Thursday, March 27, 2008

job opening

So, last night. Blah. It was my first night using the brandy-new computer charting system recently unveiled at work. It wasn't too bad, but added a lot of time and confusion and discomfort to my charting process at work. I didn't have any huge problems with it, although I'm fairly sure I only charted about 12% of what I was supposed to. In the midst of the confusion, and the weirdness of no longer having paper MARS (it's all electronic now) I missed my patient's chemo dose. So it ended being about three hours late. In the morning when the managers got there they all flipped out and I stayed late writing an incident report and feeling like the sloppiest stupidest nurse ever. BUT by that point in the morning I was numb and sad and annoyed and just sick of looking at computers at all.

My patient died last night...not the missed-chemo patient, a completely different patient. A young man I'd cared for over the past several weeks. I wasn't his nurse last night but spent some time helping the family and was able to have a nice talk with them before I left in the morning.

Meanwhile, the ICU admission that I got was the furthest thing from the cakewalk DNR/DNI hemonc patient that I expected. What exactly do you do when your patient rips her leads off, smacks you out of the way, and insists on leaving the unit to smoke despite the fact that her lips and hands are blue and her oxygen saturation is 68%? I wish I could just say fine, go ahead then, and come on back when you're ready to accept our help. Uff.

Anyway. Tonight is definitely a Pagliacci's night. Yes, I use food as a coping mechanism. Is that so wrong? It's cheaper than crack.

6 comments:

girl_in_greenwood said...

Gah. What DO you do? If she's able to get up, can you actually stop her from leaving the unit?

rosebuttons said...

I don't know...on other units I've worked, she would have been on some kind withdrawal protocol, so I could have shot her full of ativan and clapped on some 5-pt restraints. As it was, I called the docs ("Uhm, will you get back into bed and put your mask on?" Thanks, Dr. Smarty! If only I'd tried that!) and then my charge nurse called security. But I would not have physically restrained her, if she left the unit...We ended up giving her some haldol ("Start with 0.5 mg -- " uhm, no Dr. Smarty, I'm starting with 4 mg, go ahead and write for that...)

old nurse said...

Back in the good old days we used to be able to do that (restrain hypoxic patients). I suppose the argument STILL could be made that a cyanotic patient with sats of 68% was impaired due to hypoxia and incapable of making a rational decision at this point in time -- hence restraints for her own safety. Health care has taken a big turn for the worse with the advent "customer service" culture -- Hospitals are NOT hotels and should NOT be run like them! Sick people come to us for our expertise and clinical judgement -- and then we are prevented from using our expertise by the customer service culture.

The best example of this is the "pain is always subjective" pain scale crap. Yes, pain is subjective, but if a patient is talking on her cell phone, eating potato chips (that her family snuck in) wants a shower and then blithely tells you that her pain is "10 out of 10" and she needs her Dilaudid -- PLEASE, let me use a little clinical judgement, and not enable her growing fondness for narcotics.

old nurse said...

I read in the Tacoma News Tribune an article this weekend -- unintentional drug overdoses are now THE LEADING CAUSE OF ACCIDENTIAL DEATH in working age adults in Pierce County, Washington -- they now out number car accidents. And it was not drug addicts OD'ing on herion -- it is working adults OD'ing on prescription pain killers. The public health department attributes the deaths to a "change in prescription practices" by physcians. In the hosptial, we now need to complete incident reports every time Narcan is given to treat oversedation with narcotics. So, MAYBE, the tide is turning and we will be able to use our clinical judgement in managing pain again...

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Bo... said...

What I used to do when I worked ICU/ER was to simply say to the patient: "Okay, that's fine. But you do realize that I will have to write on your chart that you went against the doctors' orders, okay?" Somehow they didn't like it when they knew I was going to "write something down". (And then I was happy that I had absolved myself of blame if their actions created further problems....)