Thursday, January 31, 2013

happy new year

Yes I realize that wish for a happy 2013 is about 31 days late but damn, it's hard to commit to much of anything in the bowels of winter when all I want to do is burrow under my blankets until the crocuses come up. So it's a month late but it's meant most sincerely. I hope everyone survived the holidays with a minimal amount of stress and a maximal amount of good food and fun.

I think January and February are the two months I hate the most, followed closely by December but I can't completely hate on that month since my birthday and Christmas happen then. But it's so much anticipation and excitement which, it just seems like it can never live up to the hype, especially when I'm not able to even muster enough energy for the annual Christmas card. I promise one for next year, although sometimes I think it would be fun just to send out cards on some other random holiday 'Happy Tax Day from my family to yours, let's hope for a BIG return'.

I started the weekend program, which means I only work two days a week and get full time pay and benefits. I can't be thankful enough to my boss for making this happen, because I can now consider going back to school. Of course, I'm now panic stricken that I'm going to lose my job over a facebook post. Okay, I stress out a lot about work and I didn't name specific people or where I work and my facebook rant was really more of a frustration with the whole nursing culture in our country, which is incredibly stressful and masochistic. I was never in a sorority but it seems like a totally dysfunctional sorority and/or high school. I was pulled from my floor on Sunday to float on another floor that I've never been to before. I was terrified and overwhelmed. I  had six patients, I'm used to 3 - 4 tops. I'm used to patients I know, like I know their first and last names, their spouses names, whether they have leukemia or lymphoma, where their central line is located. It's one of the things I love the most about my job, seeing the same patients. It's awful the circumstances under which I see them so frequently, but I truly feel I can help better people the better I know them. I'm a creature of habit, who isn't? I'm used to the standard med regimens for my heme/onc patient population, the hanging of blood, platelets, chemo, the daily stresses and issues that arise on my floor, they are trying but nothing compared to being on an unknown floor. This floor I went to was a disaster. Disorganized and dirty! Oh my word, I couldn't take the dirtiness. And two patients per room! So I quadruple checked meds because two people per room seems to increase the rate of med errors exponentially in my mind. I am going to loooose my shit with all the things I see in healthcare that seem so inefficient, that seem designed to frustrate and increase the time it takes nurses to carry out their tasks and that puts the safety of patients at risk. I am anal and look at the world in terms of how I can fix it, this isn't a winning trait to have, it's most likely disastrous from an intimate relationship perspective, but, it allows me to see a lot of things that people might not notice, the things people overlook or become inured to I can't help but see and get ready to hop up on a soapbox about. Because, when it all comes down to it, I want to help people. I want to make a difference. And after work on Sunday I was ready to weep but I was too tired from the day I had.

I am one of those nurses that sweats the small stuff. I am rule based and try to follow the rules I learned in school to the best of my ability. But I wound up in a room where I almost gave a patient the wrong med. I was in an unfamiliar environment. There was a therapist ready to take the patient for rehab, I was already over two and a half hours late getting them their morning meds so I'm rushing to get the medications ready and give a shot when I just felt something wasn't right. I looked at the patient's wristband and saw I had the wrong person. I was in the wrong room. I was so rushed I wound up in the wrong room. I can't tell you the depths of how ashamed I was, my face was so hot and red. I wanted to die. Thank God I caught myself in time but this was too terrifyingly close for me. I'm a checker, I am anal and fastidious and every other adjective you can use for being a pain in the ass perfectionist and I almost made a huge fucking error, which I blame on being placed in a situation that wasn't comfortable or safe. I talked to nurses from my floor at the end of the day and this whole floating/being pulled thing, it's almost like bullying the responses you get for not feeling comfortable about doing it. One nurse told me that she when she questioned being pulled to other floors she was told, 'It's within your job description. You're more than capable of doing this and if you don't feel able to do it than you need to speak up.' I get that this sounds relatively benign but it's like a pervasive, perverse culture of healthcare where you're indoctrinated to 'suck it up and do what you're told and don't be a baby about it' but then, if you mess up, it's all 'well why would you do that?! you should have said something if you didn't feel you could handle that?' Does anyone else think it sounds like a recipe for disaster?

Nurses and aides are placed in impossible situations almost daily. W'ere expected to take care of too many, that are too ill and all the while chart on everything we're doing and you can't do everything and chart and eat and pee, something has to give, which is why so many nurses are familiar with 30 minute lunch shifts that they skip or going 12 hours without using the bathroom (when, ironically, we're to call an MD if patient has urine output less than 30 cc's an hour). And you'll hear nurses swap war stories like it's a badge of honor, who had the sickest patient, the most grueling conditions, and I'm thinking, we're supposed to be considered professionals but we're going shifts without peeing? Haven't companies been sued for women going all day without using the bathroom at work? Why is our profession so intent on suffering in silence? Am I a wimp to think we should be in an environment that treats nurses better? If our critical thinking, moral and ethical code of conduct is so valued why are we swiping in and out, our minutes clocked and if too long they must be accounted for? It seems to devalue our profession.

And I've seen what happens when people feel undervalued and unappreciated. I've seen aides and nurses say woefully inappropriate things, to patients and coworkers. On this floor I was pulled to, there was a patient I had a soft spot for. He reminded me of David Straithairn, the same sort of rumpled good looks. The patient had left sided hemiplegia and needed two people to help reposition him in bed. I called for assistance from one of the aides and she's started muttering under her breath. She came into help me, all the while she's complaining, to the patient, about how he's continually slinking to the bottom of the bed and that he has to stop doing that. That she can't be in his room all the time, she's got a bad back. I was speechless, until the patient replied, 'Wow, I'm really sorry about your back problems' to which I stifled a laugh. Oh my I wanted to hug him for being so funny in spite of her.

I laughed but stuff like that makes me want to cry. Because I don't believe that aide is a bad person, or an unfeeling one. I think she's overworked, underpaid and maxed out on her stress level. At the end of the day a different aide was saying that another patient I had was lazy and that she could get up and use the bathroom perfectly fine on her own but chooses to pee in her brief. This patient had a midline abdominal wound about ten inches long. It was stapled at the bottom and top but the middle five inches were open. No sutures, the wound got packed with saline soaked gauze. Call me crazy but if you've had your rectus abdominis and transverse abdominis sliced through and not stitched back fully something tells me that you probably will need assistance going to the bathroom. I see the best and worst of humanity at work. I'd like to do what I can to help bring forth more of the best of humanity at work.

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