evening of visiting. Kathie, Sr, the past volunteer and Santa Barbara left. San Fran went to bed and some of MM went home, which left BH, myself and Jess up to drink hot cocoa with peppermint schnapps and play catch phrase and a bit of N64. Grand Times. I should also mention that MM decided to wear ugly sweaters/vests. Mine had glitter and bears on it.The next ev
ening the family went to Pershing Square for the Winter Festival. It was booths set up for families and kids to enjoy the holidays. They had foods, baked goods, face painting, crafts, etc. They also had an ice skating rink and a "hill" of snow with "sledding" The height of the hill was probably 10 feet or so and the length was about 75 feet. Still, they made it work. It was about 75 degrees that day, so it was very out of place. It was a cute little event that showcased some joy in the downtown that we know if a different light. We got a free picture of us in the "Winter Holiday Festival" Train. It's a touch blurry, but there wasn't a charge!This week at SFMC was a busy and a good example of how every day is different. Holly and I have been working set schedules now that we're both off orientation. I work every Monday, Wednesday and Thursday; She works Tuesdays, Wednesdays and Fridays. As volunteers, Holly and I don't displace or cancel any staff. We don't take regular patient assignments like the other floor nurses. Instead we cover the LVNs patients and do other things on the floor. Typically, the LVN has 5 patients just like the RNs. Each patient will be covered by another RN on the floor who has their own assignment. The LVN can do just about everything the RN can. The major differences are that RN must document an assessment or co-sign the LVNs assessment and the RN must administer all IV piggyback and push medications. Typically my day looks like this:
-Arrive and get assignment. Get report from night shift with LVN.
-Assess patients
-Check meds
-Administer AM meds
-Open all charts
-stay at pod while LVN takes breakfast. If the other nurse at that pod hasn't had breakfast at this point, cover them when the LVN returns. Then I take breakfast. This is usually sometime between 10:30 and 11:30. Sometimes it is so busy I don't take a break.
-Once the charts are open I am free to help out until about noon when I start covering nurses for their 30 minute breaks. Usually I cover about 3 or 4 nurses and the charge nurse covers the other 3 or 4. This consists of me receiving a brief report on their assignments and assuming responsibility for their assignment while they are gone. This was very nerve wracking and challenging at first, but I'm getting the hang of it and what I need to know before they go.
-I'll take my 30 minute break around 3:00 if I'm not too busy. Sometimes I will take only 15 or not at all.
-3:15 is change of shift for CNAs and the Unit Secretary. Usually there is no evening secretary, so I help the charge nurse fill that role as well.
-The remainder of the shift I just help out the nurses that need help. By this time I've covered about half of the nurses on the floor so I have a pretty good idea of what is going on with the patients so I know what I can do that will help them out. Everyday is different. Some days I do a lot of secretary work, others I perform a lot of technical skills (IV starts, foleys, NGs, blood transfusions and the like), sometimes I'll do discharges and/or admissions. It really varies, but I usually keep very busy.
That's my typical day. Monday I was with Blanca, an LVN, who just returned from maternity leave. We had a good day that was similar to what I described above. I hung 6 different anti-microbial piggybacks for ONE patient! It was epic. The reason was that he had 3 or four and the ID doc dc'd a few that I had already hung earlier that day and ordered 3 more!
Holly and I work every Wednesday. The reason is because Wednesdays are usually the busiest days on the floor because it is skin day. Every patient's skin breakdown risk score are assessed and we make sure that the proper interventions are in place. Additionally, photos of all pressure sores are taken and put in the chart. I've done the skin sheets the last two weeks. This week Holly did it and I covered the LVN like I do on regular days. The skin doesn't take up our whole day, so there is even more extra help on the floor.
I went in Thursday to discover on the assignment that there was no charge nurse. This has happened before and what we did was instead of me covering the LVN, I took the would be charge nurse's assignment thus giving us a charge nurse and having the assignment balanced. It's nice to have these days every now and then. I've done it once a few weeks ago and had a chaotic assignment. I had 5 patients. I discharged two (both before 1pm!), transferred one out and received a transfer from ICU. I opened my last chart at 5:00pm. I was hella busy. This past Thursday I had a much easier assignmet. It started off a bit rocky, but I got it worked out. It was a great day to practice being a patient advocate and getting what I needed for my patients.
One patient had a lot of nausea and vomited a few times. She had surgery two days prior and was on clear liquid diet. She wasn't tolerating it well and had pain. I talked to the doctor and she dc'd morphine leaving the patient with round-the-clock motrin. we made her NPO. she was up later and ordered a radiology study if vomiting continued, which it did. I sent her to the KUB study and shortly after she returned she was short of breath. I tossed some O2 on, sat her up and got a pulse ox. She was ok and we got her breathing better. She was in a lot of pain, so I got her toradol. It turns out she had an ileus. With less than an hour in the shift I had to put an NG tube in. I started to put it in and she grabbed my hand, ripped it out and started sobbing. I endorsed it to the next shift. (She was doing a lot better the next day, she apologized to me-not necessary, but nice).
I had another patient, total knee replacement, Spanish speaking only. I walked in there, first patient of the day that I saw-his entire right side of his gown covered in blood. He pulled out his IV. Great. I got a new gown and got him cleaned up a bit. He was in a good deal of pain. I told him I would need to start an IV to give him the morphine that he had ordered but he would not have it. He could also have 1 vicodin every 4 hours. He was down for it. I may not know a lot of Spanish, but the dialogue was pretty clear. I gave the vicodin and called it a day. Later, after PT about 1030 he was having more pain. I told him we could do the IV and he said no. The CNA talked to him in Spanish to no avail. I called the doctor, but he was in surgery. A while later, I got a hold of the doctor and got an order for IM morphine. For whatever reason, he was completely fine with that needle. He actually was fine for pain the rest of my shift. The only other problem was that the CPM (continuous passive motion) machine stopped working. They had to get one from an outside source. Again, endorsed to next shift.
I had another patient who had morphine every three hours. He was the patient who waited for the EXACT time to get his next dose. He slept most of the day, which worked out in my favor. He was a nice guy, but I am not a fan of when patients tell me to "push it in faster" or not to dilute it in the TKO lines.
I had another patient who had his CT removed early in the day. He didn't have pain and pretty much just slept all day. He got discharged the next day.
My last lady was a weak woman who was to be transferred to hospice the next day. She took a good deal of my time. Up to chair TID. I got her up twice and that was a feat. I put a new foley in because hers leaked. Thank goodness I had a nursing assistant for her for my whole shift. It made my life that much easier.
Actually, because we didn't have a charge nurse (technically speaking because I am not a part of the staffing so from their standpoint we didn't) we got extra nursing assistants, which means we had 3 on the floor (enough to cover almost all patients) PLUS two 1:1 sitters (one of which I had) which means I had a CNA for all 5 of my patients for the first 8 hours, which makes a world of difference. Again, it was a pretty easy day. I got busy in the last hour or so, but so it goes. I gave a rock solid report at change of shift. During which time, Beverly, my manager, asked if I'd be willing to come in the next day to cover assignments so people could go to the fall risk assessment training class as it was the last day.
I had offered to do this two weeks prior, but she declined because she was didn't want me making overtime. I got that cleared up. I don't make overtime, I have a set stipend and if I am at SFMC anytime I am covered by their insurance. I mean, I need 1700 hours to get my AmeriCorps scholarship. The program is designed for me to do so, but I'd rather get to that number sooner than later in case something happens. A buffer if you will.
I went in with Holly Friday. She covered the LVN and I discovered we didn't have a unit secretary. I took on the role for the day. There were only two nurses on that day who needed to go to the 1 hour class so I covered one in the morning and the other for the afternoon session. I also helped out when I was putting in orders or covering. The last few hours were unusually slow on the floor, but it was a nice break for everybody.
So I was the volunteer covering the LVN/extra set of hands; nurse with patients and improv unit secretary this week. Never a dull moment. I can't think of an RN role that is like ours. We get to just help out around the floor. It's good for us and it is good for the floor. Other nurses who float to our floor are jealous that we are there but very thankful for our help.
It was a difficult transition to our current role on the floor. There was a great deal to learn, but even after a mere 4 months I feel much more confident in my skills. I am excited to for the next 7 months there. As for the rest of this experience, it is great. I am really living on a budget-not that I wasn't before but now more than ever. My housemates are amazing and we've shared in so much in this experience together. We are 1/3 done with our year with VSC. It blows my mind, but I am very glad I made this decision. I've done a lot of things I never would have otherwise, and I've learned a lot about myself by putting myself in a very different situation than what I'm used to.
Today we went to Homegirl cafe after reveling who our secret santas were with the final gift exchange. It was a great lunch to celebrate the end of 2010 and our 4 month marker. If you're unfamiliar with Homeboy industries, I recommend you check it out. I've had the privilege of hearing Fr. Boyle speak and I've just started reading his book "Tattoos on the heart". My housemates say it has a lot of stories in it that he told us at the Vincentian Family Day. If that is the case, I recommend reading it.
Holly and I are both going in Monday and we fly back to MN Tuesday. I'm extremely exciting and worried I won't be able to handle the cold weather! Fortunately, LA is experiencing "cold and rainy" right now, which is the closest to winter I will get out here.
