Here’s a story submission by Michelle G, RN. My thoughts are in italics at the end.

I called first thing this morning to see if they needed me to work extra. Sure enough, a scheduled nurse was not coming in. I show up on my unit which is the medical floor to see that I have been assigned 4 patients. Wonderful! Great not to have 5 right off the bat.

Today I take care of a gentleman who I had taken care of just 4 months ago. He was diagnosed back then with liver failure and was not a candidate for liver transplant. This admission brings him in with End Stage Liver Failure which means he could have a few weeks to under 6 months to live. He is in denial and refuses some of the treatments/medicines/blood draws. Patient’s wife is excited to see that I will be his nurse again with this admission. Patient has been noncompliant and has not been following medical advice. He is on a 1500ml fluid restriction but doesn’t seem to want to adhere to those restricitons nor acknowledge them. I gently remind him about his fluid restrictions during the day which seemed to agitate him. I explained to the patient why the fluid restrictions…there was a reason for this.

Well, now he wants a wheelchair to go outside. I know exactly what he wants to do….smoke. We are a smoke free hospital but I am not security. I explained I am not going to babysit him nor police him. I explained to he and his wife that we can not cure him nor are we going to give him anything that will make him better. If the patient wants the extra juice or cup of ice than who am I to restrict a dying man?! Who are we to deny a dying man’s last pleasures…ice, a smoke, a visit outside on a sunny day?

Much of nursing is not only carrying out doctor’s orders and educating the patient why those orders are there…but looking at the BIGGER PICTURE.

At the end of my shift; patient and family were greatful to have had a nurse that took the time to explain the disease process and plan of care but also most importantly to treat him as a human being with respect and care.

What do you think?

I think Michelle is absolutely right. If the patient is able to get all the information he needs, then it’s up to the patient to make the decision. If there is no cure what what ails – heck, sometimes even when there is – a life lived with restriction after restriction with no pleasure at all is probably not worth it to many people.

“milly rn” writes:

Another day, another patient – of kuwaite nationality. No surprise I work in an icu in a private hospital in london uk. kuwaite families ship their loved ones out to london when given any kind of grim diagnosis in the misguided hope that we over here will be able to fix the problems! they usually arrive half dead having been rotting in one of their own country’s hospitals for weeks ( tip – dont get ill next time you visit kuwait) all paid for by the kuwaite government (nice lot arent they!)

Anyway mama m arrived, supposed to be very sick ventilated unstable blah blah blah……….. in a wheelchair launched herself into her bed on arrival with no assist (we didn’t have time to get near her such was the speed of her action all we saw was a blur of black cloth) and proceeded to mime the urgent need for food and beverages moi moi moi sista!!!( translation -water water water sister!!)

moi & munchies were obtained, mama was happy, family were happy. doctor not happy – mama had a K of 7 and no percievable kidney function at all.
cue bit of action…..insertion of 1 vascath, trundling out of 1 Prisma CVVHD machine….priming of machine ……..attachment of mama to said machine.
followed by 12 hrs of machine alarming constantly….. stopping constantly… generally not doing its stuff..mainly due to the fact mama was a rolling around in the bed…as you in the know will know, not good for flow in a vascath not good for attempting cvvhd (or to the uninitiated the sort of continuous dialysis thingy we do in icus for clapped out kidneys & clapped out patients)

mama could not sleep (nurses could not read gossip magazines), due to the godamned racket the prisma machine was making & also probably if im honest due to the nurses (me & collegue) stomping up to the machine cursing & restarting it approximately 500 times every hr…….for 12 hours……..

mama who supposedly spoke not one word of english apart from the term sista (nurse) announced wearily in the morning-’mama no sleep machine crap!’
i was very impressed! that woman will go far in this city of ours.

I wasn’t sure if I should post that submission, because it is a bit insensitive and because I don’t have the patience to edit it enough to read smoothly. It’s literally been in my inbox for 2 YEARS and every time I read it, the end just cracks me up. Because sometimes the CVVH machine is crap. -ed.

“Catheter Commander LVN” writes:

Having worked for 2 years in the ER, my experience became most helpful when I went into Correctional Nursing. You ask, “why do they fake a seizure?” They fake it for several reasons here: To get out of their cell when the facility has been locked down. To get the attention of staff. To get to an outside facility (hospital) where the women are much more abundant and prettier and the FOOD is sooooo much better.

We now on a case by case basis use the hand drop, pen across the nailbeds and brushing of eyelashes to determine validity of the “seizure.” We’re running about 95% on the FALSE side now. Before, we just tossed in an IV, threw on some O2 and out the door they went to the hospital. Since we started doing these checks, the seizure activity has slowed tremendously, go figure. Its nice to see them walk back to their cells, head hanging with a write-up for attempted staff manipulation.

And finally, “loved nursing RN” submitted this:

My mom, an active 83yo was fine till she got hit by the truck called CNS Lymphoma. Getting her admitted to , we thought she had a good chance at recovery. The last 7 months have been a nightmare with hospital acquired infections, 3 rounds of pulmomary edema, poor transfer of info at change of shift, blatant lies by staff from nurses up to and including administrators.

The infection control standards are appalling, compassion lacking in most of the doctors and NPs even knowing I am a nurse with a wide variety of technical skills did not put them on guard to do the right thing. No they would argue that keeping a used red rubber suction cath in a liter bottle of saline on the FLOOR was acceptable clean technique. Administration would never acknowledge a mistake. When I suctioned mom myself because of a 2 hour wait for the nurse, I was reprimanded and threatened with my license. The large medical centers are not what they should be.

Yikes.

Submitted by My Own Woman:

It was one of those rare nights on midnight shift where the ER was eerily quiet. The quiet and calm doesn’t happen often in the ER and the nurses try to take advantage of it when it occurs. After all the supplies were stocked in each room and the trauma carts and the Zoll monitors were checked to make sure all was functioning properly; the nurses sat down together for a rare moment of rest. It was 4 AM, the time on night shift where the wind starts to go from your sail before you catch your second wind about 5AM.

As we sat and talked about non-nursing related things in our lives the Ambulance phone went off. I got up to take the call. “This is A-1 Ambulance. We’re bringing in a 20ish year old male with severe injuries to both of his legs. He was hit by a car while riding on the back of a garbage truck. His heart rate and respiratory rate are within normal limits. His blood pressure is slightly elevated and he rates his pain in both legs at a 10 out of 10. He has an IV established with Normal Saline at 100 and we have him on high flow oxygen. We’d like to give some Morphine. He has no allergies. ETA 5 minutes.” I relayed the information to the ER doctor who authorized Morphine 2mg IV and we will re-evaluate upon arrival.

The patient arrives to the ER 5 minutes later without any relief from the previous Morphine. His legs are deeply cut and crushed at the level of the knees where the car clipped him while he was riding on the back of the truck to collect garbage. His vital signs were stable except his blood pressure was elevating probably in response to the increased pain. After an assessment by the nurse and the ER physician, Dilaudid 2 mg IV was ordered and given along with some IV fluids. X-ray came to the department for a series of xrays on his legs. The Patient Care Technician came into the room to draw blood and do an EKG. All the while the patient kept asking me if he was going to lose his legs. “Please, am I going to lose my legs? Please tell me.” I couldn’t answer him, I had no way of knowing at that time but the prospect of him losing his legs was a good probability. He had no pedal pulses and no sensation below his knees. I told him, “I don’t know right now, we have to wait to see what the tests tell us.” It was an honest answer. He turned to the Patient Care Technician and asked her the same question, she immediately responded, “No, you’re not going to lose your legs, quit thinking like that. Everything is going to be fine.” I wanted to scream at her but held my tongue and tended to his immediate care.

We cleansed his gaping wounds behind his knees and bandaged them with sterile water and gauze. We gave him repeated dosages of Dilaudid as we prepped him for surgery. It was horrible watching this young man with his whole life in front of him crying because of the pain and the uncertainty of his diagnosis that must surely have been going through his mind. After a short time we shipped him off to surgery and the Emergency Department was relatively quiet once again. We had added a few more patients in the time I spent in this man’s room, but everything seemed to be under control.

I couldn’t get the young man off of my mind and the scene and conversation I had witnessed between the Patient Care Technician and him. Finally, after wresting with my conscience, I took her aside and told her that telling him he was not going to lose his legs was not a very good thing to do. I told her that she could have very well given him false hope and that is the last thing you want to do to a patient. She apologized to me and told me “she just wasn’t thinking.”

The night ended without any more trauma and we all went home to our beds. I had the following day off and went about my normal routine. The following day I returned to work and my arm was grabbed by the Patient Care Tech that had helped me with the young man two days earlier. Her eyes were red and swelling with tears. “He lost both of his legs,” and as she spoke the words the tears rolled down her face. “They cut off both of his legs, they couldn’t save either one of them.” At first her words were not registering in my mind until I realized what she was talking about. The young man who she told would be just fine had lost the very thing he was so concerned about and wanted reassurance about. The tears welled up in her eyes more. “How could I have done that, how could I have said everything was going to be ok?” My heart went out to her. In her attempts to ease his mind, she let him down and herself. “How can I ever make this up to him?”

I shook my head back and forth and said, “You can’t do anything for him, but you can learn from him and never tell anyone things that you don’t know for sure. You learned, and learning is a good thing.” She replied, “Yeah, I learned, but I still have both of my legs.”

This is a very good lesson. However, I can’t help but wonder if despite her comments, the patient really knew deep down that he was going to lose his legs. Denial is a double-edged sword. It can keep one from seeing what’s really going on, but it’s also a highly effective coping mechanism meant to protect us from knowledge that we aren’t ready to process. I doubt that the young man took the tech at her word. I’m not condoning what she did, but really? Truly? Deep down, I don’t think he was surprised at the outcome. So tragic. -geena

I’ve updated the sidebar links again. My loooovely husband got me my Image Manipulation Program of Choice for Christmas and it’s been so very nice playing around with it again. I’ve added some blogs, deleted some, and in checking to make sure the links work, I’ve noticed that some of your blogs underwent a makeover. So if the mood struck, I went ahead and redesigned your button.

As always, if you don’t like your button please feel free to make one of your own and I’ll replace it. You need to stick it in a .jpg file that’s 90 pixels x 25 pixels. Yeah, it’s small.

Here’s a story submission from “traumanurse,” and she sent it almost an entire year ago:

I am a fun-loving person. I work in a Level One trauma unit. We have a lot of fun as all the RN’s and MD’s are great people and we make a great team. This helps a lot with all the drama in trauma.

We have a few resus’ every week. And these are fine – training and adrenalin take over and we actually manage to maintain a sense of humor before, during and after- but it’s going home that gets me.

How do I explain to my small children that I am not a mommy right the moment I get home? That I need a couple of minutes to myself just to become a mommy again? I am the highly professional person that has just witnessed the life seep away from someone’s husband, father, child, and now I have to be the referee in the fighting, dish up equal portions and put Barbie’s shoes on- so they stop slipping off. I think is the main reason I prefer night shift is because you get home when everyone is asleep – so I can do mindless things like water the garden or feed the cats – or just sit and stare into space.

To explain to a non-medical person what it’s like is very difficult. In a resus- it is not a human being. It is not someone’s dad. It is an airway, a chest, a blip on the ECG; a vein to put a drip up. A pupil that may or may not react to light. These are the patients that you leave behind when you go home – nonsensical and they don’t haunt your dreams. It’s the ones that grab your hand, that make you look at them, that make you SEE them, who make it difficult. How do you explain this to your five year old? That fine line between life and death. That fight to keep someone from going to the “light.” There is no light in the trauma unit/ICU – there is only the adrenaline taking over – the clear instructions, there is no pain – no emotion – until it’s over. Until someone said those words: “time of death”.

How do I explain this?

——————————–

I’ve sometimes found it very difficult to come home and act as though something emotionally earth shattering hadn’t just happened. Sometimes it’s hard to get back to “life” because whatever has your brain scrambled won’t leave your thoughts. Sometimes I’ve found that it’s because it doesn’t feel right to go back to normal life. After witnessing and being a part of a profound moment in someone’s life, it feels like you literally have to take some time and process it and honor it in a way before you can get back to your normal life.

I usually take the drive home as an opportunity to absorb events that happen at work. Sometimes it takes me a lot longer – days, even. There are some situations at work that still haunt me years later. I have a feeling it’s like that for almost everyone.

From “psychosis buster, RN:”

(For the longest time I kept reading it as “psychosis butter.”)

Way back in the eighties I was working on a 40 bed acute psychiatry ward in a fairly large Canadian city. One day, one of our repeat customers, a chronic paranoid schizophrenic patient, was admitted from Emergency. She hadn’t been looking after herself and she was covered in lice, as was her (expensive) fur coat.

Two of my co-workers figured they’d do her a favor and send the coat down to our laundry department for cleaning. Unfortunately, they thought it would be a really good idea to send it in a red “contaminated laundry” bag – this was before the advent of universal precautions. What they didn’t know was that the laundry department didn’t open those bags – they just tossed the whole kit and kaboodle in the washer, along with very hot water and strong soap.

The next day, a plastic bag arrived on the ward from the laundry department. It contained what looked like a hairy collar, with several strings dangling from it and some ratty fur, with a note asking “what was this?”

Well, it had been a fur coat valued at something like five thousand dollars. Fortunately, the hospital agreed to reimburse the patient. To this day, I don’t know which was funnier: the pathetic remains of that coat or the expressions on my colleagues’ faces when they saw it.

Suzi has a question for ya’ll:

I had a kidney stone episode January 2007 which took me to the hospital unexpectedly. My urologist could not remove the stone because there was massive infection caused by the stone rubbing up against the “wall.” I spent five days in the hospital with fever, passing blood, on IV antibiotics, oxygen, and with incredible “sweats” that required clothes and bedding changes several times in a 24 hr. period. I couldn’t get out of bed alone to use the bathroom. I was terribly weak.

After 5 days and under medical advice I was sent home to bed. I was to continue oral antibiotics, and a “stent” was put in place until the stone could be removed. A week or two later I did have the surgery and the stone was removed and another “stent” was inserted. My doctor told me I had been very very sick and I was to do exactly as he said, which was basically to stay in bed until the second “stent” was removed.

Now, heres the question: How long should I expect to be “recovering” until I am back “up to speed?” The doctor told me it would be about 30 days after the surgery. This estimate was way off!

It is now the middle of July and while my recovery seems to be steadily improving,
I continued to experience loss of strength and energy (I can now run up 15 steps X 3 without getting winded) But I cannot power walk the distances I used to. I also “break out” in sweats when I use physical energy. Have any of you had a similar recovery experience from a blood infection (sepsis) and if so, would you share it with me? I just want to know if I’m in the “normal” range.

I knew someone who had sepsis and was hospitalized. It took her MONTHS to fully recover enough to come back to work. At least 6, I believe. Any other experiences?

Donna, RN writes:

A young man died this weekend. He had a loving wife and a bouncing 10-month-old baby girl. Like all of us, he had a promising life, with many friends, many challenges, many opportunities and many wonderful dreams.

He came to us ill, but strong willed and hopeful. He had a medical team that was strong willed and hopeful. He had a family that was strong willed and hopeful, he had nurses that were strong willed and hopeful.

And yet, this young man died this weekend.

That day, amidst the turmoil and growing clutter of medical equipment crowding his ever shrinking hospital room there was a sense of collaboration, creativity, intelligence, hope and humanity.

It was the humanity that I clung to as we brought in the crash cart and began the final battle for his life.

He was young, maybe he could make it.

I let hope push back reality. Denial gave strength to our chest compressions. He was young, and his young daughter’s picture on the wall facing him gave that much more hope so I wouldn’t face despair.

We battled for him, with drugs, ventilation, compressions, anything and everything we had. We collaborated and encouraged each other. As I was getting exhausted from my turn at compressions, I felt the humanity in the room around me, and I heard myself saying, “Come on, M.” as I looked at his face and into his young eyes. The words felt naive and innocent, yet I had to give him the humanity and dignity of his fight. I knew I was saying goodbye.

This young man died this weekend. We all felt wounded as we were ripped from a delicate fabric, fraying ends weaving a bad dream. The nightmare for his wife and family had just begun.

It was cathartic to remove the signs of battle from that room, to restore calm and dignity to him and for his family. The emotional resonance of his death was palpable throughout the unit, as tears, anger, hugs and quiet sighs prevailed.

A young man died this weekend, and he put life and all its wonder into grand perspective.

I embrace the pitfalls, the pettiness, and the disappointments life can harbor, as the brighter, grander enlightenments of life prevail. The chubby hand of my granddaughter, the fighting heart of my biking husband, my dog’s warm, wet tongue, the “volunteer” rose that grew up amongst the lavender. These are what matters in life. This is the symphony that blends discord and harmony. Anything else is just so much noise.

A young man died this weekend, And he reminded me to let my heart sing.

Patricia, RN writes:

In nursing practice, I have found that a sense of humor is one of the most valuable instruments of healing. In a caring event, it provides relief and hope as an alternative to the pain and fear of the illness. For me, the nurse, humor provides a self-healing outlet from the intensity of focused energy needed to be fully present with the patient regardless of the outcome. The same healing instrument is used, although differently, to meet the needs in both the nursed and the nurse during the caring event. Drawing on the healing instruments of laughter and play within the midst of tears and high technology has provided me with some of the most memorable moments in my nursing career.

When I went home to care for my mother during an acute and potentially life-threatening phase of her illness, I took Ruggles, a large, soft, and very huggable therapy bear on the plane with me. Although we boarded the plane together, it was the last I saw of him until after landing. I seemed as though everyone, even businessmen, in formal three-piece suits, wanted a chance to enjoy a moment with Ruggles.

He was treated to his own ‘Pilot Wings’, given special treatment by the flight attendants, and asked to assist in the cockpit during the landing procedures. Due to his celebrity status, we were given BIP treatment through the airport to catch our connecting flight. The news of Ruggles and our mission had gone before us. After our final landing we were transported directly to the hospital in a special airline limousine.

The story of our most ridiculously fun flight experiences and the formality of our arrival, via limousine, brought back my mother’’s smile and a twinkle of mischief in her eyes. Fortunately, this was the perfect tonic to initiate the courage and strength needed to cope with the immediate health crisis. There was nothing within my training that could have provided a more positive healing environment than bringing her Ruggles.

Ruggles continued to enjoy his celebrity and healing status throughout her hospital stay. There were photographs, articles in the hospital review, and special visits to the pediatric, adolescent, and oncology inpatient units. One bear and a nurse, with a fun sense of the ridiculous, brought healing, love, and laughter to people from New York to Illinois. My mother recovered to the point that she could return home and continue at a more comfortable level of wellness for several more months.

My mother flourished in ways that would not have otherwise been possible and kept this piece of fantasy and fun as a charm to help her though the bad days. Her medical care interventions were completely met during that time at home by a wonderfully caring and competent Hospice treatment team. Although proud of my technical skills and knowledge, she didn’t need that part of my nursing practice. It was my ability to live nursing as an art form of care and caring that allowed her to share life, laughter, joy and healing during those last few weeks. My development into a highly skilled artisan within the caring practice of nursing intuitively allowed for the need to share tears of sorrow and loss as well as the hope there would be joy.

I am a nurse: I don’’t just provide nursing care, it is who I am. I became aware of the uniqueness that belonged only to nursing. I didn’t settle for nursing, I actively chose nursing as my vocation and profession. Florence Nightingale’s vision of nursing excellence enabled me to understand that no one can be what nurses are except a nurse. It was so easy, so clear. Nurses nurse. My nursing practice is an art form of caring within a highly scientific and technologically based health care environment. It is through nursing that I facilitate, enable, and empower the nursed.

In the final analysis, I believe a successful treatment outcome within our high technological care environment is ultimately patient defined and reflects how well the nurse’’s technical care was balanced by the interpersonal art of caring. This, from my perspective, defines nursing excellence in practice.

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.

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.