So after working 6 in a row I slept a coma on Monday only to be woken up by my phone ringing. I was so groggy that I let it go to message and fell back asleep. When I finally came to this is what I found on my phones voice mail...
"Hey, I know that you've worked like a million shifts BUT I really need a nurse for the ED tonight. If you could come in that would be great. Give me a call if you can!"
I politely deleted the message and pretended that I never heard it or saw it, and I didn't even feel bad. I went out to dinner with the hubby, came home and promptly fell into a coma again.
Yesterday I was nursing a cold I seemed to have picked up. If I ever chose to work like a maniac again I will make a note to load up on the Vitamin C. My phone rang with caller ID showing the staffing number, again. I let that one go to voice mail too, once again the staffing office admitting that they know I've worked a ton but could I please consider coming in as they are short an ED nurse again tonight?
At that point I turned off the ringer and pointedly ignored my phone, if the staffing office couldn't be responsible, I would. I know my limits.
Sorry for the layoff folks but that whole "Real Nurse" thing got in the way of...well everything this week. This week I worked SIX shifts straight, because I can't say no when the staffing office calls looking for someone to come in extra. Don't get me wrong here, I'm happy I made a load of overtime this week, but I am exhausted, which leads me kinda to the point here. When does overtime just become overworked?
Let's be honest, being fresh out of school I still have very vivid memories of what it is like to not know how you are going to make ends meet. So kinda like a stray cat that eats whatever you put in front of it, I will take any chance to pad my bank account. Whether it means floating to any floor in the hospital to avoid being called off due to low census, working holidays without a complaint, or picking up pretty much any overtime shift that is offered to me, regardless of how insane it is. I'm sure plenty of new nurses reading this know exactly what I mean and plenty of you nursing student who are set to hit the workplace soon are planning to do this too, the money is good and it's there for the taking if you are willing to do it, but should you?
There are always pros and cons to everything you do, and now that I have done what I really thought was impossible I can sit back and go over in my head how smart or stupid this little exercise of my endurance and love of a fat paycheck really is.
Having done it once now I'm not sure I'll do it again and I am not sure how much I recommend it to any nurse. To be quite honest my whole body hurts and I think I have totally undone the work the massage therapist did on my back last Saturday. My sleep schedule is now seriously messed up having gotten used to sleeping in the AM and being awake in the PM , that it's going to be tough to revert back to being a "normal" person on my days off.
More concerning is the how my ability to handle stress went slowly down hill the further into the week I got. No matter how you slice it, working 12 hours a day is rough. Now when you are into your 48th hour in 4 days you may find that it has some toll on your emotional endurance. Yes, I was a little crabsy this week, and was that really fair to my patients? I'm not sure, I guess one could argue that with the way things were going, having a nurse was better than the outlook had been at the beginning of the night. At the same time I may have been a better nurse if I hadn't been on day 5 of 6. Also, my concentration was not great by day 5, when I began to notice I got super cautious with everything I did, double and triple checking meds to be certain that I wasn't making an error. Sure I get a gold start for being careful, but it really slowed down my productivity and was a little nerve wracking at times.
On the flip side, there ARE upsides to picking up some overtime besides the big paycheck.I have made friends for life with he staffing folks for saving their butts and my co-workers all think I wear a halo for giving up a couple days off to help them out. My boss, our director, thanked me for being such a great team player and probably has a touch more respect for me now. For a new nurse it's really important for me to establish to the higher ups that I am a team player, I have a connection to my unit and show them that I am willing to work, I think I established all these goals this week.
So, was it worth losing a week of my life? Yes. Would I recommend you do it? I can't speak to that in a yes or no way. Instead this is what I suggest, nursing is about total honesty. Be totally honest with yourself. Take some self inventory and ask yourself if you REALLY can handle that extra shift. Don't think about it in dollar terms, just be honest about your limits and if you have even an inkling of a doubt in your mind don't do it. If you are worried about feeling guilty or caving to pressure, don't answer your phone and talk to your staffing person, let them leave a message, they always do. Then take a moment to take a personal inventory and decide for yourself if you can handle it, only you can figure that one out. Remember, another opportunity will always pop up down the road to pick up a shift, just because you don't feel like you handle one in the here and now doesn't mean you won't be able later, another day, another time.
In the end I am glad I did it. I learned that I can handle way more than I thought I could, but I also learned a few things about my own personal limitations. I also learned that limitations are not a bad thing, or even written in stone, but just like road signs, they are something that you really need to pay attention to.
As a student I always giggled when a nurse exclaimed "Oh crap I've lost my brain again". It always sounded so strange, calling that ratty, dog eared scrap of paper your brain. I never fully appreciated how such a small piece of paper could assist a nurse with keeping all pertinent information straight.
That was until now. Now I totally understand how devastating losing my "brains" is. I have also learned that no nurses keeps hers exactly like another nurse. From organization to pertinent information, every nurse has their own unique way scribbling it down to fit on one sheet of paper, making it very apt that we call these papers "brains". Not to mention every department requires a slightly different brain sheet, you'll notice a Tele nurses brain looks nothing like an ICU nurses brain.
When I was first getting started it was one of the things that required a lot of trial and error for me to get "just right". In the development process I looked at how the other nurses around me scribbled down their information, paying close attention to how they organized it and what info they kept and what they did not. Now I have a system that works for me pretty well, and I figured I'd share.
So let's start with a brains for Telemetry.
Obviously this is a HIPPA-ized version of my report sheet, but it IS a real one from my last trip to Telemetry.
It was made on a single sheet of paper that was folded in four so that it can be folded and fit easily into my pocket for quick reference.
My belief behind my brain is that is should contain only relevant information but at the same time I should be able to know everything about the patient in just a glance to my brains. So let's go over a few of my organizational tricks really fast before I go in depth into my brain.
The first thing I do is color code my brains, notice the red and black pen. Basically the black pen is your basic information, major systems information, vascular access, labs etc. The red pen is important information that you want your eyes to fall on like drug allergies, medical history and diagnosis, and things to do like blood glucose checks and meds to give.
Second thing to do is decide what information is relevant to me and my treatment of the patient. On a Telemetry ward it's handy to know what telemonitor the patient is assigned. Generally I take down information by exception, meaning I only write down what is abnormal with my patients rather than everything that is going on. I always right down what lines the patient has, where they are and what is running through them this way I know who is going to have IV's to hang. Also if the patient has any procedures going on like dialysis it's important to note what days they generally have it done on in case the Doc wants to know.
Third thing I do is review what is on the To Do List for the the shift and jot it down (in red) so I know what has to be done with each patient. More importantly this gives you a picture of what your night is going to look like as a whole and gives you the ability to prioritize. By doing this I can now look at all the meds that I have to give on this shift and know that Patient #4 doesn't have any meds due until 2300 so I can leave them to last for med admin and get to the other folks who have earlier meds due.
To help sum up everything I've said
here is what my brains for just one patient looks like.
I hope this helps and makes it easier for you to summarize the whack loads of information that we get as nurses down into a small concise picture of what is going on with your patient.
If you are looking for some more templates for brains
Trying to eat better means more veggies in the diet, and we all know that boiling them to hell isn't really what the doctor ordered. Since I've been doing the majority of the cooking now I have been trying to come up with more interesting ways to prepare veggies so my poor hubby doesn't feel like he is on some crazy chick diet.
We both love cauliflower, but up until now there has been two ways to eat it, steamed or raw with dip, neither of these ways is really great for you. Then I stumbled across a recipe for Roasted Cauliflower which is done in the oven, but with the temperature hitting about 110 degrees I was not about to turn that darned thing on. Then it hit me, I have a barbecue and guys love barbecued food right? Why not try this on the grill?
It turned out I was right, you can get a guy to eat anything that was cooked over an open flame with no complaints, in fact this has become a much requested way of prepping cauliflower now. I throw this on the grill when doing up the meat and don't have to worry about dirtying another pot to make a healthy side and the house stays cool.
For a change of pace I often sprinkle Parmesan cheese over top during the last 30 seconds of cooking so that it melts on top for a nice salty crunch.
I have tested this dish on cauliflower haters and they asked for the recipe, so if you have picky kids this might be a good one to try. The cauliflower gets a nice smokey flavor with a touch of tang from the vinegar or lemon, and you can save time and dishes by throwing this on the grill at the same time the meat is cooking.
Last night I got called off for the first time in forever, no I'm am not going to start complaining about that. What I am going to complain about it a comment made by a co worker the night before. She was irritated and asked me how it was that I never seem to miss a day of work when she has been cancelled two night in a row due to low census. I told her I float to any department that needs the help, and the ED is never slow in our hospital so they are always happy to have another nurse to help out. Oh no, she told me, she won't float there ever.
So please allow me this moment to throw a quick rant.......
This is the nature of the beast, you are at the mercy of the census. This is our slow time, all across the city nurses are finding themselves called off for low census and we all know it. So you have two choices, suck it up and float to where the need is (aka ED) or stop whining! I am not going to apologize for taking the bullet and floating ever where across the hospital so that I can make my hours. And if you think about it, because I float it means someone gets to work in the ICU because I'm not there. To all the whiners who are complaining about having to float, please stop it. You should be happy that your staffing office is trying to find a way to have you work instead of not caring and just calling you off. So do us all a favor and please stow it and be grateful for the fact that you are working. If you have no desire to float please tell the house supervisor and I am sure he or she will be able to arrange to have someone who wants to work come in and have you called off for the night.
The Dress Code, everyone has one, most people hate it. That little bit P&P that tells you how you must look when showing up to work, even when some days just showing up deserves a medal.
You would think that as nurses we are used to this idea of someone dictating what we wear right down to our socks, I mean we all went through nursing school and I DID have an instructor tell me to wear white socks instead of the colorful ones I was wearing. Sheesh! Talk about Nurse Ratchet! Anyhow, it has always been a constant source of amusement to me that nurses have been bucking the Dress Code. Yes several years ago we could wear whatever scrubs we wanted and were able to walk into the unit looking like Rainbow Brite if we wanted to, but as I have said before, the Good Ole Days are over and the days of Customer Satisfaction Scores are here, for now.
Seriously though, in some ways this ain't so bad. I mean really, I wouldn't be able to take a nurse wearing Dora scrubs seriously if she was treating me in the ICU. I'd be like:
"Hey did you get lost on your way to the peds floor?".
Don't knock it folks, I have seen it. Let's be honest, your outer appearance has a lot to do with how people see you. Yes, we should never judge a book by its cover but in reality people make decisions about you based on what they see. I mean would you take financial advice from a guy wearing torn jeans and an AC/DC shirt? Probably not.
That being said I do understand how uniforms can cramp your style, I'm relatively lucky in that my employer simply asks all nurses to wear navy blue. That's it, individual style is up to you, no company logos embroidered, no material preferences and you can wear whatever you want to on your feet. Awesome! Navy blue is a sight better than white if you ask me, and yes two hospitals in my town require the nurses to wear white, eeks! I personally love my uniform and am happy that I don't have to think about what I put on when getting up to go to work. But if you have the uniform blues, here are a few of my tips on how to make peace and maybe love it.
Love the clothes you are in. Meaning there are a ton of scrubs out there. If your employer only dictates color than go wild and shop around. Find scrubs in a cut that you find flattering and in a material that feels good!
Cheapest isn't always best, remember you are going to be wearing these for 12 hours straight! Most people don't wear one outfit for that long. Find something you look good in and feel good in, it makes it way easier to get up and go to work when you do.
Work around it. Dress codes specify what you can and can't do, so get to know yours and work with and around it. My dress code doesn't allow us to wear nail polish or fake nails to work, but I love getting my nails done, and I still do. Now I get a full pedicure and a shape and buff on my fingers with a parafin dip, this way my fingers look great, it actually helps keep breakage and hangnails down to a minimum but I don't get nailed at work. Ok that was a horrible pun, couldn't help it. Other gals I work with wear crazy socks, one gal has a pair of socks for every holiday and wacky colorful ones for days in between. It's her little way of rebelling, and it makes us all laugh.
Accessorize! Have fun! Get a badge holder you love, a cute stethoscope tag, or sweet pair of earrings. It's your way of expressing yourself, go to it, just remember a couple of safety tips.
Don't go hoops, not even the little ones, they catch things way to easily and you don't want to make a trip to your own ER. Trust me I've seen it happen with a pair of tiny gold hoops and a pediatric patient, it was ugly. Also, nothing that doesn't have a break away feature, I saw a nurse nearly get strangled with her own lanyard when she was running to a code and got caught on a piece of equipment. Pretty scary stuff.
Have fun with your hair. It's easy to fall into the one hairstyle rut, but there are a ton of cute hairstyles that keep your hair up and out of your face. You'd be surprised how much a difference changing up your routine will make.
Here's one of my favorites that takes about 5 minutes and looks awesome.
The Simple Gibson Tuck
For instructions on how to get this cute look head over to saralynnpaige.com she has a full video tutorial on how to get this up do and a bunch of other really sweet hairstyles.
In the end, I guess everyone has their own version of a uniform, as nurses ours are just a little more defined, but it doesn't mean we can't have fun with it and learn to love it. We worked our butt's off to earn this recognition, lets wear our scrubs proudly no matter what color they are!
Due to low census, I worked all three shifts this week in the ED. I think there is a conspiracy brewing to convince me to transfer over, as everyone has been super nice to me and asking me if I like working there better than in the ICU. Every time someone asks me this question I am totally honest, they may share a lot of commonalities but they are two very different worlds and I enjoy both.
For example, my last night on the red line (direct line to ambulance) buzzed and alerted us to a code coming our way. Teenage male found down in home in asystole and was headed our way in a hurry, ETA was about 10 minutes. I tagged along to see how the ED handles a code figuring that since it was looking like I might be spending a lot of time here I would get a feel for how things are done here.
They opened the ambo room, it has big double doors that opens right up to the ambulance driveway so they can wheel the patient straight in. The code cart was wheeled in, IV start cart was brought in, and IV poles positioned. The staff began to divvy up tasks, two nurses assigned to starting large gauge IV, one nurse to record, two RT's to assist with intubation, three staff were assigned compressions, one nurse was handling the code cart and meds and me, the runner. The Doc began giving the RT's orders on what to set up for intubation. Then we waited with the bay doors open wide, several minutes ticked by and then we heard it, the wail of the ambulance sirens. The ambulance pulled up and the lead EMT immediately gave report to the Doc.
What followed next was 10 minutes of what looked nothing like an ICU code to me. If you watch medical dramas like ER and see those crazy, wild frantic codes with everyone yelling and it looks like chaos, well that is what an ICU code looks like. The code that I saw last night was clean, controlled and although the tension was coiled tighter than a bed spring there was no chaos, just a group of well trained people who knew their roles and worked like a well oiled machine.
Afterwards I stopped to think about why I saw such a difference in that room and then it hit me. Preparation, because of the red line heads up everyone was ready for what was coming. Everyone knew their jobs and had some idea of what the situation was. In the ICU we don't get much of heads up, yes you can "see" a code coming by monitoring your patient well, but you can't predict when they are going to crash. This gives you little time to do more than nudge the code cart closer to the patients room so you don't have to run as far.
The other thing I noticed when all was over was that the staff seemed less impacted by the code. In my limited experience in the ICU, most people look a little shaken and need a moment to recover. The nurses in the ED returned to business rather quickly afterwards, very few of them looking overly shaken up. Perhaps just having that moments notice, having a minute to prepare mentally for whats to come really does help.
As for me and what department I like better, I am unsure at this moment, but I can say with certainty that I am very lucky for this unique opportunity to try my hand at both the ED and the ICU and learn what I can from both. Not many newbies get such an opportunity, and I am truly grateful for it.