girl in greenwood

One year ago I was a brand-new nurse scared out of my mind about starting work.

Today I precepted a brand-new nurse (a graduate from the same school I attended) who was scared out of her mind about starting work.

One year ago I could barely handle taking care of two patients.

Today I had a total of six patients with admits and discharges.

One year ago I had successfully drawn blood once.

Today I helped my preceptee try to draw blood for the second time. She didn't succeed. I stuck the patient once and while I had to dig around a bit for the vein, I got the blood sample.

One year ago I had no idea how to put a tele monitor on a patient, much less how to read an EKG.

Today I admitted a tele patient, stuck on the monitor and assessed his rhythm, then called the doctor to report on the weirdness I was seeing without breaking a sweat.

One year ago I was nervous every time I went into a patient's room because I felt awkward and incompetent.

Today I breezed into a patient's room and was greeted by the patient's daughter, who informed me that I was her mom's favorite nurse.

One year ago I was not sure how I would like working in a hospital with lots of people I didn't know.

Today I got hugs and kisses from most of my coworkers, including a doctor.

This job has worked out brilliantly.

Labels: nursing

People I hugged today:

-a patient
-a patient's daughter
-a jail guard
-an MD
-a nursing assistant
-5 of my coworkers

I kissed my husband but I didn't hug him because he was still lying in bed when I left for work, and lying down on the couch when I got home from work.

Labels: hugging

More conditions my patients have had that I'm glad I don't:

Huntington's disease. And a big honkin' meningioma as a "bonus".

Multiple enterocutaneous fistulas secondary to surgeries to treat colon cancer.

Diffuse large B-cell lymphoma - this was actually a patient who had undergone chemo in the past, and when it was discovered that the cancer was back, she declined further treatment and went on comfort care. She died on my shift.

Labels: dread diseases, nursing

# posted by girl_in_greenwood @ 11:42 AM 3 comments links to this post

In nursing school, we spent a great deal of time discussing therapeutic communication. We were taught to validate feelings, express respect for the other person, and try to steer the conversation in a productive direction.

Yesterday I heard the following interaction while out with a group of coworkers:

Nurse 1: "You know that guy G*** with the possible mad cow disease, and how he's totally crazy?"

Nurse 2: "Sure, yeah, he calls everyone "f*cking b*tch," right?"

Nurse 1: "Yeah, that guy. The other day I gave him his meds and then asked him if there was anything else I could do for him, and he looked me straight in the eye and said, "Yes. You can suck my dick."

Nurse 2: "HAHAHAHA! What did you say - "It sounds like you're feeling horny right now. Would you like to discuss those feelings?" "

Nurse 1: "No, I just covered my mouth and ran out of the room because I couldn't stop laughing!"


I love my coworkers.

Labels: nursing, nursing school

Recent diseases that my patients have had lately that I am glad I don't have myself:

-Full blown AIDS with Kaposi's sarcoma and C.diff diarrhea as a bonus.
-TTP and resultant amputations of both hands & both feet
-completely out-of-touch with any kind of reality schizophrenia (and a foot infection)
-Median arcuate ligament syndrome. (No, I'd never heard of it before, either.)
-spontaneous pulmonary embolism for no apparent reason.

I think this may become a recurring topic on my blog, since I find new conditions that I really don't want to have on a regular basis.

Labels: dread diseases, nursing

Hey, I'm thinking of you and wondering how your nursing school journey is playing out! Update me when you have a chance. Hope you & yours are well.

Okay, okay, I've been promising this post forever. Consider it a cautionary tale. (If you don't like gross stories, don't read this one, ok?)

I took care of a patient a while ago who was a young woman who had decided to leave her boring suburban life and plans for college to hang out with the wrong crowd. She was using heroin and while her claim was that the massive necrotizing infection in her face started when she just picked at a scab on her forehead... it seems more likely to me that she had either injected or dripped a solution of heroin into her eye. That's right, her eye was the center of the infection. And man was it gross. The eye was swollen shut and continually oozed bloody drainage... when we cleaned it, it drained more, so that it looked like she was was weeping blood. Amazingly, she didn't lose the eye, although she is blind on that side now.

The good news is that she stopped using heroin and got into a methadone maintenance program. The bad news is that she came back to us a couple monthes later with abcesses in her thighs... apparently she decided to change things up by injecting cocaine into her femorals. I didn't ask her this, but I wanted to ask why she would risk infection by injecting when she had a perfectly good cocaine nozzle right on the front of her face... I suppose that would be a less-than-therapeutic message?

So, the takeaway lessons here are:
1. If you use heroin, keep it the hell away from your face and eyes.
2. If you want to use cocaine instead, I really can't recommend injecting it.
3. Srsly, college is not that bad. At least give it a try before you turn to drugs & whoring yourself out. Kthx.

And finally, heroin factoid of the day: dealers apparently cut black tar heroin with many things including fecal matter. Yes, poop. Which then users inject. And get nasty infected abcesses, big surprise. Could it get any grosser?

Labels: nursing

I started this entry back in October... but it's still relevant to me so I'm posting it anyway.

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You know what's funny? I precepted a newer-than-me nurse this weekend. And it went really well. I think that was partly because the new nurse is EXCELLENT. She was a nurse tech at Big County Hospital for the last year, so she is already very familiar with the work environment. Partly it was because I am so recently finished with orientation that I remember it keenly, and have lots of opinions about what makes for good vs. bad experiences. At the end of the first day together, she thanked me for helping her have a good day... which made me feel great.

Otherwise, I'm doing all right. I've been in kind of a funk at work lately - I think I'm reaching the point where I need to shake up my expectations for myself. Right now, I feel like I do a decent job with basic nursing care like making sure that my patients get their meds, have good pain control, get fed appropriately, get blood sugar checks if necessary, get their braces cleaned and adjusted if they have 'em (we have quite a few patients in spinal braces of various shapes & sizes)... which is all good. I'm pleased with that. But! Remember how I was talking about how I feel like there is so much more I could be doing? I have quantified some of that for myself. (I apologize that this is going to be boring for non-nurses, but I've got to get this stuff in writing before it gets away from me!)

In a perfect day, I would go into each patient's room and do the following:
-introduce myself
-update the whiteboard (we use these to write the nurse's name, the patient's name, the date, and any other assorted information like questions or goals)
-check vitals, assess for pain
-listen to lungs/heart/abdomen
-ask the silly orientation questions (do you know who/where/when/why you are?)
-check their name band
-if they're someone who needs to be turned every two hours, go ahead & turn them unless the night nurse told me they were just turned.

It doesn't sound that hard. But I don't think I EVER actually get all of that done in one visit.

Later on in a perfect day, all my patients would get:
-a bath
-teeth brushed or oral care; frequent oral care for unconscious or trached patients
-lotion applied to dry skin, especially feet
-room tidied & organized
-turned/repositioned every two hours like clockwork
-education packets on pertinent health conditions
-a chart review that included not just med checks, but tracking down details like the location of their belongings and starting discharge paperwork
-new IVs if the old one(s) was due to expire
-their freaking disgusting nails trimmed (if applicable)
-whatever sort of wound care they may need
-an offer to help fill out their menu requests (if applicable)

I'm sure there is more that will come to mind over time.

Labels: nursing

We visited Vancouver, BC over the past weekend and had a marvelous time! I want to make some notes for future reference, and for anyone who happens to be looking for information online.

We took the train from Seattle to Vancouver - it was cheap and easy. Actually, we got on in Edmonds, which was a good choice because only a few other people got on at the same stop, so there was not much waiting in line. We did have to wait for a quite a while to get through customs at the Vancouver train station, but oh well. It was nowhere near the 2-hour wait at customs at Blaine that some of my work friends described recently.

Wedgewood Hotel - Absolutely marvelous. The room was spotless and comfortable, the service was excellent and cheerful, and the massages we had the spa were lovely.

Bacchus Restaurant and Lounge - the lounge is intimite and cozy, with lots of dark wood, cushy chairs, heavy drapes, and soft lighting. The drinks are expensive but delicious, the lounge menu is tasty, and the breakfast & afternoon tea are quite good. However - the main dining room is overpriced and underimpressive. It's not that the food is BAD - it's just that it's uninspired and costs much more than it should.

Diva at the Metropolitan Hotel - we had lunch this trip, and had a prix fixe dinner on a previous trip. I remember being wowed by dinner, but that was years ago and I'm sure my tastes have gotten snootier. We had a prix fixe lunch this time, and it was quite good. There were three courses - the appetizer & dessert were quite excellent, but we felt the main course was somewhat off the mark. Not that it was bad, it just didn't work as a cohesive dish. However! I would go back just for cocktails. I had one they called a "Poire Belle" and it was AMAZING, like the essence of pears distilled with vanilla and a hint of spice, incredibly smooth.

Cioppino's - don't let the generic-sounding name turn you off - we had a really terrific dinner here. The chef is considered one of the best in the city, and I can see why. We had a mushroom & chestnut soup that was to do die for. I had a bowl of cioppino for dinner which was hands down the best I've ever eaten, and R* had duck which came in 3 different preparations on one plate and was outstanding. At dessert, R* had the house tiramisu which put all other tiramisu to shame - like we may consider driving back to Vancouver just for dessert, it was that good.

Vancouver Symphony - Put Seattle's symphony to shame. The hall is run-down and chilly, the bathrooms are a little yucky, but the orchestra is terrific. Louis Lortie was the guest pianist, playing two Lizst pieces (not for the faint of heart or small of hand!) and he was stunning. I'm so pleased we went to this performance.

Kirin Seafood Restaurant - we went here for dim sum and discovered that we've only eaten cheap crappy dim sum in Seattle! The food was excellent, the staff steered us through the experience since we obviously didn't know what we were doing, and the restaurant was full of Chinese people chowing down. I would love to go back with a bigger group so we could try more dishes. (Note, the dim sum is of the order off the menu variety, not the wheeled around on carts variety.)

Vancouver Art Gallery - we visited this art museum the last time we were in Vancouver and had the same reaction: the building is lovely, the collection is nothing special, and the museum store is the best we've ever seen - and that includes MOMA and the various Smithsonian/National Gallery stores. Good news: you can shop at the museum store without paying admission to the gallery.

Bill Reid Gallery - Bill Reid was a half-Haida (Native or First Nations group) artist who put a phenomenal amount of effort into reviving and publicizing his people's native art forms, as well as bringing many of the native motifs into modern media. The collection is really lovely and features lots of multimedia stations such as videos, interactive displays, and audio recordings that help place the art in context.

Chambar - Amazing Belgian restaurant. The menu features crazy cocktails, a nice variety of Belgian beers, moules et frites in multiple preparations (yes, I am in love with mussels!), gorgeous entrees, and artistic & tasty desserts. I wish we could have gone back at least twice more.

We also bought some nice stuff at Danier Leather (R* got a coat, I got a purse) for ridiculously good prices, and I stocked up on tea at Murchie's.

All in all, a terrific vacation. Wish we could go back every couple of months.

Labels: travel, vacation, Vancouver