There are some things which can be defended with the age-old excuse: "It seemed like a good idea at the time." But even I have to admit that there are some things to which I have to say, "No, it never seemed like a good idea. But maybe later, down the road, I'll look back and say, 'it was sort of a good idea,' " Case in point, somehow scheduling myself to work 12 out of 14 consecutive night shifts. Yes, 12-hour night shifts. Yes, I realize that's 144 hours, or a couple of 72-hour work weeks. But I'm hoping that as I'm sitting at a sidewalk cafe in Paris, ordering another bottle of wine, or browsing the little boutiques in Le Marais district and contemplating an adorable pair of red shoes, I tell myself, "Self, I'm really glad you worked some extra hours because it's making my adventure in Paris so much more better," except with better grammar of course. And in French.
I'm working at both hospitals now, PUH, and per diem on my old unit... the hospital that is like an old boyfriend to me. You know, comfy, I have good memories from our time together, I miss it there, and time and other hospitals only serve to help me forget the reasons why I left in the first place. But anyway. I'm sort of hoping that by splitting up my shifts, some at each hospital, it won't make a 5-night stretch feel like five nights. Heh. Stop snickering at my faulty logic. Paris! Red Shoes!
Oh! And now for some nursing content....things that are also NOT a good a idea: (Ahem..residents, listen up...) No matter how "unresponsive" you think your intubated patient is, always always always always ALWAYS write PRN sedation orders for him. Always. Because when said patient is an angry sweaty confused 400-pound man, and he suddenly wakes up with a tube in every orifice, and you're a little too slow returning his nurses's pages, there really isn't too much said nurse could have done prevent him from contorting his massive body in such a way to pull the ET from his throat. Wrist restraints be damned. Additional things that suck about this little vignette: Patient was already requiring 100% ventilator support, meaning that when he removed the ET tube from his throat, I had to call a code to get lots of people in that room STAT to re-intubate him. And sedate him. And also, you know how night shift nurses kind of work like a big team, and really step in to back each other up? Yeah, not so much. Apparently this is not universally true. The two other travellers on the unit really stepped up, one of them watching my patient for a couple of brief intervals to let me take brief breaks off the unit, and also helping me change a foley and insert an NG then lavage until clear. The other helped me turn and clean the verylargesweatypatient then even offered to take my other patient from me once she realized how swamped I was with verylargesweatypatient. To be fair, later in the shift the charge nurse stepped up and helped me set up my arterial line and drew labs for me when the three sets I had drawn hemolyzed.
Another little piece of advice to residents: When the patient's hematocrit drops from 48 to 32, please notify the nurse and ask her to re-draw the blood sample before you order a GI consult, and order four units of blood on the patient. Which I would have done, had I noticed the lab value before the residents did. But I didn't, because I was too busy titrating drips, inserting a foley and an NG, and various other little tasky things.
Anyway. I'm done ranting now. Back to work tonight, at the Old Boyfriend Unit (OBU). Kind of looking forward to it. But in the meantime, there are guidebooks to tab.