another first

{ April 10, 2009 @ 10:36 am } · { Uncategorized }
{ Tags: , , , } · { Comments (1) }

back to work yesterday. kept  busy with a couple of emergent patients. one, an older man who came by ambulance from a nursing home with respiratory distress, turned around nicely – was opening his eyes and looking much more comfortable (according to his family much more like his norm) by the time we sent him to a regular medical floor. it’s kind of amazing to see that process when it happens – when someone comes in really sick and gets better by the time he leaves. the other one was a middle aged man who was sent by a clinic where he was having an outpatient treatment. he’d had a sudden change in his mental status. he was pretty out of it by the time he got to us, and deteriorated over the several hours that i was taking care of him. i watched his neurological status change almost before my eyes – from being confused and disoriented to being very lethargic and only responding to pain/discomfort. i found myself feeling worried and helpless as i watched him decline, even while the diagnostic process was going on – CT scan, blood work, etc. – just wondering what it actually was that he needed and whether we would be able to get it done in time to help him.

initially he was quite aggressive, probably because of the fact that he wasn’t understanding what was going on, and because what was going on was decidedly uncomfortable. his condition was such that we needed to do a number of invasive procedures over the course of the time he was there – from taking a rectal temperature to putting in a foley catheter and a nasogastric tube. we started with the IV – one of the techs had to hold him down while i put it in and drew blood. then – i don’t even remember what it was that we were doing, maybe something as benign as repositioning him, but all of a sudden, he lurched up in bed and landed a heavy punch to my chest. i wouldn’t have liked to have been on the receiving end of his full force had he been less debilitated.

i’ve often had to fend off swats and scratches and general resistance, but never something as direct (or as powerful). the funny thing was that although i was surprised, i almost didn’t register it – i remember thinking, am i hurt? i don’t think so. and then just going back to whatever it was we were trying to do. the resident next to me asked if i was ok and i said yes and that was it. i was almost surprised that she asked somehow.

except for fights with my siblings when we were kids, and the odd spanking from my parents, i’ve never been hit. i know that nurses (along with other health workers) frequently face violence in the clinical setting (some of which is not a byproduct of confusing/mental changes) and i don’t think it’s particularly uncommon in the ED. it’s something i haven’t spent much time thinking about. do i feel vulnerable? not really. but i think that’s because my tendency is to assume that people are not going to attack me, not necessarily because that’s an accurate assumption. perhaps i need to tune up my alertness to danger. not what i expected to get out of this new undertaking! but not a bad thing.

busy busy busy

{ April 6, 2009 @ 1:20 pm } · { Uncategorized }
{ Tags: , , , , } · { Leave a Comment }

worked all weekend… spent my time back and forth from work to home, with barely enough time to sleep and eat. it was good to be there for three days in a row, though. i have the next 3 days off, which is great on the one hand, because i have a big exam to study for (it is of the employment-contingent-upon variety!) but on the other hand, i felt like i learned so much over the past 3 days and i’m afraid of getting behind by the time i go back on thursday. had my first evaluation with my manager and preceptor – they thought i was doing fine in terms of my knowledge base, which was one of the things i was most concerned about in this transition. the main thing they think i’m behind on is speed and time management, which was something i didn’t expect to have so much of a problem with. ultimately, i still don’t think i’ll have a problem with it – i’m sure i have the capacity for it – but i can see that i’m definitely not there yet. sometimes things feel like they’re going along smoothly, and sometimes i feel like i’ve been turned into the dumbest person on the planet when i forget or miss something that should be really obvious. and time flies so quickly once we start getting busy, and then all of a sudden i find myself behind and catching up for hours.

but i like being there, and i want to succeed…. it’s just a matter of working through the process. i don’t mind putting myself in unfamiliar situations, but i also feel a lot of discomfort in that pre-competence space…. which i think is part of why i tend to learn quickly, so i can get out of it!! i’m trying to figure out how to get up to speed, and also how to take advantage of the opportunity to work with my preceptor during orientation and learn from her. she is just so knowledgeable and great at what she does.

the truth about the ER is that there’s no rhyme or reason to the pace of things – you can have one patient at the beginning of the shift and then have 5 more walk in during the next hour and be completely swamped. i notice patients’ reactions too – those who come in with less acute problems, if they happen to be there while there’s nothing more acute going on, may end up being very happy with the care and attention they receive. but if that person with the scraped knee walks in, and ten minutes later we all get called into the trauma room, we may not be back for an hour, and even when we are out, there is probably someone else waiting with something more important that needs to be addressed first. so, while we’re trying to keep someone from dying right that minute, someone who has a minor problem that may not even actually need medical care is stewing about how terrible all the nurses and doctors are and how he is not getting the attention he deserves. almost every day i have a patient tell me i am a good nurse and almost every day someone else tells me how bad a nurse i am. (right now, to be honest, i am a lot more concerned about what my manager and preceptor think!! although obviously, i try to take the best care possible of everyone.) and almost every day someone complains about how long the treatment is taking, even if it’s not being abnormally delayed, and someone wants us to hurry up because of needing to get to another appointment or take care of some commitment. i think a lot of it goes back to the acuity of patients’ medical problems and how that compares to what else is going on at the same time. but i also think that somehow the idea of the emergency room connotes instant gratification – which is far from reality!! some people think we’re mcdonald’s, where they can ask for exactly what they want and get it right away – cheap/easy/tasty – but in reality we are a lot more like a soup kitchen, where they get whatever we have available, with extreme variation in speed and quantity. and then we ask them for their co-pay.

season change

{ March 31, 2009 @ 9:53 am } · { Uncategorized }
{ } · { Comments (3) }

well… it looks like i still have a few readers left, even after neglecting my little blog for a few weeks. i don’t know what exactly i have been doing that’s been keeping me away. i have yet to feel that i have a routine, and actually am not overly concerned about developing one because in a couple of months i’ll be switching to nights (7pm to 7am), at which i will have  a much more intensive restructuring of my time! that’s right, by june i should be on my own… kicked out of the orientation nest and hopefully flying! i’ve been away from the unit for over a week thanks to several class days last week… i am finding that when i go back after several days off it’s hard to get back up to speed or kind of hit the rhythm of what needs to happen with everyone. but now that classtime is mostly done, i’ll have a chance to really dig in and hopefully start hitting my stride.

spring is finally putting in its appearance… much too late, by my estimation… every year i turn into more of a shivery snowbird. all winter long all i think about is how to escape it and how soon it will be over! an old roommate of mine is moving to san diego this summer, and i must admit that although i have no sense of whether i’d actually like the city itself, i do think of those moderate climes with longing! but for now, we’ve got plenty of sun and it’s slowly warming up. just what we all needed!!

iso… ?

{ March 8, 2009 @ 8:58 pm } · { Uncategorized }
{ } · { Leave a Comment }

a while back, i decided to make my blog searchable on google… no particular reason i guess, just thought i would experiment. i have a handy little page called ‘blog stats’ that only i can see, which tells me how people come to the site. so if someone puts a link to me on a blog, and someone else clicks it, i see that it came through that particular site. and now, i can see if someone visits me via a link that pops up in a google search. here are a few search terms that brought people to me:

betel leaves

madurai

flowers stall

madurai meenakshi temple photo

shiva madurai temple

view through a window

swallowflight.files

sri meenakshi temple, madurai

betel leave

demolished building

shri meenakshi

backpack india pics

most seem to be explicable through the tags on my posts or something in the text – the only ones i really can’t figure out are “view through a window” and “demolished building.” go figure…

dipping my toes in

{ February 20, 2009 @ 6:06 pm } · { Uncategorized }
{ Tags: , , , } · { Comments (2) }

i think i am starting to get a little sleep-deprived.. the ironic thing is that i am hoping it gets better once i start working the night shift!! ha ha…that must be total wishful thinking!!

today was my last 8-hour day on the unit – sunday i start 12-hour shifts with my preceptor. there was a little smattering of this and that… my manager whisked me off for trauma morbidity & mortality rounds, with the trauma surgery team & the emergency team from residents on up. it was an interesting glimpse of the overall decision making and some of the big-picture stuff that is happening behind all the hustle and activity of getting someone in the door, trying to stabilize the person and figure out what happened and what needs to be done.

then, my preceptor and i spent the morning looking for anyone who needed an IV … and if we found someone it was that person’s lucky day to have me do it. (read: irony/sarcasm!) i’d been doing pretty well the rest of the week, and had either hit it just right the first time or had been able to maneuver things with a little help/guidance, but today my fingers were not so magical – three poor fellows were left with a couple of extra sore spots, but i nailed the last one (even with a pretty nervous patient and an audience of couple of family members hovering)… hopefully that will typify the continuing trend.  i felt terrible about the ones i missed, though even more motivated to improve. in addition to making patients less uncomfortable, i’m also seeing how important it is for the flow/time management aspect of things – i just don’t think i can afford to spend the time to repeat a procedure when there are other, more pressing things, waiting or coming along in the meantime.

i’m finding the transition interesting, if exhausting -i feel so much motivation to learn, but when i stop for lunch or get home at the end of the day, i find i’m spending a lot of time staring into the middle distance. (hoping the ol’ subconscious is occupying itself with sorting out some of this new information while i’m in zone-out world!!)

but other than that – i am so conscious of how i am learning and how things are fitting together, or where there are gaps – there is the level of practicing or acquiring skills – the iv’s, different routes of medication administration, the flow and layout of the space, types of supplies i need and where to look for them (you will notice i did not say ‘find’!), a new charting system — those are all the sort of task- and skill- related things that i know it will just take time to conquer. but then aside from that, there is a whole other level of really putting together the picture of what is going on with the person in front of me…. a much more subtle and intricate undertaking.

now, in a different setting, i definitely feel the specificity of my former practice – how there was an identifiable type of patient for whom i cared, with a certain set of typical issues and how that defines (and limits) my knowledge. of course there is overlap, so at least i feel i have a base where i can build, but at the same time there is so much that is totally new. and it’s kind of incredible to think about just how many people and different types of situations/conditions i’ve encountered over just a few days. i find myself thinking different kinds of thoughts sometimes – i look around the people on the train and check out their veins or wonder what might bring (or has brought) them into contact w/ the emergency room… (just said they were new thoughts, didn’t say they weren’t weird.)

starting over, sort of

{ February 17, 2009 @ 9:01 pm } · { Uncategorized }
{ Tags: , , } · { Comments (3) }

i’ve got a preceptor and she seems to be exactly right – smart, quick, on top of everything, careful and takes good care of her license, great at teaching/explaining, relates well with patients and seems to have strong relationships with other staff at all different levels and roles in the department. i feel, as ever, most grateful for my very good fortune.

a handful of new grads started last month (i’m the lone newcomer this month). they are friendly and have that fresh-minted new grad shine; rather endearing, i must admit. they’ll all be working nights with me, and seem like they’ll be good co-workers.

all the activity can be a bit dizzying – i think i’ll thrive on it once i have a better grasp of the work environment and how to find everything i need to work, but for now it’s a lot of work just trying to take in a constant stream of new information, new faces, new tasks and procedures. sometimes during the day i found myself automatically jumping in to ask questions, translate something into spanish, spike an iv bag or give someone their meds… as if i’d always been doing it. but at other times i was struck by how incredibly different this type of practice is from what i’ve learned to do over the past four years, and feeling how much of a disconnect there is between the two environments, how much i’ll actually need to drop out of use from my old repertoire of skills and how many totally different things i’ll need to add. all in all, though, it just feels good to be learning and doing something new.

but the early mornings!!! though i’ll be working nights eventually, orientation kicks off on the day shift – which means waking up at 5:30 so i can make my entrance by 7am. this does NOT agree with the constitution of a nightowl! but for the time being i’ll just do my best to enjoy the phenomenon of staying in a single time zone.

first day

{ February 9, 2009 @ 10:55 pm } · { Uncategorized }
{ Tags: , , } · { Comments (3) }

so… i’ve officially started the new job. spent the day in hospital orientation. it was the usual stuff – code of conduct, infection control, security, etc. etc. pretty painless, in the end.

but one thing struck me funny – the very first presenter, a vice pres of something or other, started off by saying, “let me tell you the reason you’re all here. you think you know why you’re here, but i’m going to tell you why you’re really here.” [dramatic pause] “patient satisfaction.” she proceeded to a discussion of what makes patients happy, which is, according to her, happy employees, which in itself is supposed to make us happy, because we know that the organization cares about our happiness.

well… i may be overly cynical, but i think that what the hospital actually cares about is the bottom line, and that it is currently in vogue to link that to patient and employee satisfaction (by the way they call us “associates,” not employees).  i don’t mean to fault them for thinking this, or even for saying it, not least because every healthcare organization in this country is probably in the same boat considering the climate of consumerism and competitiveness that drives our healthcare system. (a little more lexical trivia that i’d argue is not so trivial – the trend of replacing the word “patient” with “client.” supposed to be less paternalistic, instead more consumeristic; i’d argue we’re moving toward the greater of the two evils.)

but, i have to say, on some level i find the whole premise (not of patient satisfaction being important in general, but of reducing my raison d’etre as a nurse to promoting/creating patient satisfaction) to be pretty demeaning. as a trained professional with a personal and professional code of ethics, i can safely say that i do not do my job in order to make patients happy. i don’t do it to make them unhappy, either (lest any reader attempt to shove me into the nurse ratchett paradigm). i do my job in order to help people be healthier, and/or to help them cope better with conditions that can’t be improved. sometimes this means being part of giving “bad” news that things aren’t going to improve. sometimes it means figuring out how to engage with people who would rather be anywhere else but in the position they’re in, who don’t want any help, or who are experts at thwarting others who try to help. sometimes it means just being with people – simple presence. sometimes, it means setting limits on abusive and manipulative behavior (which, believe me, results in ANYTHING but happiness!!).

to be told that all i’m there for is to make patients happy undermines the breadth of my role as well as the complexity of the relationships that i will develop with patients. i don’t think i’m crazy to think that when i’m doing my job in the best possible way, the outcome may not be patient “happiness.” a lot of times it probably will be, but…. if we’re trying to make people happy, why don’t we send them to an amusement park, and focus on making the hospital the place for professionals to practice and patients to receive compassion, respect, and care that is competent & humane.

free rice

{ February 5, 2009 @ 7:23 am } · { Uncategorized }
{ Tags: , , } · { Leave a Comment }

so… i came across this addictive little site a few days ago and wanted to share it with everyone – the idea is, you play a vocabulary game, and the site donates rice to the UN food program. you only accrue 10 grains of rice per right answer, which doesn’t seem like a lot, esp when you consider that you’d have to answer . but.. the site breaks the numbers down -

one serving of rice = 400 grams

1 gram = 48 grains (or about 5 correct answers)

therefore…. one serving = 19,200 grains, or 1,920 right answers. by the time i got to this point in the calculation, i thought things looked pretty grim for this project. but when i checked the totals i found that last year 43,942,622,700 grains of rice were ‘earned’ through the site, equalling 2,288,678 servings! i was amazed.

and… even better… the word game has 60 levels, gets into serious GRE territory, (it automatically adjusts to your level based on the questions you’re answering, but you can also choose a level) and, if you are tired of the vocab, you can even change to questions about different topics. and there is an animated rice bowl on one side of the screen where you see your right answers translated into rice.

try it!! i guarantee it will be even more fun than compulsively refreshing your email inbox all day.

http://www.freerice.com

india pics

{ February 1, 2009 @ 12:37 pm } · { Uncategorized }
{ Tags: , , , , , , , , , , , , , , } · { Comments (3) }

i am still figuring out where i want to locate an online album besides facebook (i’m finding that uploading is prohibitively slow on a lot of sites, and using picasa, which i’ve done in the past, puts duplicates of all the photos on my computer hard drive, which sucks up a ton of memory — so any suggestions on good options for digital albums are extremely welcome!)  — but here are a few of my favorite shots from the trip.

003

view from inside the indian coffee house, bangalore.

006at the bull temple, bangalore.

095temple on chamundi hill, mysore, karnataka state.

100happy calf, on top of chamundi hill

161mysore by night, with illuminated palace in the background (it’s covered by 100’s of light bulbs!)

169better get some of that incense….

174banana row in the mysore market.

175cow all dolled up for pongal, a tamil holiday.

188a flower stall in the mysore market.

191ladies  in the mysore market selling leaves for wrapping betel nut.

193another lady i made friends with in the market (from the stand selling the leaves)

267waterfalls near wayanad wildlife sanctuary, kerala state.

301view through a window in fort cochin, kerala state.

309fort cochin, kerala.

374cochin harbor

3771a very interesting artist i made friends with – i mentioned him briefly in an earlier post – who only paints elephants. being in his shop/studio was like being inside an elephant meditation – seeing endless reflections and iterations of the same thing. he’s also on a mission to free all elephants. i wanted to buy everything he had!! my favorite one was the big canvas to the left of the photo, with the horizontal bars of color. i settled for a smaller painting that i could stuff in my backpack.

p1030601kanyakumari, behind a demolished building, looking out into the harbor.

p1030679i just like how the only word i can read in this sign is “socks.”

p1030683some cool statuary in the sri meenakshi temple in madurai.

home

{ January 30, 2009 @ 1:01 pm } · { Uncategorized }
{ } · { Comments (3) }

here i am at last… it felt so good to walk in my door this morning after 24+ hours of travel! it’s amazing how quickly the trip begins to recede into the dreamlike distance, but further reflections to come… and pictures!

Newer entries » · « Older entries