Last week was a busy albeit great week. I decided to pick up Tuesday because I'd like to get some extra hours in occasionally to give myself a buffer at the end of the year. There were 2 LVNs on the schedule so I decided it would work well to pick up that day, so Holly could cover one and I could cover the other. As it turns out, one floated to another floor so I covered the LVN (because I had the assignment the day before) and Holly was extra hands on the floor. I covered the LVN on the same assignment Monday-Wednesday and I was in-ratio (They were short staffed so I took a full assignment myself) on Thursday. Fortunately, it was the same assignment, so I knew the patients.
I've worked 4 days in the week; I've worked 3 in a row, but I've never worked 4 days in a row (Keep in mind these are 12 hour shifts). It worked out well. There was no way I was doing a 5th day. Wednesday was a really busy day, and Thursday started and ended great, but in the afternoon my patient, who was a trauma-blunt abdominal and blunt head trauma had increase abdominal pain. Ultimately what happened was we sent her to Telemetry (She complained of Chest Pain at admission and her Cardiac Enzymes were elevated on the second set).
It was stressful because both the Trauma Surgeon and the newly consulted Cardiologist were both there and there were hella new orders. Thank goodness for our unit secretary who knows how to enter in all of the labs and tests. The really frustrating parts were: it took lab 2 hours to come draw some STAT labs (For the record, I called them 3x and the charge nurse called once and that was documented). One of the labs, Lactic Acid was critically high (4.67). She was the image of sepsis. What's worse is that when I went in to help the resource nurse get her ready to go to her CT, her O2 was Off!. She was on 4L! I was pissed. She ended up going to CT, up to Tele, then to Emergency Exploratory Laparotomy due to air and blood in her Abdomen...
As I think about this know, a mere 3 days later I think about what I could have done differently. What I should have done, what I should have caught on to sooner. I'm not beating myself up, but I am learning from this. She is going to need some aggressive care. I'm put money on her being transferred to ICU after surgery.
After that day and the three preceding it, I spent most of Friday lounging about the house not getting a great deal done. That night, we hung out with Connor, Darby and Ann (VSCs from last year) at Ann's place in Culver City. It was very laid back and fun.
Saturday morning we went to Baldwin Hills. It is a park in the middle of a very industrial area. The main goal of the park is to call attention to nature vs. concrete. It was quite a hike up some very tall stairs to a garden and more trails. We had a picnic and went home. A very quiet night at home rounded out the night.
I found cheap free weights for the house on Craigslist. The money came out of the community account. We now have a basic, but pretty good, exercise room in the house. After we picked them up, we got Dim Sum and Yogurtland. I tried out the weights (I've gotten quite a bit weaker in the past couple months since I haven't done much of anything physical). It will be great to get back into the swing of things. Nachos for supper and it is time for bed!
It was meant to be a short post, but I needed to unload a bit about Thursday.
Sunday, January 30, 2011
Tuesday, January 18, 2011
Thoughts at the halfway mark (A lot of rambling)
We're nearly halfway done with our year of VSC. I should be slightly over halfway done with my hours at the end of the month. I've been at SFMC for 5 months-6 more remain. Many of us in the house are sending off applications to programs, updating resumes and performing job searches.
Personally, I'm up in the air in many ways. I've recently had the possibility of another year of volunteer service re-opened up when informed I can make loan payments on my private loans with my AmeriCorps Scholarship that I get from this year. Whether I want to do this for certain remains unclear at this point.
I do know that I will not be returning to VSC West for another year. It has been a great year, but I don't feel that I second year would benefit me personally in the way this year has. I've done a bit of searching for programs. I'm really open to possibilities regarding another year regarding where I serve and what I do there. I'd really like to do something completely different from anything I'll ever do again in my life.
At the same time, I would like to be able to be close to friends and family....or at least pulling an income that would support me visiting them without great financial difficulty. Plus, I'd like to establish myself as a young adult. I got some advice from a nurse who did years and years of work with the peace corps back in the 60s. She told me that she had a fantastic experience, but she missed out on her young adulthood. When she returned to the states (from Southeast Asia) all of her friends were married and with children. I don't believe another year of service would set me back greatly, but it does make me think and that is worth something.
I've also thought about the fact that if I did do another year of service I would be done when I'm 24. That is so young and I'll have plenty of years to establish myself as a young adult, get a job and start....the rest of my life. Well, at least until I decide to go to grad school, but that is another story entirely.
Then there is the question of where do I apply for jobs if I go that route? Minneapolis? MN? Midwest? Elsewhere? I think I'll conduct a search similar to what I did last spring. Shooting for Minneapolis but open to other places. I may look into the Pacific Northwest. It's nice to know that I have family in the region. The east coast is less appealing for that reason.
It's nice to be able to put this thoughts done into words. I can come back to this in days, weeks and/or months and see how many thoughts have changed. Decisions, decisions....
Personally, I'm up in the air in many ways. I've recently had the possibility of another year of volunteer service re-opened up when informed I can make loan payments on my private loans with my AmeriCorps Scholarship that I get from this year. Whether I want to do this for certain remains unclear at this point.
I do know that I will not be returning to VSC West for another year. It has been a great year, but I don't feel that I second year would benefit me personally in the way this year has. I've done a bit of searching for programs. I'm really open to possibilities regarding another year regarding where I serve and what I do there. I'd really like to do something completely different from anything I'll ever do again in my life.
At the same time, I would like to be able to be close to friends and family....or at least pulling an income that would support me visiting them without great financial difficulty. Plus, I'd like to establish myself as a young adult. I got some advice from a nurse who did years and years of work with the peace corps back in the 60s. She told me that she had a fantastic experience, but she missed out on her young adulthood. When she returned to the states (from Southeast Asia) all of her friends were married and with children. I don't believe another year of service would set me back greatly, but it does make me think and that is worth something.
I've also thought about the fact that if I did do another year of service I would be done when I'm 24. That is so young and I'll have plenty of years to establish myself as a young adult, get a job and start....the rest of my life. Well, at least until I decide to go to grad school, but that is another story entirely.
Then there is the question of where do I apply for jobs if I go that route? Minneapolis? MN? Midwest? Elsewhere? I think I'll conduct a search similar to what I did last spring. Shooting for Minneapolis but open to other places. I may look into the Pacific Northwest. It's nice to know that I have family in the region. The east coast is less appealing for that reason.
It's nice to be able to put this thoughts done into words. I can come back to this in days, weeks and/or months and see how many thoughts have changed. Decisions, decisions....
Sunday, January 16, 2011
Service...
Over my winter break I had many opportunities to catch up with friends and family, which meant I talked about what I've been doing for the past few months many times over. In doing so much talking about what I've been doing, I had the chance to reflect upon my experiences more and engage in a number of different conversations. Ultimately, it made me more aware of the fact that I'm very much engaged in all of the core tenets of this program. They are: Serving the poor and marginalized; living simply; living in community; and personal/spiritual growth/development. I'd like to spend some time blogging about my experiences in each of these.
At the end of 2010 I wasn't feeling like I was getting the full effect of serving the poor. My role at SFMC has me often interacting with a great number of patients but in very short interactions. I often will spend 2 minutes of less with a patient. While many of our patients come from poor environments, I don't often get to hear there stories. I was feeling like I was serving the nurses and staff at SFMC who serve the poor rather than serving the poor.
Last week I met and interacted with a patient who made me realize this isn't true. I got to work on Monday to find that I would be covering a float from the 6th floor. I had a few nurses remind me that I was not to do his work, but rather get my job done as covering RN (Initial Assessment, a note and IV piggyback and push meds) and go about my business helping others on the floor. Well, one of our patients was...challenging. She was very frustrating with the care she had received thus far (She was at SFMC late December, they found a small bowel obstruction and she left AMA-Against Medical Advice. Of course, she came back about a week later). She had surgery a few days prior. She was most disenchanted by her pain control. She has breast cancer and was taking 10mg morphine (A hearty dose) at home every 4 hours as needed.
I tried to listen to her concerns and offer some solutions, apologizes and gather more information; however, she was very tired of telling so many people the same story. During this interaction she complained to me about things I had nothing to do with and had no control over and didn't want to listen to anything that I had to say about things that I could do for her. After a challengling initial interaction and assessment we got out of the room and onto our other 4 patients. Fortunately, the surgeon came by and I told him before he went in the room what's been transpiring. He wasn't surprised. In fact, I believe it went something like this:
Me: "Hey Dr. Stafford, I'm really glad you're here!"
Dr. Stafford: "You have the patient in bed 14 today don't you?"
Clearly, this was nothing new for her. Ultimately, he changes her pain medication. She had a PCA-patient controlled analgesia (The one where the patient pushes the button when they want medication). He increased her settings. She went from getting 2mg continuous infusion every hour and 2mg on demand every 5 minutes to 2mg continuous to 5mg every 15 minutes. She was still frustrated she had to push the button and wanted to just be able to get the 10mg every four hours as need. The PCA didn't go higher and Dr. Stafford convinced her to stick with the PCA. Oh, he also took off the bandage on her abdominal incision.
I'm covering someone for break around noon at the front nurses' station. I get a call from the LVN saying that she wants me to come look at some drainage from the incision. I ask why he doesn't look at it. He says he did, but she wants me to see it. I tell him that I'm covering someone for break and didn't have time but that I'd be back later. This is especially frustrating because I feel like I was babysitting this man in several ways and compound that with this difficult patient just made for a stressful day. She had taken to me a bit and vented her disdain for him. Part of this came from the 4 hour delay in getting her thyroid medication. She has hyperthyroidism, which can cause your emotions to get elevated and somewhat manic (explains a lot).
After I was done covering, I head back to the nurses' station where he was (we have 3 stations on our floor-8100, 8200 and 8300). Mayra, our charge nurse for the day and an overall great nurse, told me she went in and looked at the wound per the patient's request. She said it was fine. I went and looked. A scant amount of serous (clear) drainage. Very minimal redness. Dr. Stafford had apparently told her, right before leaving, his main concern was infection. While that is his job and he is totally right, it seems she interpreted his concern as something very great. To keep a long story from getting too longer here is a snapshot of the next hour:
Pharmacist at desk working on getting thyroid medication dose
LVN working on thyroid medication with pharmacist
Charge nurse calling surgeon
Nurse manager getting filled in on the entire situation
Myself-feeling very caught in the middle
I go in and talk to her. Surgeon orders prophylactic antibiotic. Manager talks to patient. Charge nurse fills in patient on her conversation with surgeon. I educate her on types of drainage and what they mean. LVN gets her the thyroid medication. I stay after the others leave (since I don't have anything else that I need to do as I'm a VSC and don't have my own patients) and talk to her. I come to find out the following:
-She lost her job last june
-She is unmarried and lost her only son when he was my age (I'm not sure when. the date was July 4th-I was under the impression it was 2010; however, based on a picture she had of him and her age I'm not sure. Either way she lost her only son)
-She lost her health benefits in the fall
-That happened around the time she was diagnosed with terminal breast cancer with metastases.
Quite frankly, I'd say her outlook was pretty great. She and I talked. She acknowledged she was a terrible patient and appreciated a lot of things happening. She had come to like me by this point in the afternoon and I to her. Later in the day she told me she apologized to the LVN for being rude and had a short conversation with her. I enjoyed our conversation and was glad I got past the challenges in order to get to know who she was as a person, not just the snapshot of her as a patient in the hospital
I saw her again Wednesday when I popped in to say hey. She was doing better, still not great, but was on the right track. She was thankful I stopped in and we chatted for a bit about stuff. A bit about her status and clinical stuff, but mostly just talked about stuff. I went in the next day a couple times. It was the day before her birthday, I wished her a happy birthday and said I'd be off until Monday. Hopefully she has since been discharged. I don't imagine she'll still be there tomorrow. Maybe.
Collectively, I spent a good number of hours in her room. I got a hug from her before I left Thursday. Quite the turn around from Monday. I think I would have had a good connection with her even if I was a staff nurse and she was my patient; however, I think that because I had the time to devote to her I got a deeper connection. That right there is part of why my role as a VSC RN is special. That is how I serve our patients.
At the end of 2010 I wasn't feeling like I was getting the full effect of serving the poor. My role at SFMC has me often interacting with a great number of patients but in very short interactions. I often will spend 2 minutes of less with a patient. While many of our patients come from poor environments, I don't often get to hear there stories. I was feeling like I was serving the nurses and staff at SFMC who serve the poor rather than serving the poor.
Last week I met and interacted with a patient who made me realize this isn't true. I got to work on Monday to find that I would be covering a float from the 6th floor. I had a few nurses remind me that I was not to do his work, but rather get my job done as covering RN (Initial Assessment, a note and IV piggyback and push meds) and go about my business helping others on the floor. Well, one of our patients was...challenging. She was very frustrating with the care she had received thus far (She was at SFMC late December, they found a small bowel obstruction and she left AMA-Against Medical Advice. Of course, she came back about a week later). She had surgery a few days prior. She was most disenchanted by her pain control. She has breast cancer and was taking 10mg morphine (A hearty dose) at home every 4 hours as needed.
I tried to listen to her concerns and offer some solutions, apologizes and gather more information; however, she was very tired of telling so many people the same story. During this interaction she complained to me about things I had nothing to do with and had no control over and didn't want to listen to anything that I had to say about things that I could do for her. After a challengling initial interaction and assessment we got out of the room and onto our other 4 patients. Fortunately, the surgeon came by and I told him before he went in the room what's been transpiring. He wasn't surprised. In fact, I believe it went something like this:
Me: "Hey Dr. Stafford, I'm really glad you're here!"
Dr. Stafford: "You have the patient in bed 14 today don't you?"
Clearly, this was nothing new for her. Ultimately, he changes her pain medication. She had a PCA-patient controlled analgesia (The one where the patient pushes the button when they want medication). He increased her settings. She went from getting 2mg continuous infusion every hour and 2mg on demand every 5 minutes to 2mg continuous to 5mg every 15 minutes. She was still frustrated she had to push the button and wanted to just be able to get the 10mg every four hours as need. The PCA didn't go higher and Dr. Stafford convinced her to stick with the PCA. Oh, he also took off the bandage on her abdominal incision.
I'm covering someone for break around noon at the front nurses' station. I get a call from the LVN saying that she wants me to come look at some drainage from the incision. I ask why he doesn't look at it. He says he did, but she wants me to see it. I tell him that I'm covering someone for break and didn't have time but that I'd be back later. This is especially frustrating because I feel like I was babysitting this man in several ways and compound that with this difficult patient just made for a stressful day. She had taken to me a bit and vented her disdain for him. Part of this came from the 4 hour delay in getting her thyroid medication. She has hyperthyroidism, which can cause your emotions to get elevated and somewhat manic (explains a lot).
After I was done covering, I head back to the nurses' station where he was (we have 3 stations on our floor-8100, 8200 and 8300). Mayra, our charge nurse for the day and an overall great nurse, told me she went in and looked at the wound per the patient's request. She said it was fine. I went and looked. A scant amount of serous (clear) drainage. Very minimal redness. Dr. Stafford had apparently told her, right before leaving, his main concern was infection. While that is his job and he is totally right, it seems she interpreted his concern as something very great. To keep a long story from getting too longer here is a snapshot of the next hour:
Pharmacist at desk working on getting thyroid medication dose
LVN working on thyroid medication with pharmacist
Charge nurse calling surgeon
Nurse manager getting filled in on the entire situation
Myself-feeling very caught in the middle
I go in and talk to her. Surgeon orders prophylactic antibiotic. Manager talks to patient. Charge nurse fills in patient on her conversation with surgeon. I educate her on types of drainage and what they mean. LVN gets her the thyroid medication. I stay after the others leave (since I don't have anything else that I need to do as I'm a VSC and don't have my own patients) and talk to her. I come to find out the following:
-She lost her job last june
-She is unmarried and lost her only son when he was my age (I'm not sure when. the date was July 4th-I was under the impression it was 2010; however, based on a picture she had of him and her age I'm not sure. Either way she lost her only son)
-She lost her health benefits in the fall
-That happened around the time she was diagnosed with terminal breast cancer with metastases.
Quite frankly, I'd say her outlook was pretty great. She and I talked. She acknowledged she was a terrible patient and appreciated a lot of things happening. She had come to like me by this point in the afternoon and I to her. Later in the day she told me she apologized to the LVN for being rude and had a short conversation with her. I enjoyed our conversation and was glad I got past the challenges in order to get to know who she was as a person, not just the snapshot of her as a patient in the hospital
I saw her again Wednesday when I popped in to say hey. She was doing better, still not great, but was on the right track. She was thankful I stopped in and we chatted for a bit about stuff. A bit about her status and clinical stuff, but mostly just talked about stuff. I went in the next day a couple times. It was the day before her birthday, I wished her a happy birthday and said I'd be off until Monday. Hopefully she has since been discharged. I don't imagine she'll still be there tomorrow. Maybe.
Collectively, I spent a good number of hours in her room. I got a hug from her before I left Thursday. Quite the turn around from Monday. I think I would have had a good connection with her even if I was a staff nurse and she was my patient; however, I think that because I had the time to devote to her I got a deeper connection. That right there is part of why my role as a VSC RN is special. That is how I serve our patients.
Tuesday, January 11, 2011
A Quick Update. Perhaps the first of many more??
So I've been meaning to do a post about my winter break in MN, but I just haven't had the time/energy to sit down and write it all. Instead, I am going to update with a bit of what I've been doing lately. Hopefully I will come back and finish a post on MN and continue to write some longer, insightful posts while having small updates.
Last week everybody in the house got back into their routines. We returned to work, caught up with one another and re-established our food supply. We also learned that VSC west was interviewing someone for a half-year.
Fast-forward a few days to pretty low-key weekend, to hearing about the new VSC, Jon. He was accepted and placed in MM. We met him tonight and dinner and he will move in Thursday. He seems like a cool guy and should mesh well with our community. We're excited.
Backtrack to yesterday. I covered a float LVN's assignment, which shouldn't be any different, but this guy is...not the greatest nurse in the world. Pair that with a patient who was under a lot of stress and it just isn't a good thing. I want to come back to this patient in greater detail, but basically I did a lot of customer service/saving face/education while I was there. We had some pretty great discussions too. I needed that because I've felt like I'm lacking in true interaction with patients since I float around the floor a lot.
I'm meeting with my site supervisor, Gilda, on Thursday. We're going to talk about a number of things, one of which is perhaps added another dimension to my service here. I'm not sure what implications that will have regarding my service on the 8th floor. I have not intent to leave there, but I wouldn't mind doing one less day a week there or something to that effect. We'll see what my options are based upon who pays for my stipend and the like.
This was meant to be a short post....it's a bit verbose, but it didn't take long to write. I'm working tomorrow and Thursday so it is time to get to bed!
Last week everybody in the house got back into their routines. We returned to work, caught up with one another and re-established our food supply. We also learned that VSC west was interviewing someone for a half-year.
Fast-forward a few days to pretty low-key weekend, to hearing about the new VSC, Jon. He was accepted and placed in MM. We met him tonight and dinner and he will move in Thursday. He seems like a cool guy and should mesh well with our community. We're excited.
Backtrack to yesterday. I covered a float LVN's assignment, which shouldn't be any different, but this guy is...not the greatest nurse in the world. Pair that with a patient who was under a lot of stress and it just isn't a good thing. I want to come back to this patient in greater detail, but basically I did a lot of customer service/saving face/education while I was there. We had some pretty great discussions too. I needed that because I've felt like I'm lacking in true interaction with patients since I float around the floor a lot.
I'm meeting with my site supervisor, Gilda, on Thursday. We're going to talk about a number of things, one of which is perhaps added another dimension to my service here. I'm not sure what implications that will have regarding my service on the 8th floor. I have not intent to leave there, but I wouldn't mind doing one less day a week there or something to that effect. We'll see what my options are based upon who pays for my stipend and the like.
This was meant to be a short post....it's a bit verbose, but it didn't take long to write. I'm working tomorrow and Thursday so it is time to get to bed!
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