Beer, ice-cream, integrative research, and cry-babying…

It's currently 9:06 pm here in the Mitten and it's still 86 degrees, on the lakeshore. Mind you, the lakeshore is generally approximately 10 degrees (or more) LESS in temperature than inland.

No biggie, but seriously hot enough to combine beer & ice cream sandwiches! Yes!

Additionally, I just finished the rough draft to a stupid paper and I am feeling very accomplished. For now.

So I am spending my summer writing papers, responding to discussion boards, and developing silly scenarios. Yeah. I rule.

My house is trashed, I haven't cleaned my bathroom in two weeks, I am washing the same pairs of scrubs, shorts, t-shirts, tanks, underwear, bra, and socks over and over again because I do not have the time (nor the desire) to catch up on laundry. Hubby, frankly, at this point, is doing well at taking care of himself (as he should, for crying out loud. Men only THINK they need a woman to do their stinky laundry). As are my adult children. And the cats (as long as their dish is filled, litter-pool scooped, and water dish at a satisfactory level).

But not the dog. Never the dawg.

The dawg needs love and attention and approval and praise and pets and open doors to venture forth toward the wilderness (of the Mitten) to pee-pee and poop-poop. I am not a dawg person, but I love that dog! She's a good girl, even with as dawg as she is! Anyway, thank gawds her and hubby have one another. I don't think the family would have made it this far (in nursing school, because, as you should know, it's a family venture, achieving passing grades in nursing school...) without the dawg-love.

In any case, I am still rambling, as I did with my ridiculous paper that researched the research on the effects of nurse to patient ratio reduction on compassion fatigue. Sadly, like so many things in our world, healthcare is a bureaucracy and it is delegated, highly, by insurance companies. Health insurance calls the shots, tossing the constraints of care at upper management who pass the buck to midlevel management who pass the buck to lower-level management that do not have education and are therefore job scared and will not go to bat for that of which is important; the patients and the well-being of those caring for the patients.

It's pathetic, really, but, believe it or not, the U.S. still has it better than most countries when it comes to healthcare, even Canada. Regardless of what is read on the internet (I've had Canadian patients vouch for this, real, live Canadians visiting the U.S. who were seeking treatment for their cough due to cold), healthcare in the U.S. is not sooo terribly bad.

I will not allow myself to begin the rant. I would LOVE to, though, and vent about my many frustrations regarding Medicaid, Medicare, and abuse of the healthcare system, of which many providers are a part of, btw, because they are tired of arguing with google degree'd patients. But I will spare potential readers of that monotony.

But I will say this... please, for the love of gawds, don't initiate an entire emergency visit for a picked at (now infected) bug bite. Just... don't. No, no, I promise, it's not

Necrotizing Fasciitis

... *sigh*

Stop picking at your bug bites and apply your Off bug spray. Just do it. And STOP googling your symptoms unless you're smart enough to do so.

And stop insisting that you "got jumped by some guys that you don't even know FOR NO REASON AT ALL. Please. Do you think we work in healthcare because we're stupid? Just tell us that you cannot, for your own safety, disclose who the hell "jumped you."

And stop yelling at us because you're not getting what you want or that you've been "waiting for over an hour." It is likely that the medical staff is busy, very busy, taking care of other patients. Seriously, it rarely happens (though it does happen, and TRUST me, nobody likes working with a fellow clinical staff member that prioritizes FB and Instagram ahead of work, seriously not KEWL) that clinical staff sit around and let patient visit minutes accumulate unnecessarily. Do you have any idea how much shit we would get from nursing leadership about this? No, don't yell at us about your wait because it is likely we are under-staffed and doing the best we can to make sure we save the patient who IS, IN FACT, dying (and doesn't realize it) and doing our best to tend to the new Hilton Hotel elite standards of healthcare. Don't yell at us, unless we are rude. That's never necessary. But if we're sweating and drawing your blood and collecting your urine, be nice. Please. It's likely we have to pee or eat, or our cat just died at home (true story) and we are waiting for the end of our 13-hour shift to deal with it.

And how many times has a post similar to this been posted on social media? Likely a BILLION.

If you want to make a change, fill out the stupid, tree-burning patient survey that accompanies your discharge instructions (some facilities do it that way still). That's what "management" will read. That's the only way to be effective, and, by the way, you'll have to be aggressive and fill out a survey daily, with the same complaint for several weeks to actually get the attention of anybody who is capable of changing a damn thing.

Oh, and did you know that in nursing school we are taught to address patients as clients. CLIENTS.

And there you have it. I ended up venting. I'm not even sure how to categorize this one.

 

So here I sit… procrastinating.

Yeah. So why not get something out of my procrastination, like... a blog post. This, too, shall serve as preparation for the tasks I do not wish to complete today...

Today is the day I must start my Integrated Literature Review paper. Oh yeah, a paper, not a biggie, but recall (if you will or can [busted?] my front page and how I say:

Woo-Hoo! It's my bloggie and I can blog how I want to! I feel FREE not having to abide by the rules of formal writing and APA.

So much work! And so many rules and criteria and formalities and commas and parenthesis and periods and semicolons and colons and capitalizations and dates and authors and citations. Oh sure, it's my literature review paper but I cannot write how I want to! 

So I should suck it up, of course, because let's be real; it's damn paper. It's not the removal of one of my limbs or revocation of my birthday or mother status. I've not been given terminal cancer and told to shut up and deal, it's nothing more than a stupid paper. And still, my butt hurts just thinking about all that damn sitting... (insert cry-baby emoji here, RIGHT THERE [that was from DB #3, for those who caught it]).

So let's do this. Let's go for a quick walk, get the tanning salon out of the way (yes, of course I know it's bad for me, just like smokers and crack-heads know smoking and crack is bad for them), shower, eat, and get that paper going. Just do it.

Finally, was there a point to this post? Absolutely not. I simply wanted to snuggle up in a space that makes me feel cozy and spend constructive time with my procrastination.

Please, let's spread the misery!

Comment and share with me your procrastination story... No judgments, really!

This one time… at clinical…

... I had to cath (insert a urinary catheter) a patient. Oh, c'mon, actually, this happens all the time. Simply put, this is what nurses and nurse techs do: we get the pee and when we have it, we are happy, I mean, it's almost like Christmas!

In any case, each cath experience is unique and that is likely because each patient has unique anatomy. That's right, all private areas are a little different, especially on females. Also, FYI real quick, females are difficult to cath in that the urethral opening (the pee hole) is usually difficult to locate visually. So, insertion begins with approximations and guess-work. It's the hard truth, there is not a sign on poot-poots that say, "Insert cath here."

Now males, on the other hand, are easier when it comes to locating the urethral opening. Seriously, it's right there... one-eyed Pete. Boom. However, cathing males poses an entirely new list of potential issues. One, first and foremost (especially on older males) is the prostate. The prostate gland sits between the bladder and the penis with the urethra (pee canal and in male cases, semen canal as well) running through it. It is common for older men to experience swelling of the prostate which compromises the efficiency of bladder drainage. So, imagine the walnut-sized prostate gland swelling... and occluding (blocking) the urethra. Cathing a patient with an enlarged prostate is difficult and requires a specific type of catheter called a Coude catheter (google it if you want to know more about it).

Secondly, males have a much longer urethra than females (hence why men rarely get urinary tract infections (UTI) as opposed to women who have shorter urethral tracts and suffer commonly from UTIs). The cathing kits generally have plenty of cath for instances of cathing males without any worries. Except. *rolls eyes* Except when the male patient has a ridiculously long penis. *sigh*

For real, cathing is intricate and must remain a sterile procedure. The risk of infection is high anytime an invasive procedure is done on a patient, so it is crucial, especially once sterile gloves are donned, that the nurse touches nothing except the sterile materials in the cath kit. Therefore, the penis is considered non-sterile and can only be touched with the designated hand, leaving the other sterile and available to all the work.

So, this one time at clinical, I had to cath a patient. My leading nurse that day was a young male and was happy to have me cath his male patient for him. We had just received the report from the night shift and were beginning our rounds with the gentleman who needed to be catheterized. The nurse remained with me during the procedure, but I will never forget approaching our incoherent patient and flipping the sheets back. Omg. The old man had a ridiculously long penis. Now, this is what is funny. I didn't think about anything else but whether or not the catheter would be long enough to make it into his bladder. The patient did not have any prostate issues, I could tell immediately upon insertion, however, I ran out of catheter and there STILL was not any urine flowing. I literally had to scrunch the poor old man's flaccid penis up to gain more catheter line to continue advancing until I reached his bladder. Anyway, I had to fuss for a while, but I finally got a flash of urine and it began to flow out. I froze and kept my hands exactly where they were when the flash began, only making small adjustments of the penis to keep the urine flow going... I did not want to lose my drain!

After several moments of this, my leading nurse started to laugh. I looked at him with questioning and he blurted out, "Drop the penis. Just... drop the penis. He's gonna end up with a boner!" See? I never thought about the penis and what its instincts and natural responses are. I laughed to myself at how I was so medically focused that I forget what unit of the human body I was handling.

And that's why I am sharing this entire story. I want to point out to anybody reading that that's how it is... nurses do not care what naked parts they have to handle, so's long as they can get what they need from whatever it may be.

So, holy shit! I dropped the penis! Consider it, if it were you, would you want to be standing around with stranger-boner in your non-sterile hand? More importantly, how about losing that urine flow? If the penis grows, the scrunch, catheter length, and tragically, THE PEE DRAIN would have been compromised.

In any case, dropping the penis did not interfere. Thank gawds I continued to get a flow of urine.

 

Nurses Happily Eat Their Young

The Nerdy Nurse https://thenerdynurse.com

Truth! I do not understand how a profession so full of compassion and caring manages to be so cruel to new nurses... (or is it just something that happens in OB and other forms of floor nursing? *gasp*) in any case, nursing cannibalism is learned straight away, in nursing school. Lemme tell a quick story...

So, one time, not so long ago, I was doing time during a med surg rotation. I was assigned 2 patients, one of which was also assigned to a “higher ranking” senior student nurse. Needless to say, in comparison to the senior student, I required very little guidance or attention. I simply needed to assess and chart on our patient. I was not to be performing any procedures or giving any meds that day. The senior student was not happy with my presence. Honestly, I have no idea why. I mean, I am not unpleasant, I did not overstep, and I was actually going to make her job easier! I figure the senior student found her opportunity to trump me and so she did with as much attitude as she could. She would reference me to the assigned nurse as “she,” never referring to me directly (gawds). She was also sure to delegate the “lesser” tasks to me all through CNA, of course. Certainly, her behavior annoyed me, but I was able to see past it all. The senior student was simply a poor, dumb, bitch who got off on utilizing what little power she had. Fine. I had my assessing and charting done already, anyway. Pick and choose daily battles, right?

Anyway, later, after I had finished my lunch break, I checked in on our mutual patient. He was restless in his bed, claiming that he knew his bowels were about to move, and LAWDS, it had been days! He was excited, yet apprehensive. I eased his anxiety with some classic, professional nursing education and educated his wife on how to assist him when the time to FINALLY pass the bowels arrived. Specifically, however, I instructed them both to press the call button, when it was time, and ask for (assigned nurse and bitch-student nurse) by name. Both patient and spouse agreed and demonstrated to me that they understood by repeating my instructions back to me.

The best part!?! The patient actually did what I asked! He called for the assigned and senior student nurse to assist him with his poop. It was an amazing poop, too! As they were assisting him, with the door to his room wide open and the warm scent of stale shit crowding the hallway, I knocked lightly and asked the patient if he was ok. He said he was great and that the ladies came to help him just as I said they would. I told him I was glad and reassured him that those ladies were happy to assist him.

Later, the senior student gave me a razor-beam-death stare. No biggie. I was just ecstatic that revenge had worked for me. In the past, when I had made attempts to plot revenge, scenarios back-fired. I accept this, as well, because I believe that spending life plotting revenge is a gross neglect of energy; make the world better, not worse, do not feed the fire. But sometimes? Damn, utilize free-will to humble the terrible people!

#fuckhierarchy

Image credit: The Nerdy Nurse

Get. Out. Of. Here.

“Get. Out. Of. My. Room.”

Truly. A patient hissed this at me. Lemme tell you all about it.

So, last year, I had a female medical-surgical (med-surg) patient in her mid-fifties. She was amicable enough and cooperated with performing self-care. She had been admitted to the hospital because of an exacerbation of COPD (Chronic obstructive pulmonary disorder. A person suffering from COPD cannot breathe worth a shit. Their lungs are shot, their alveoli, which are tiny little air-storing sacks at the “tree tips” of the bronchial chain, are popped and expanded. COPD patients, in a sense, are fucked). I can not remember the details exactly, but she was classic COPD and, (sorry, not sorry), classic white trash. Her personal belongings reeked of cigarette smoke and she gloated while I performed any care that she was not capable of doing herself (expelling her own turd from her anus, for example. She would get too short of breath while venturing to the commode, so the duty nurse and I had to help her, while she lay on her side, dig the turd from her butt. Yes. This is what the fuck nurses do).

In any case, her oxygen saturation (aka SpO2 – how much oxygen red blood cells are carrying to extremities, organs, etc., because (btw) THAT’S WHAT RED BLOOD CELLS DO) averaged around 91%. This was where she functioned, for the most part, and that is not uncommon for COPD patients. Normally, a person in optimal pulmonary health, maintain an SpO2 of between 96% and 100%, FYI. Anyway, at one point, while visiting with her son, my patient’s SpO2 reached 94%, of which I was very impressed, and I observed that she was content and conversing easily. I felt good for her.

Of course, nurses (and even nursing students) do not have JUST ONE patient. There are at least two or three more people relying on the expertise of one specific RN to ensure that their care and healing are accommodated to. While I was away from my COPD patient, respiratory therapy came into her room to perform nebulizers and assess her lung residuals and capacities, etc. That’s their job. They also know that O2 (via nasal cannula, usually) is mandatory, for comfort and perfusion. That being said, COPD patients cannot tolerate a high flow of O2 (it’s a whole pathophysiology thing) and their flow rates MUST BE MONITORED closely. They need O2 at all times, but NEVER too much (it has to do with the brain stem… too much O2 in the blood trumps CO2. The presence of CO2 triggers the brain stem to initiate breathing… not enough CO2 in a COPD patient, not enough breathing). In short: O2 is essential, even a low flow, for COPD patients. It is necessary. Respiratory therapy, of all groups, would know the importance of these O2 protocols.

Ok. About 15 minutes after respiratory therapy had left her room, I went in to check on her. Her son was gone and she was alone. She was not comfortable and was restless. She breathlessly explained to me, as we went through basic self-care routines (hand and face washing), that she did not feel well. I observed and assessed her closely. I put her on an SpO2 monitor and shockingly noted that she was maintaining only 88% – 89% blood oxygen saturation. I encouraged her to continue to breathe in deeply through her nose (that’s where the nasal cannula is, and I could hear the O2 connection running from the jet on the wall) and out through her mouth. Her O2 continued to drop and before my very eyes, her extremities (fingertips, lips) began to turn blue. I was desperate. I had pushed the call-button moments ago, to no avail; not a soul was coming to my aid, except for another nursing student and bless her soul (much love to you, Sarah!). I sent her out of the room to bring back help (as I could hear the damn call-bell dinging at the nurses’ station) but I decided I could not wait. I was eyeing the Code Blue button on the wall. My patient was moments away from the full-on respiratory distress of which I knew she would likely not make it back from. I needed help. So I left her side, stood in the hallway, complete in my dorky-ass nursing student uniform and yelled, “I need help! Now!” Help came. During the next split moments, I was told many things, like, “You must assess the patient, not just what the machine is telling you.” To this, I retorted, “Look at her lips and fingers.” The nurse began to look concerned, especially as the damn white-trash patient began to panic. The nurse noted the O2 jet, of which was set appropriately. She stood there, for a moment, at a loss. And then she did something I will never forget; she followed the nasal cannula line from the patient’s nose, fingering it all the was until she reached the end. The end lay on the floor. The end of my COPD patient’s nasal cannula was not even attached to oxygen. It lay, listless, behind her c-pap and bi-pap machines, completely useless. What WAS attached to the jet on the wall was a random cannula that ran to one of the machines. My patient was not getting any O2. This is bad news for a COPD patient.

Do you see what happened? Not to pass the buck but FOR REAL! After her respiratory therapy session, she was never reattached back to O2… the therapist FAILED to follow the cannula from her face to the jet. Almost costing this poor white trash woman her damn life. Thankfully, the patient recovered within moments of being reattached to O2. I remember feeling relief to see that she would avoid respiratory distress, intubation, and a coma. She would live another day to have shit dug out of her ass.

Ha. Oh, but that patient hated me. She had no idea that the only mistake I made was NOT FOLLOWING THE CANNULA LINE FROM HER DAMN FACE TO THE O2 JET (This is a huge thing for nurses to do, as menial as it sounds, I realized the validity of menial that clinical day). From her view, I fucked it all up. I did everything wrong. I scared the shit out of her and almost killed her. So she said after she caught enough breath to talk, “Get. Out. Of. Here.” Actually, she didn’t say it, she HISSED it.

I left. I cried. I wandered for a bit, reflecting. I found my clinical instructor in the med room and cried again. She informed me that the nurse had already reported that I was not at fault for anything more than NOT following the line. A report had already been filed against respiratory therapy. My clinical instructor asked that I gather my wits, continue caring for my other patients, and share my disaster at post-conference so that the other students could learn from my horror. NO problem. I don’t care how competitive and full of morons life is… I do not wish for another nurse to experience what I did. I do not wish for another patient to panic as mine did, either, because she could not breathe. Not cool.

I owned it, man. I am not big-headed, but I am smart and lemme tell you, I follow every mother-fucking line I come across now.

Done.