to hurry up and pay me before I left. He said that it was already taken care of, but she kept insisting that he stop wasting my time and reimburse me. It was at that point that I ducked out gracefully (okay, my pager went off at the utmost perfect time).

That's probably enough for now. Good night :-)

It's been awhile :-) I hope to post more later, but I thought I'd take a few minutes to put up a couple of pictures that we took in CCU last week.

The first is of Mei and I. The second is of my boss's daughter giving a massage to Donna. She comes every once n awhile to do this for us. You can kind of see where I work in the background :-)

g

First of all, I would like to remind everyone that I am currently kicking Dave's butt in our Sportbrain contest. Today he only had 5,678 steps, and I had 8,100 steps. This oddly worked out to be 3 miles for each of us, though.

Now back to our regularly scheduled programming :-) Tonight I took care of a woman who has had the crappiest medical life ever. She is a nurse as well, but has been through cancer, bilateral amputations of the legs, multiple infections in one "stump" that caused her to have a blood infection ("sepsis") and become hemodynamically unstable (Blood pressure 60!), thus requiring the fine services of the CCU. By the time I got there for my shift, she was muchly improved and I had a lovely time with her. She was actually quite cheerful, smiled a lot, and had a great sense of humor. Quite inspiring. Anyway, she's on fairly heavy doses of pain medication (you would be too, if you had people sticking 1.5 feet of guaze up a hole in your thigh every day). Her last scheduled dose for me was at 11pm. At 10:30, I went in to give it to her. She was fast asleep. I said her name, but she didn't wake up. So I tiptoed out and tried again at 10:45. Still no response. So I had to, like, majorly wake her up by shaking her. Yes, I, Gina RN, woke up a perfectly peacefully sleeping patient to give her pain medicine. (At least it wasn't a sleeping pill!) Now I'd like to defend myself by saying that I *had* to wake her up... otherwise her scheduled pain medicine would have been late, her blood levels of it would have dropped, and we might have had a really hard time getting control of it again.

So, in addition to not playing with equipment that is attached directly to your heart, next time you are a patient and your nurse wakes you up to give you pain medicine, be extra happy that she cares enough to make sure that you will be pain-free when you next wake up! :-) And, by the way ... she did thank me for waking her :-)

my right from my left. See, I don't think I really internalized the exact meaning of "left" and "right" until college. By then, I was learning how to be a nurse. When nurses assess and chart on patients, they are facing the patient across from them. So when I'm checking out an IV site on the patient's right arm, my perspective of their right arm is that it's on my left. But later, when I write it down, I have to remember it as being their right arm. Since I spend MUCH more time paying attention to the left/right thing at work, my mind almost immediately thinks "right" when I'm looking at something that's on my "left." It's a really difficult life. :-)

Recently, I helped take care of a man in CCU. One day as we were helping him to the chair, I noticed what looked to be an Apple computer power source thingy laying on his bed amongst all the other assorted wires. It looked very much like the little recharger apparatus that my iPod came with. He had asked a few days earlier if it would be okay for his wife to bring in his computer to listen to music with. So I said, "Oooo! You brought your iPod!" To which he gave me a rather odd look... so I said "You know ... to listen to your music?" to which he stated, "An iPod? No way...that's just my computer. iPod's are way too expensive for SOME of us to afford." Which then made me feel really stupid. At around $300-$500, iPods are indeed pricey, but entirely worth it and I use mine on a daily basis. So that conversation was thus dropped, ending with a quite awkward silence, until someone helped break it by saying to me, "Hey, take his catheter bag." Ha!

A day or so later, I happened to simply walk past this man's room. I noticed that his laptop Apple computer was on his bedside table (I hadn't actually seen it in the previous conversation, just the power source). Upon closer inspection, I noted that the Apple computer sitting on his bedside table was none other than an Apple *Powerbook.*

Which retails for anywhere from $2,000-$3,000.

Work was fairly ho-hum tonight. I had a zillion year old woman that I had to put an ng tube down for tube feeding, and a 50ish year old that had a reaction to a tetanus vaccine a few years back and is now a quad. Anyway, she's ours because she got an overwhelming infection in the nursing home. Fortunately over the course of the last week we were able to save her life using a ton of medications. Yay us. Now she can go back to her fulfulling life of being a bed ornament. Bleah.

On a slightly funnier note, we have a 50ish man who recently had cardiac bypass surgery. Sometimes during surgery, the surgeon deems it necessary to put in pacer wires ... these are wires that are kinda embedded in the heart and come out the chest. If needed, we RN's hook those wires up to a temporary pacemaker after surgery. The pacemaker is a little smaller than a VHS tape, but about that size. Anyway, this guy has been hooked up to one of these since surgery. He's an engineer. One night, a fellow RN went into his room and found him holding the pacemaker fiddling with it, and when he saw my coworker said, "Ya know, I can't for the life of me figure out how this thing works!" We nurses find this sort of thing quite humorous :-) (Tiz okay ... you have to push many buttons simultaneously to get it to work so you can change the programming on it.) Lesson ... if you are in the hospital hooked up to boxes and things, please try not to play with them :-)