Change of Shift is on its second year and is being hosted by Beth over at Nursing Link. It’s the first time CoS has been hosted at a site other than a nurse blog! Lots of great posts to read!

Kim
at Emergiblog has been writing about the new nursing forums, so I thought I’d chime in, too!

First of all, Nursing Voices is a brand-new forum with lots of categories in which to post. Kim, Mother Jones, and yours truly (username geenaRN) are the current moderators of the forum and would love to see you there! Lots of discussions going on – there’s definitely something for everyone!

And Nursing Link is a brand-new site encompassing almost everything having to do with the rapidly expanding world of nursing! Stop over there to peruse the latest nursing news, forum discussions, featured bloggers, and product reviews. Beth of Pixel RN is overseeing the site along with Affinity Labs and there’s already a phenomenal amount of information.

I have already spent lots of time on both websites.

I do also want to plug another place for nurses to get together – Everyday Nurses. This is another message board/forum started by Terry of Counting Sheep to share information and get connected with fellow nurses. I have not yet had time to head over there, but hope to soon! I seem to find a new nurse blog almost every day!

Enjoy!

I was out at the desk putting more paper in the recorder when a patient’s wife came running out to the station.

“Please come quick! Someone come check on my husband!”

Not having heard any alarms, I quickly glanced at the monitor and saw nothing out of the ordinary (Not like that comforts me any more) but headed into his room right behind his wife.

“He’s breathing fast, he’s coughing and his pulse is really high!”

I looked at the patient. He was on the ventilator and yes, he looked as though he was breathing a bit fast. The vent confirmed this, showing that he was breathing over 40 times per minute. Looking at the monitor, I saw that his heart rate was 88. I then turned towards the wife and she knew what I was going to say…

“Well, it was 102 a second ago!!”

“But it’s okay now. And you’re right, he’s breathing fast. This is the second day that we’ve tried to wean him from the ventilator and he’s not tolerating the lower settings. His nurse is in with her other patient; I’ll go let her know.”

Her shoulders relaxed almost imperceptibly, but then tensed up again as she looked back at him lying in the bed. She started wringing her hands and talking defensively. “I don’t usually panic like this, it really does take a lot to…”

I put my hand on her shoulder as I interrupted her.

“But he’s your husband.”

I don’t know what she was expecting me to say, but it wasn’t that. Her face showed a split-second of surprise before her shoulders relaxed entirely. I don’t know how to describe it except to say that every feature of her face soon followed in a display of utter and complete relief.

“Yes,” she nodded. “He’s my husband. Thank you for saying that.”

Sometimes we take care of the families, too.

Here’s a story submission from a loooong time ago. My apologies for not posting it sooner.

“She says she’s depressed. What she needs is to get a life.”

“She only comes to the hospital for drugs. Take a look at all the psych drugs she’s on.”

“Hey, take a look at this list of medications, she must really be crazy.”

“Depressed? What does she have to be depressed about? She has a great husband and two kids that are never in trouble. She must just want some sort of attention.”

All of us, at one time or another, have said these things about our patients; if not out loud, then to ourselves. Each and every one of us has a preconceived idea about depression and the people who say they are depressed. I’m sorry to say, but most health care professions hold a somewhat negative view when it comes to mental health issues.

I have been more aware of these kinds of stereotypical comments about people who are being treated for depression than ever before. The comments that people make hurt me down deep into my soul. It helps perpetuate the myth that being physically ill is acceptable, but being mentally ill is not. Insurance companies will cover the cost of lab work ordered for a physical illness at 100%; whereas lab work ordered for a mental illness is covered only at 80%, if at all. What kind of message does that give the general population? I’ll tell you, it continues to keep depression in the dark ages. I think one of the reasons I have become more aware of how health care workers and the general population treat people who are depressed is because I am one of those “drug-seeking, crazy people who needs a life and wants attention.” What is worse is that I am a health care professional. Yes, that is right, I have been treated for Major Depression and lived to tell about it.

Surprisingly to most people, depression is just a chemical imbalance that can be treated, in some ways just like an electrolyte imbalance. What is the major difference? An electrolyte imbalance is acceptable, a chemical imbalance is not. The real scary part is that people like me – and you – can get it!

Let me start by telling you my story. Last year, I was hospitalized in the “Psych Ward.” Apparently I had been depressed for some time and didn’t know it. I, like so many others, held the view that a person would know if they were depressed. They did not have to be told. You see, I was always so confident and self-assured, always smiling and laughing, not the picture of a depressed person. A person who was depressed was a weak individual with no self-confidence or self esteem; I had both, so I could not be depressed.

A few months prior to my psychiatric hospitalization, I started to have some “serious health problems.” I call them serious because I couldn’t get a definite diagnosis about what was wrong with me. Every time I ate, I got terrible abdominal pains, nausea, and at times I would vomit. My gastrointestinal disorders were so bad, I was sure I was dying of some exotic disease that only occurred in one out of 100 million people. I had all the “tests” that accompany a GI problem. That’s right. I had an endoscopy, colonoscopy, upper GI, and a lower GI. The only thing that I can remember from those tests is that the doctor was surprised at the amount of Versed and Demerol he had to give me to calm me down and even then I was carrying on a somewhat intelligent conversation. In fact he told me, “You must really be anxious to require all the meds I gave you.” A light should have gone on then, but it didn’t. I was sent home with medications to help my “Irritable Bowel Syndrome.”

Well, the GI problems continued despite my compliance with the medication. In the meantime, my family and close friends started to notice a change in my personality. I had become more quiet and withdrawn. Apparently, I was no longer able to convince myself or others that I was happy and I retreated into myself. I talked only when absolutely necessary and my mind was often preoccupied and I would just stare out into space. My family kept asking me what was wrong, but I kept telling them “nothing” and “I’m fine.” You see, I didn’t know what was happening. I didn’t realize how quiet and withdrawn I had become. I thought everyone else had gone crazy because I was the same as I had always been – or so I thought.

In many ways, I am more fortunate than most because if it were not for my family and friends who know me so well, I would not be here today to tell you this story. Slowly, without realizing it, I had become suicidal. I had thoughts of driving my car off of a cliff, into a tree, or into the path of a rapidly moving 18 wheel semi-truck. The only problem I had with those ideas was that I was afraid that I wouldn’t die, but become a quadriplegic and then I would be unable to finish the job. Were these rational thoughts? No! But to me, they were real options, very real. A good portion of my waking hours were spent thinking about ways to kill myself; and I did have a good portion of “waking hours” because I could no longer sleep. I felt my whole life was falling apart and the only rational thing to do would be to end it all.

Why was my life falling apart? I don’t know. My children were not on drugs, they had not been sexually molested by any of their relatives and they were not terribly misbehaved. My husband was kind, attentive, supportive, and helpful. He was not having an affair with one of my close friends or relatives like the people on Jerry Springer, so what could be wrong? I didn’t know.

After several office visits to my family doctor for my stomach ailments, he told me he thought I was depressed. Of course I told him he was crazy because I did not have anything to be depressed about. You see, even then, I would not accept the idea that I had a chemical imbalance and was depressed. There had to be some reason, some precipitating event, some physical problem that brought on depression and I had none of those. I couldn’t be just plain depressed. I wasn’t “weak.”

As the days progressed, I became more and more despondent. I had essentially quit talking to everyone except while I was at work, and then, only when necessary. I could not make simple decisions, like what clothes I should wear, without going through a major crisis in my mind. My mind was overloaded. My head was spinning. Help me! By now, I knew something was wrong. I knew I was having some severe emotional problems. Yes, I had a brain tumor, what else could it be? I couldn’t go on like this. I was scared. My family was scared. My friends were scared.

I allowed myself to be locked up in the “crazy ward.” I was led blindly down death row accompanied by my husband and doctor. I was being locked up. I had gone mad never to return to sanity again. I would be the “mad housewife” for all eternity. I was hospitalized for about 10 days. I can’t remember much about my stay except that I cried a lot, was hugged a lot, and was made to feel absolutely safe – and sane. I was comforted not only by my family and friends, but the staff as well. During the night when I could not sleep, the staff was there to help me. During the day when I couldn’t make simple decisions, the staff was there.. When I needed to cry, there they were. Easy job? I don’t think so.

It has been well over a year since my bout with Major Depression. I no longer require medications to help keep me “sane;” but right now I do live with a little fear that the depression that sucked the life out of me will return. By far, my experience with depression is the most devastating thing that I have been through to date. It’s not only the depression that was devastating, but what I knew people’s perception of depression to be.

A year ago, I would not have told my story. I have come a long way and still have a long way to go. I tell you this story in hopes that the hidden comments and giggles will stop when you see a diagnosis of “depression” or have a patient who is on “Pamelor or Mellaril.” You allow me to hear your comments because you do not know I am one of them. If you only knew . . . . . . . .

________

This is a true story that I wrote almost 15 years ago. Although it’s an old story, it is still something that needs to be said.

Everyone who hosts Grand Rounds gets an interview and write-up by Dr. Genes in Medscape. Here’s mine. Thanks Nick!

(I think subscription is required!)

Welcome to Grand Rounds 3:39! This is my fourth time hosting (The second four-time hostess!) and to commemorate the occasion, I’ve decided to unleash Henrietta the Healthcare Worker, my inner advice columnist. Enjoy the links!

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DEAR HENRIETTA: I’ve had a problem for a long time. I’ve seen many specialists and have had many tests to figure out what’s causing my problem. None of the treatments work. Surely the doctors in the ER have seen it all and might know how to help me? –OUT OF OPTIONS IN OKLAHOMA

DEAR OUT OF OPTIONS: GruntDoc puts it best – “Sometimes expectation management is the best we can do, for everyone.”

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DEAR HENRIETTA: My child has physical limitations. He’s resistant to doing his therapy and everyone treats him as though he’s made of glass! How can I encourage him? –DAD TO DELIGHTFUL TOT IN DELAWARE

DEAR DAD: Ambulance Driver has experience with this topic and writes eloquently about how to incorporate exercises into everyday situations: “I let her steer, taking care to keep her left palm firmly pressed to the handlebars. The vibration is good feedback for those dormant nerve pathways we’re trying to awaken. We do lots of right turns to, once again, extend that left arm, and we also do plenty of flat spins to the left, to teach her to shift her weight.”

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DEAR HENRIETTA: I feel sad and frustrated about the patients who are brought to my hospital because they have intentionally overdosed. I just can’t relate. What on earth are they thinking?? –FRUSTRATED IN FLORIDA

DEAR FRUSTRATED: Sometimes suicide attempts are meant to be successful, sometimes not. In either case, drytears tells us exactly what she was thinking: “I was scared, I felt there was no way out, and down went the next two.”

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DEAR HENRIETTA: Why can’t we all just get along? –ANGSTFUL IN ANAHEIM

DEAR ANGSTFUL: Kim at Emergiblog shares her observations and has a few suggestions for keeping the peace: “May we never forget that there is a person on the other side of that URL.”

Rita from MSSPNexus Blog gives some tips for building relationships at work: “You could accurately describe a rose as soft and beautiful or as difficult and thorny; it all depends on your focus.”

If you want to walk away from the drama and just do your job, Dr. Emer at Parallel Universes lets us know what patients want: “Human interaction requires skill sometimes, and for overworked and stressed physicians [ed: and everyone else!], that can be quite a challenge.”

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DEAR HENRIETTA: I have my own practice and am struggling to make ends meet. A colleague has asked me to buy into a new practice that he’s starting. What should I do? –STRUGGLING IN SACRAMENTO

DEAR STRUGGLING: Mother Jones RN at Nurse Ratched’s Place has done some reconnaissance work and has some interesting findings: “And I thought nurses were the only ones who could be that malicious to their colleagues.” I dunno, Struggling – doesn’t sound good!

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DEAR HENRIETTA: My husband was just diagnosed with diabetes and he won’t follow his treatment plan! Doesn’t he care about what could happen to him? –MRS. NON-COMPLIANT IN KANKAKEE

DEAR MRS. NON-COMPLIANT: Being diagnosed with a chronic illness is a big deal. Most chronic illnesses require major life changes. It takes some getting used to! Kerri from Six Into Me explains how even grocery shopping becomes an internal struggle: “Stomach: Baby spinach, baby carrots. You eat babies. Heh heh. FEED ME. I’m running out of patience.”

Chronic illnesses affect both young and old and can interfere with even the most basic human activities. Ann, featured on Chronic Babe, describes the difficulty she had after giving birth due to having been on bedrest during the end of her pregnancy: “The worst, though, was having no strength whatsoever. I couldn’t even move myself up on the bed, or get up and attend to my daughter.”

We do our best to predict or explain our chronic diseases, as Dr. Lei from Eye On DNA found out when she interviewed Kendra RN, who had a genetic test for diabetes: “I was primarily concerned that if “those” genes were present in my DNA, there would be an increased risk factor for my 3 daughters.”

Fortunately, when we have problems managing diseases such as diabetes, there are advocacy groups ready and willing to help us out, as Amy at Diabetes Mine discovers: “DM) OK, so if one of our community is arrested during a hypoglycemic episode we can really call you? MG) We have enough money in our slush fund to get you out of any jail. It’s called bail money.” Whoa!

And when it all gets to be too much, Rachel from Tales of my Thirties reminds us that sometimes a moment to relax and have someone pamper us can put things into perspective: “Ahhh, she’s working on my aching calves. The words metformin, Januvia, and Byetta slip away from my mind.”

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DEAR HENRIETTA: I work night shift and am finding it difficult to make it home in the morning! What can I do? –SLEEPY IN SYRACUSE

DEAR SLEEPY: Maybe you could take a page out of TC’s (donorcycle) book when the sky goes from navy to pale pink: “Row houses and hospitals, court houses and schools, all come alive again with a rosy light. Look out the corner of your eye and instead of morning traffic, you’ll swear you see a guy delivering ice with a team of Clydesdales.”

Or maybe you need to start working day shift. Your call!

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DEAR HENRIETTA: My grandmother was just diagnosed with Alzheimer’s Disease. What can I expect as this disease progresses? –WORRIED IN WICHITA

DEAR WORRIED: It’s probable that the disease will make her regress, as Dr. Val from Revolution Health writes, “But the strangest part of grandma’s journey with Alzheimer’s was that it took her on a reverse tour of her former life. She seemed to be reliving each day that had had the most emotional impact on her – in descending chronological order.”

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DEAR HENRIETTA: I was a patient in the Emergency Room the other day and the person in the gurney next to mine was ranting and screaming. No one paid her any mind and eventually I was discharged home. What was that all about? Why wasn’t anyone trying to help her? –CONCERNED IN CONNECTICUT

DEAR CONCERNED: The person next to you may have had a mental illness or was withdrawing from their substance du jour. Sometimes security personnel can keep an eye on them, but sometimes not, as Susan from the Rickety Contrivances of Doing Good relates: “Security will still show up to evaluate each of these patients, and will put them in restraints if there seems to be any danger of violence, but they’ll no longer sit with them.” I guess I always assumed every ER already operated this way. Henrietta is sad that this ER is cutting back on security services for this patient population which seemed to be serving in the best interest of the patient and the staff.

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DEAR HENRIETTA: I am a consumer of healthcare, not a provider, and am also an avid reader of medical blogs. The other day I came across a blog written by a doctor that included details of a patient’s history, including their name and procedure! Is this accepted practice? Should I be worried about my doctor having a blog? –APPALLED IN APPALACHIA

DEAR APPALLED: It is absolutely NOT an accepted practice to divulge any details about patients in any kind of public forum. Mike at Interested Participant describes a recent case in Australia involving this very topic, and muses about how this case would go down in the US. (No quote here – you’ll have to read to find out just how bad it might get!)

JC at Health Observances also proffers some advice to healthcare bloggers: “Sure, we all need to let off steam now and then about stressful situations at work, but when it involves intimate details of the lives of other human beings – we have no right to parade those details in a public forum.”

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DEAR HENRIETTA: Is there anything in the world that is quite such a lovely phenomenon as the incredible wicking white cotton granny panty? –WONDERING IN WAIKIKI

DEAR WONDERING: MonkeyGirl has just the answer for you!

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DEAR HENRIETTA: I can’t stand when bad things happen to my favorite patients! I go home at night and I can’t get them out of my head. Do other practitioners have this problem? –DISTRESSED IN DELAWARE

DEAR DELAWARE: Of course they do! It’s hard not to become attached to some patients. Bohemian Road Nurse describes a recent event when a home-health patient of hers coded in the hospital, while the agency’s CNA looked on: “Jenna was helping Mrs. Turnwater hobble over to a chair next to her bed after her bath, and Mrs. Turnwater suddenly grabbed Jenna with both arms, pinning Jenna’s own arms. Then Mrs. Turnwater went unconscious and limp.”

And Dr. Bishara from The Doctor Blogger relates a story about a patient that not only has little support at home for her major illness, but is taken advantage of as well: “She is trying not to think about the cancer and “keep going”. Weirdly, her son and his family have moved back in with her so she can support them because her adult son lost his job. The family does not believe she has anything really wrong with her and keep telling her “you’ll be alright” while still living under her roof and allowing her to work and pay all their bills.”

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DEAR HENRIETTA: I don’t get all of this single-payer national health insurance business. Some people say it’s good, some say it would be a disaster. What is your take on it? –PERPLEXED IN PITTSBURGH

DEAR PERPLEXED: Henrietta is not the person to ask about such things, as they are very confusing to her also! But Bob at InsureBlog has some thoughts: “Seems no one ever mentions the queue in other nations. No one says anything about how some citizens of these supposedly superior systems buy private insurance to supplement the nationalized system or they pay out of pocket or sometimes even come to the U. S. for care.”

And here’s an account from Prudence of Prudence and Madness regarding a practice in the Philippines – pre-payment for services: “So now comes the almost never-ending haggling. The hospital wanted them to make a deposit of, at least, P10,000 within 24 hours because 2 patients will be having major operations and the money can be used to cover the initial treatments and the units of blood that will be used. The relatives just couldn’t make up their minds.”

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DEAR HENRIETTA: How can I ruin the birth of my child? –NUTTY IN NASHVILLE

DEAR NUTTY: Dr. Nic at Shoe Money Tonight has 12 suggestions on how to do just that!

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DEAR HENRIETTA: How do practitioners know when new treatment therapies have been discovered? –OLD SCHOOL IN OSWEGO

DEAR OLD SCHOOL: They read blogs :-) Dr. Rosielle at Pallimed informs us about a study published in Neurology regarding early treatment limitations and their effect on mortality: “Translation: don’t withdraw/limit life-prolonging care immediately because you may be wrong.”

Dr. Schwimmer from Tech Medicine describes aquapheresis as a new therapy for heart failure: “In an attempt to overcome the problems with diuretics and the requirement of a dialysis machine for ultrafiltration, a company called CHF solutions has designed a device for ultrafiltration — which they call “aquapheresis.” (In two parts, link at bottom of part 1)

And Matt at the Behavior Ecology Blog explains results from a study about pre-op hematocrits and surgical outcome: “Unfortunately, in a recent study published in JAMA, and highlighted in ScienceDaily about hematocrit and surgical risk- the 2 relationships are seriously confused…”

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DEAR HENRIETTA: How do practitioners know about new drug therapies or new uses for old drugs? Or how Coca Cola can be used in medicine? –PRO-PHARM IN PENSACOLA

DEAR PRO-PHARM: Again, blogs! Liana from Med Valley High professes this: “Interestingly enough, Coca Cola also reigns supreme as the most commonly used therapy in a small but important area of medicine: the unclogging of gastrostomy tubes.” Look for the scientific explanation in the comments.

Girlvet at Madness: Tales of an Emergency Room Nurse muses about the new birth control pill that can stop menstruation altogether: “This feels like another step toward trying to control nature. If it’s inconvenient get rid of it. There can be no discomfort in our lives.”

Dr. Bookspan at The Fitness Fixer addresses the recent news about a teenage girl that died after using too much Bengay: “Deaths are rare, but salicylate poisoning is not rare or unknown.”

And David Williams at the Health Business Blog writes about an interview with Genentech’s CEO, who was quite involved with the development of the cancer drug Herceptin: “I think his points are generally right. But he uses a classic technique: talking about the issue in macro terms. I don’t know that anyone has said that cancer drugs are bankrupting America.”

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DEAR HENRIETTA: I’m a first-year medical student. This is the most stressful year of school I’ve ever experienced! Tell me it gets easier! –STRESSED OUT IN SANTA FE

DEAR SANTA FE: Ah, I cannot tell you such a lie. And Vitum Medicinus delivers the truth better than I: “I was talking to a doctor the other day who described third year like this: ‘You get thrown into it and are just like ‘WOAH – I’ve learned more in my first four weeks of third year, than in my entire last six years of university.’ Scary.”

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DEAR HENRIETTA: What is this crazy news I heard recently about Dr. Heimlich infecting HIV patients with malaria?? Why would he engage in such madness? –SHOCKED IN SOHO

DEAR SHOCKED: Tara from Aetiology explains how malaria was once thought to cure syphilis, and why trying it out on HIV is fallacy: “And unlike syphilis, HIV doesn’t directly attack our heart, or our circulatory system–it damages the very system we rely on to defend ourselves against a host of pathogens.”

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DEAR HENRIETTA: Enough questions! Just tell me something I don’t know! –FED UP IN FRESNO

DEAR FED UP: Okay! Here are a few things you may not have known!

Mousetrapper at Med Journal Watch delivers some good news in the bad: “Women who are at risk of getting a more aggressive type of breast cancer are also most likely to detect the cancer by breast self-exam.”

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The Clinical Cases Blog points us to YouTube, where a pathologist has uploaded hundreds of histopathology videos.

Bertalan Mesko of ScienceRoll shows us what could be in store for the future, wheelchair-wise.

And Jeffrey of monash medical student informs us of how best to eat while training for a marathon and throws in some info about what exactly triggers thirst, a very interesting race photo, and a neat little tidbit about the hippocampus.

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And thus concludes another edition of Grand Rounds! As always, thanks to Dr. Nick (who must have more inbound links than any other medblogger EVER) for his management of this carnival. And send your latest submissions on over to Wandering Visitor, who is hosting next week.

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I don’t prune submissions for Grand Rounds – everyone is included. If you don’t see your submission here, see this post for a possible explanation and then resubmit your post if you like – I’ll add it in as soon as I can!

I noticed a few months ago that the primary address that I was using for this blog (geena at codeblog dot com) was delivering some emails, but not others. So I got a gmail account and started using that.

Unfortunately, I did not remember that my story submission link went to the previous address until this morning. It has been changed, but if you submitted your post for Grand Rounds via that link, look for a response from me – I have acknowledged every post submitted through the link. If you have no such acknowledgment, please resubmit with my apologies!

To those who used the codeblogrn email – your posts should have come through just fine. I’ve had no problems with that address!

I’ve received many great posts! Keep ‘em coming!

Hard to believe it’s already been a year, but this week’s edition of Change of Shift, up at Nurse Ratched’s Place is the 1 year anniversary edition. Kim of Emergiblog has done a great job of taking this idea and turning it into a wonderful bi-weekly carnival for and about nursing!

This week’s Grand Rounds is up at Dr. Val’s. Very clever with the short attention span version and the relax-and-have-a-cup-of-coffee version!

Grand Rounds is hosted here at codeblog next week, June 19th. Send your submissions to codeblogrn at gmail or use the “Submit your story” link above. Please try to get them to me by Sunday at the latest! Thanks!

In response to this post about the mountain of paperwork that we as nurses have to deal with, Mary Anne wrote this:

I thought hospital nurses had it easier with paperwork, boy was I wrong!
I’m a geriatric nurse in long term care. Have been for my 12 years in nursing, and the amount of paperwork has increased 10 fold especially in these last 7 years.

I tried to figure out, once, how many times I write my name or initials, or any type of entry, on various forms, but lost count quickly.

First, there’s the sign-in sheet, then the narc book, med and treatments sheets (there are currently 41 residents on my unit and 1-7 pages for each). Then you have the POC book, in which I as an 11-7 nurse must generate hand-written I&O sheets (both daily and weekly), glucometer check sheet, toileting sheets, assignment sheet, elimination and food/nutritional sheets (all three done monthly), the charts, the log book, and God forbid someone falls! Then you have the incident report, statement sheet, chart entry, care plan update, injury to extremity and/or head injury flow sheets, update of the fall risk assessment, call to the MD/NP and family or all the transfer paperwork if you have to send them out to the hospital.

There are weekly skin check sheets and incident report if you find a skin issue, and department copies for that. In with the med sheets (or MARS), are the prn pain monitoring sheets, behavior sheets, and O2 sats and lung sounds monitoring sheets (for use with any inhaler and nebulizer treatment).

Needless to say, the majority of my night is spent writing SOMETHING. I have been feeling like I’m pulled further and further away from the bedside and I’m getting very sad about it. Guilt when I take even more time away from my residents? I have it. Especially on Book Night. It’s the last day of the month going into the new month. And it’s hell!

We must turn over all the old month’s sheets into the new month’s sheets. Actually, leading up to it is worse. That’s where the pharmacy we use sends us all the Residents MARS AND TARS (med and treatment sheets) and we have to edit them. It’s not easy especially when they screw them up from one month to the next or a resident has a lot of new orders, or the pull doesn’t get done on time. We have to check the accuracy of every med and treatment the person has ordered along with allergies, doctor, birthdate, diagnosis, room etc.

Then there’s the Nursing Summaries. Oh joy!

These are monthly consolidated reports about what the resident has gone through in the last month, and it shows their acuity level, but it isn’t accurate if the CNA’s flowsheets are wrong which is often. This is how we get paid. If they are wrong, we lose points and money. It’s a lot of pressure when you’re not able to spend a lot of time on them.

And as an 11-7 nurse, I’m responsible for the weekly drug order for all the residents on my unit. It takes about 2-3 hours if done right. We also change the CD foley bags every 2 weeks, the O2 tubing and other equipment every week, G-tube supplies every night, do treatments, pass meds and soothe emotional or out of control residents.

Cleaning and restocking the Treatment and Med carts andordering supplies are all put aside until there’s time. No one on the other shifts ever does it. So I’m left with no supplies when I come on duty.

I’m sure I’ve missed something, there’s so much. Eight hours is definitely not enough time to get it all done. If I didn’t have to get home to get my husband off to work and child off to school, I’d leave about 9-930am everyday. As it is, I sometimes have to get my family taken care of and go back to work to finish. Sometimes I get paid and sometimes I don’t. The head honchos think we should get out on time, and they won’t pay overtime anymore. So we get in trouble if the work isn’t done, but we volunteer our time to get finished. And it cuts into my precious sleep time.

Why do I stay where I am? It’s all I know. Hospital nursing scares the hell out of me at this point. I feel dumbed down. The place is 5 minutes from my house and son’s school. I like my nighttime co-workers. And still another reason to stay is that it looks good on a mortgage application to have stayed a long time at one place, something we’re going to be facing soon.

I always wanted to be a ‘Scrub’. I loved the OR in school. LOVED IT! I know they have more surgical techs now and nurses have different roles in the surgical ward, but that’s all I ever wanted to be. Right by the doctor’s side passing instruments, watching the surgery. Cool.

When my mother lay dying from end stage chronic hepatitis, she was screaming at me “get out while you can!” She was referring to nursing. She was a nurse until the day she died, she kept up her CEU’s even though she’d stopped practicing a long time before. I wonder, should I get out or stay?

I don’t know what else to be.

It’s never too late to learn something new. Get your mortgage, then get a new job! I know, easier said than done.