Things have been horribly busy in our unit. Normally around this time of year we see a drop off in census as everyone anticipates the holiday, but this year we have been running nearly full with a really high acuity. We have some seriously sick people. This combined with the holidays being around the corner has made all the nurses a little high strung and grumpy lately, myself included. Thus, I was not overly happy when I was assigned a patient who was a total care and she was huge. She took up nearly the entire hospital bed and was in such a bad way that she couldn't even move herself, it took 3 nurses to turn her and change her sheets. After another nurse and I settled her in at the beginning of my shift, my back was already starting to ache and I could feel a foul mood set in. I looked up and I saw I gentleman quietly slip into my room. As per protocol I got out of my seat and introduced myself as the the night nurse. The gentleman smiled at me and shook my hand with a warmth that I am totally unused to seeing on a family members face under such circumstances. He asked me if I was the one who has made his wife look so pretty in bed, and then thanked me for doing such a wonderful job. I was stunned and my heart melted a little that night, I offered him a cup of coffee and stayed to chat with him. I found out that night that they had been married for nearly half a century, that they had one child, a son. He came by later and was just as sweet of a soul as his father. I also learned that they were preparing to withdraw care on their loved one, Hospice would take over in a couple of days, they were just waiting for the rest of the family to arrive so they could all be together. My heart went out to this father and son, to make such a tough decision any time is hard but to have to make it so close to Christmas was heartbreaking. The unit heard and for the next two night the entire unit kept an eye on the family. Some one would always make sure a coffee cup was full, we brought food up for the family from the hospitals annual holiday dinner to share with them, any holiday baking was offered up for sampling. The father and son were always gracious, insisting they wanted to be no trouble and thanking us profusely for anything. Every night they left, they would thank us for watching over their loved one and every morning they came in they would tell us how lovely she looked and thank us for all our hard work. My last night I came in and asked the outgoing nurse how my lady was doing and he showed my a heart monitor strip. Flat line. Hospice had come in earlier that afternoon and they let her go, easily, without pain or suffering. The Hospice nurse came out and spoke quietly with me, he let me know that all that was left was to wait for the mortuary. He said the family would like to dress her before she left and if I would be willing to help, to which I told him it would be fine, we'd make it happen. I sent both the Hospice nurse and the day nurse home, a couple of the other nurses had caught wind of what was going on and volunteered to help. Her husband wanted to help, and I had no heart to tell him no. He helped us bath her and then brought out the clothes he had brought, a beautiful scarlet dress with silver embroidery, he shoes and her favorite wig. We dressed her and he helped all the while talking to her, teasing her for being no help and reminiscing about all the places they had gone with her wearing this outfit. I brushed out the hair piece and settled it on her head, asking for his style advice we settled on the curls just under her chin, just the way he remembered. At the end he shyly took two lipstick tubes from his pocket and asked me which I thought would go better with her outfit, we settled on a bright red and I applied it to her lips. When we were all done he stopped and looked at her, then grabbed me in a huge bear hug. I could feel tears on his face for the first time, he whispered in my ear "Thank you, now she looks like herself again and I can say goodbye to her." I'm not sure how I didn't start crying. The family stayed with her waiting for the mortuary to come, they laughed and told stories about her, they held hands and cried together. When they left, they hugged us all, the son told us that he knew what we did was hard and that we should never forget the good that we do, even when it feels like no one else notices. The husband gave me a hug and thanked me for everything I did. I hugged him back and thanked him, when he looked puzzled, I told him that to be asked to be part of the beauty that I had seen today and to be made part of his family for even a few hours was an honor. He smiled, gave me another hug and told me he wouldn't forget what we did for him and that he would come back and visit us, under better circumstances.
I have no doubt that he will, and I look forward to that day,
It's been a crazy busy week with very sick patients in our unit on top of being short staffed. I worked four nights this week and in all the rush and stress I nearly over looked one very important day, December 5th. Yep, one year ago now I stepped into my scrubs and became a "real nurse". It was one heck of a ride, full of ups and downs but I have never regretted my decision to join my unit's team and I have not looked back once since. There is still much to do, like go back for my BSN, write my CCRN exam and get the courage to float to a CVICU one day. I have a ton more to learn, and as I sit here in my jammies looking back on my journey this far I am amazed at how far I have come. All this reflection is going to last for only a short while, there is so much to do, so much further to go and so many more things to learn that I can't wait to get moving again. I'll try to share some of the many things that have come to me over this year now that I have had to think, with you my dear friends. Thank you all for sharing this journey with me and for continuing down the road.
I hope everyone will forgive the lack of posts in the last few weeks, but it is that time of the year again! The unit is getting admits and most of them are train wrecks.
Normally a typical assignment in our units for a single nurse consists of one vent and one "walkie talkie" this way the nurse only has one total care patient. A stable vent requires q2hr turns, a full bed bath etc, so they take up a little more time so you don't hit a nurse with two vented patients unless they ask for it,
This past week there was not a single patient in the unit that was not on a ventilator, meaning every nurse had a double vent load and some of us ended up with seriously unstable vents that had us hopping all night. Top it off with a code, a couple of emergency bed side procedures and it made for a very busy week.
On weeks like this you will find that it is the team you work with that makes or breaks the shift. Lucky for me we had a great team and even though it was a rough three in a row we found time to laugh and although we were beat up and tired at the end of the night we walked out smiling. These are the sorts of nights where I am so thankful for finding the job that I did (or it finding me) and where I really, really love my job.
This link is aimed at helping our readers get to know us a little better,
so here goes.
My given name isn't Kitty,
it's a nick name that my husband gave me years ago when we first started dating.
He said I act like a cat,
I love napping in a good sunbeam,
watching birds at the many feeders around my yard
and cuddling up close to on a cold night.
I am a brand spanking new nurse who took her first job in a small community hospitals ICU. I float from time to time to the ER when the unit is slow and enjoy experiencing the different kind of insanity that is ER nursing.
I love my job in the ICU, when I started my job a number of people told me I should have held out for a job in one of the big, glamorous teaching hospitals in town, but I am glad I stuck with my little community hospital. I work in a unit of only 16 beds in a close knit group of nurses. I have never felt like I was alone when stuff hit the fan, I know I can always rely on my co-workers, we're like a family and we never leave one of our own out to dry. There are a lot of stories out there of nurses eating their young, but never once have I felt that way since I arrived to my unit. Every night I walk down the hall to work I am so thankful that I work with such a great team.
My husband and I have been together for 13 years now,
and it's felt like we've known each other forever
at the same time it never feels like that much time has gone by.
I could not imagine a life without him, he was my rock during nursing school.
He patiently let me practice my assessments and vital signs on him, but he drew the line at IV's which was such a pity, he has the most amazing veins ever!
He continues to support me through this last year,
letting me vent every morning when he picks me up from work
and celebrating my little victories with me.
I couldn't have a better partner,
together we can do anything!
I love to work the night shift, I am NOT a morning person, I hated getting up at 5am for clinicals. It's not for everyone but it certainly works for me!
I'm coming up on my one year anniversary in nursing,
I can't wait to see what the future has in store!
Thanks for following along with me
I look forward to sharing more experiences with you!
When Medical Scrubs Collection contacted me asking if I would review a set of scrubs for them I jumped at the chance! I had been contemplating buying some new scrubs since the ones that I bought when I was hired seem to be getting a little dingy looking. I went to their online store and was blown away with the selection of scrubs that I had to chose from! They carry a ton of brands and many different cuts, colors and styles. The first set of scrubs that I chose actually didn't fit, but no worries they were wonderful about exchanging them and getting another set out to me pronto.
I chose to try a set of scrubs from Urbane, a brand I have never tried before.
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Thank you for choosing our hospital for your medical emergency, we are glad that you think so highly of us that you would bring your family member here. I feel the need at this time to point out to you that while we are indeed a hospital and have an Emergency Dept, we specialize only in treating the human members of your family. While we do understand that canines are a very important part of any family, regret to inform you that we are unable to treat the four legged member of your family at this time.
While our doctors are indeed very skilled at treating humans, I am afraid they are rather under trained in the treatment of canines, and would further suggest that you would really not want one of them to attend to your four legged family member since I am very sure that they would have no idea of what they were doing and could potentially cause greater harm to Fido.
I would further suggest that standing at the Triage window and arguing with the nurse there will only cause further delay in the treatment of your beloved canine and that you should, without any further delay, should take him to the nearest 24 hour animal clinic if he is indeed having a medical emergency. The nearest emergency clinic is two blocks north of our location.
Please be assured that we do understand that veterinarian bills are very expensive and that it is a great hardship for you to cover the cost of treatment for Fido,however I regret to inform you that Medicare would not accept charges for Fido's care even if we agreed to treat him. Yes I do understand that he IS a family member to you, but the Federal Government does not at this time cover any animals medical treatment, please feel free to raise this issue with your local government officials.
Once again thank you for choosing Local Hospital for your healthcare needs.
Things have been busy around here, last week I picked up an extra shift at the last minute. On top of that the weather has been getting cooler so I have had more of an urge to cook now that turning on the oven does not mean turning my kitchen into an inferno. I have had a ton of leftover turkey in the fridge, we roasted a 14 pound bird on Columbus Day in celebration of Canadian Thanksgiving and spending the last 13 years with the same great guy. I already made soup and even fed the entire unit, so I was looking for some thing more involved. I decided on turkey pot pie, but with only two of us eating it would be a huge waste to make a giant one and all the recipes that I looked at made pies that would feed a small army.
Then it hit me, if we make mini fruit pies of all kinds,
why not mini turkey pot pies?
It worked under the same principle, right?
The only catch in this plan is that I truly suck at making pie pastry, and I mean I really suck at it. For some reason my pie pastry always comes out tough, hard and tasting like salt dough, I bought some pre-made pie dough from the store but that seemed so wrong. So I sat down to do some research and found this recipe, All Butter Really Flaky Pie Dough from one of my favorite food blogs The Smitten Kitchen. The recipe comes with step by step picture instructions on how to get the perfect all butter pie crust, so I whipped up a batch and made a couple test pies that turned out perfect! The pastry is light, flaky and oh so buttery which compliments the rich creamy gravy of the pot pies. This recipe makes about 8 pot pies with some filling left over for another round, however there were no pot pies left at the end of the night, just one adoring husband.
1 pie crust (All Butter Really Flaky Pie Dough from Smitten Kitchen) 1/4 stick butter 1/4 cup diced onion 1/4 cup diced carrot 1/4 cup diced celery 1/4 cup chopped mushrooms 1 cup leftover turkey, light and dark, diced or shredded (or both!) 3 tablespoons flour 1 cup leftover gravy thinned with some hot water (you can use chicken broth instead) splash of white wine (optional) splash of heavy cream Frozen peas Fresh thyme, chopped (dry thyme is fine too) Fresh Italian Parsley, chopped Garlic Powder Salt and Pepper to taste Make All Butter Really Flaky Pie Dough from Smitten Kitchen wrap the dough and put in the fridge to chill while you make the filling. Preheat oven to 400 degrees. Melt butter in a skillet add onion, carrots, and celery, and cook until translucent.Add turkey and stir. Sprinkle flour over mixture and stir. Cook over medium heat for a couple of minutes, stirring constantly. Pour in thinned gravy, stirring constantly. Splash in wine (you can leave this out if you’d like but it tastes SO good.) Pour in cream and add frozen peas.Bring to a simmer and allow mixture to cook and thicken for a few minutes. Add salt, pepper and garlic powder to taste. Toss in parsley and fresh or dried thyme to taste. Do one final taste at the end and add what you like to make it taste right. Be sure not to under season. Butter the inside of 6 muffins tins Roll out crust so that it’s about 1/8 inch thick and cut into 3 1/2 inch rounds.Scoop a heaping table spoon into the center of one round, place a second round on top and pinch the edges closed all the way around.
All ready for the oven!
Place mini pie into buttered muffin tin. Cut vents in the top of the crust.Bake for 15 - 20 minutes or until the pastry is very golden and the filling is bubbly.
The vents are REALLY important.
Allow to cool for a little bit before serving,
that filling will be volcanic!
Serve with a big salad and pour out the rest of that bottle of wine you opened making the sauce.
Worked the other night in the ER, it was a typical night of babies with runny noses, tummy aches and bug bites. So I wasn't overly surprised to hear from one of our visitors that they were bitten by a spider, nor was I surprised that they had captured the spider and brought it in a bottle for us to see so we could determine whether it was the poisonous kind. Turns out that it was a wolf spider, a pretty harmless spider that would leave you with a bite that would hurt but with no danger to the patient. PA No-Bullshit was on and he had them in and out in less than an hour much to our delight. A few minutes after they left I hear a shriek from the room and go running, I see the housekeeper pointing in horror to a water bottle that had been tossed on the floor and had rolled under the bed. The bottle containing the, still live, spider. Now seriously, first off who the heck just leaves their junk lying around for someone else to clean up? And secondly who the heck just leaves a live spider in a bottle on the floor for someone else to clean up?
I wonder about people like that...and what their homes must look like.
A couple of days ago a reader asked me for some tips on IV insertion, unfortunately I was in the middle of a three day stretch and I wasn't able to get a post up in time. It got me thinking though and I began going over all the things that I have learned in the last few months that have made putting in an IV much easier for me.
So here is what I could think of, I hope it helps.
Feel, don't look.
I know every instructor has said this and it makes about zero sense, but trust me, this is one time in nursing that your eyes can lie to you. It makes sense that every new nurse (and even some seasoned ones) will go for an easily visible vein, but often these veins are very close to the surface and will blow easily, deeper veins are often stronger, less fragile veins.
Palpate veins with your fingers tips and feel around for a springy feeling vein. It will feel vaguely like pressing down on an under inflated balloon, it will "bounce" a little under your fingers. Avoid "mushy" or soft feeling veins, these can be more delicate and blow easier. Select the largest vein you can find, they are way harder to miss, you can use a nice large catheter and they are less likely to "go bad". No point in putting in an IV that only lasts a few hours.
Once you have a found a nice big, bouncy vein follow it up about an inch or two and make sure it feels pretty much the same all the way up. A hardened area can indicate a valve or sclerotic area that will not allow the catheter to advance. If you find one of these area's be patient and follow the vein further up or down until you find a nice stretch of clean vein.
Now that you found that vein, anchor that sucker! You went through all the time to find it now make sure it doesn't run away when you try to poke it. I hear a lot of people say that a patient has veins that roll, all veins do roll to a certain extent so hold em down!
Everyone does it a little differently
For really roll-y veins try stabilizing
between two fingers.
Spread your fingers wide and hold the skin
Anchor the base of the vein close to your puncture site.
Apply pressure and pull your thumb towards yourself
pulling the skin taut
The key to anchoring a vein is to apply pressure, so don't be shy about pushing down on your patient and to pull their skin nice and tight. Apologize and let them know the discomfort will only be for a few seconds, it's a way better option than having to poke them a second time.
Don't go deep!
It's tempting to puncture the vein at a 30 to 45 degree angle, especially if you have drawn blood a lot, then drop your angle and attempt to advance the catheter, don't do it! Going in on a steeper angle than 15 or 20 degrees increases your chance of going straight through the vein, and I find that when I drop my angle after a flash I flub the insertion almost 50% of the time.
An IV nurse I work with gave me these tips, go in at an angle that is only slightly steeper than parallel with the vein and then check for your flash. If you don't have one advance slightly at a slightly steeper angle. As she put it veins aren't that deep and your aren't drilling for oil.
Don't be shy
OK so you got a great flash, but as you advanced the catheter you lose it. Sound familiar? It happened to me over an over again until my friend the IV Nurse commented that I am "bashful" in threading the catheter.
What she meant is that when I was advancing the catheter I would do so slowly because I was worried about losing my IV. Problem was that my caution was what was causing me to lose my IV sticks. She reminded me that advancing a catheter quickly would not cause any damage.
What I learned to do it insert the IV and check for a flash,
then wait and see how well the flash chamber is filling.
When I see that the chamber is nearly full,
I am sure the IV is in the vein.
Now in one smooth quick motion I advance the catheter.
I know it sounds way too simple but honestly it has worked like a charm every time. Oh yes and don't worry, if there is a valve or sclerotic area that you did not find prior to inserting the catheter won't advance, promise.
If you don't get it the first, second or even third time
Don't beat yourself up about it,
stop and think about what you learned from the experience.