bastard got what he deserved!

I love this story

It would have been even better if she would have resuscitated his ass, then killed him again....

because I said I'd blog this

*this is a sad, disturbing story*

In the nursing school I went to, we did a home health care rotation. I accidentally picked the agency that did all the sick kid home health care. Right after a very busy Peds/OB rotation. Very depressing
One day, we went to this house. It was a modest ranch style, we came in, and the home health nurse went straight to the back bedroom. In the room, was this little girl, with a tracheostomy, a ventilator, a peg tube, and everything that goes with it. And she GURGLED. A LOT.
The story went like this. The parents?
They had a swimming pool.
The parents?
didn't have a gate, or a fence. They did have a locking patio door, but they didn't use it.
The little one? "near drowning" victim.
It sounded to me like she was still drowning.
We suctioned her, and talked with Grandma, who, lived in that room, with her, taking care of her.
"The parents can't handle the guilt" we were told.
She never left her bedroom. She just lived back there, with Grandma.
When we were leaving for the next house, the parents were home. They had a 2 year old boy, little girls little brother. Running around, blond curls bouncing. Getting into everything. Things a toddler does.
They still had a swimming pool. I saw it through the unlocked patio door.

Rubber Ball

bounce bounce bounce

Started out at home, on call, knowing I would get called in. Sure enough, I was there by 2200 doing lunch relief for the surgical floor. FUN.
Then, rumor had it, that I needed to go to telemetry. For a possible admit. But I had to take a break myself first. So, I went to tele. And waited. waited more. Finally, got word of my impending patient. It was close on to 4 am, and I had been sitting for 2 hours, at time and half, doing nothing. And I am not one of those people who likes to do nothing and get paid for it. Give me SOMETHING.
I did MAR's
crash carts
glucometers
hung antibiotics
walked around, looking at people, daring them to use the call light
I got nothin;

THEN just when I got report on the patient, I was downsized. Because another nurse became availiable, who wasn't on time and a half like I was.
So I came home, at 0430, and didn't sleep.
bounce bounce bounce

I've discovered a disturbing trend lately.
A sign that I am getting "old" in nursing. Disturbing indeed.

What I am seeing, at least here in California, are nurses, with the luxury of a 4:1 patient ratio, (and it IS a luxury. 4 patients to one nurse is GREAT) struggle with their assignments.
They have such poor time management skills, that they can't effectively perform one assessment, 2 sets of vital signs (8 hours apart) 4 MAR checks, and their charting in 12 hours. The patients are BASIC telemetry patients. We are a small hospital. We don't have open heart patients, half the patients on telemetry are there because of their HISTORY of cardiac disease. Almost half the floor patients are OBSERVATION patients.

They even make acuity based assignments. So its not like the 4 they have are all difficult, total care patients. It just boggles my mind. I was in charge, on the telemetry floor last night, and sat, dumfounded, watching the 3 younger nurses squander their time and energy wandering in circles, while the one experience nurse, who'd been a nurse longer than 5 years, managed her equally as difficult (or, easy) patient load with ease.

Dare I say it? The assignments are too easy. Will they ever learn time management with 4 patients? Will they learn to prioritize, how to take fewer steps but yet get the most bang for their buck? Will they stop complaining about FOUR BLOODY PATIENTS?
God, I hope so. Or I fear for the future of nursing....

Quicky

In the middle of moving to our new house (yay!) but something interesting happened yesterday.
MM has gout. Stress flares him up. New house+moving this week= stressed MM.
He called his primary for a refill of his Colchicine and Allopurinol.
The med tech that works there? Whatever she is? Secretary, whatever?
MADE HIM SPELL THEM

she says "we like to have you spell them so that we know that you know you are getting the correct medication".
I think it is because SHE can't spell Colchicine. Of course, he couldn't spell it, either.

So on Tuesday when I go back to work, I am going to have MY patients spell their meds, too.
Just so I know that THEY know that they are getting the right ones.

lost and found

Packing has it's advantages. Even if it stresses me out and makes me miserable.
Today, I found one of my favorite books that I thought I had lost.
Or rather, thought I had lost. Because I lent it to a friend who has the bad habit of not returning things. But I guess I can't hold this book against him anymore now, can I?

The book I am talking about is this one.

Flip and see ECG.
It is so basic. But it explains rhythm so incredibly well, in a language even lay people could understand. I used to keep this in my locker at work, and bring it into patients rooms from time to time, when they were having a hard time understanding what I was trying to teach them.

Besides, who doesn't love stick figures?
So if you are looking to 'get rhythm'
get this book.

Ode to a Node
Have a heart, and have no fear
The SA node is over here,
Beating at a constant rate
60-100 is really great.

The AV node can make a show
if SA node has gone too slow,
40-60 is not too bad
If it's all you've got you will be glad.

Should the whole thing drop its speed
His and bundle branches will take the lead.
And that, my friend is the whole and part
of the conduction system of your heart.

What would you do?

So.
I was in charge of the wee little ICU the other night. It wasn't such a bad night, we had a few interesting cases, but too many of our usual, run of the mill ones, too.
Traveler that I mentioned a few posts back is working, and he has to take an admission. IVDA rule out TB patient with "chronic pain" and psych issues. Fantastic.
He deals with her, and, when it is time for his lunch break, he is reporting off to me. He tells me she had a dose of dilaudid he had wanted to give her, but she was 'zonked out', so he left it. AT THE BEDSIDE.
Yes, he left IV push dilaudid, at the bedside of a known IVDA with an IV IN HER ARM at the bedside.

He has been nursing 2 years. He says all of those 2 years have been in critical care. I explain to him that it is not the policy of ANY hospital I know to leave ANY MEDS at the bedside. Especially Narcotics. I tell him it is a fireable offense.

So he says. "You want me to go get it?

Well. Duh?

And then he says "we are going to waste it?"

Duh.

So he goes to get it. And the syringe? A saline flush syringe. UNMARKED. No label. He won't use carpu-jets. So, how do I know that it's really dilaudid in that syringe?

Yes I wrote him up. No I don't know what my manager has to say about it, yet.

I do know, that after tomorrow nights shift, where I will once again be in charge of this person, I am on vacation for 3 weeks.
I neeeeed this vacation....