Night nurse

I often tell myself, or others, in a (sort of ) joking manner, that "there are no emergencies in hospice." It helps me keep my perspective and maybe even stress levels under control. But that doesn't stop me from waking up in the middle of the night, with a sudden realization that I forgot to chart something. In the persistent, niggling way that only middle-of-the-night-lying-there-in-the-dark thoughts will do, this thought kept circling through my brain, kept me awake, and finally insisted that I get out of bed. I logged into my work laptop and sent the order: I had forgotten to change the patient's bath schedule from once weekly to twice weekly. Phew, now I could rest easily. No wait...since I'm right here in the front of the computer, I think I'll check on the status of the other patient I saw yesterday. Oh, that reminds me, I might as well submit that supply order request now so I don't forget later. Which leads us to here, with me typing a blog post at 0430 in the morning. While there might not be any "emergencies" in hospice, there's a different set of priorities that can take on the same significance. A bath is definitely never "STAT," but to the exhausted daughter at her father's bedside, knowing that someone is coming today to give her dad bath because he's now incontinent and needs much more frequent cleaning might be the only thing giving her a little relief or comfort. The added stress that I feel, while not emergency status, is that if I don't remember to change the bath schedule, it just won't get done. It doesn't just roll over onto the next shift like in the ICU, family member can't just put their call light on again or the computer doesn't pop up a little reminder to the next nurse. So that's what wakes me up at night.

Maybe my old night-shift schedule is too deeply ingrained in my brain. This used to be the time when I would toast some bread or get my yogurt out of the fridge, sit down in front of the computer, and finish up my charting or complete my nursing shift note, reviewing my shift and making sure I didn't forget anything.

So there you go...that's what goes on in the mind of a hospice nurse in the middle of the night.

What's in your car?

When my hospice nurse orientation finished and I was officially "set free" to drive the streets of King County visiting patients, I was given my "car kit." It consisted of nursing supplies in four large brown paper bags. No good drugs or anything like that, we're not allowed to carry narcotics in this state. But since I'm on the facility team and almost all my patients are living in facilities such as Assisted Living or Skilled Nursing facilities, I rarely if ever need to bring supplies to them. For several weeks these brown paper bags lived in the back of my car, with adult incontinence supplies embarrassingly peeking from the top of them. Finally, a couple of months into the job, I got fed up enough with shifting them around to accommodate Costco trips to actually organize them. I bought some pretty-colored storage bins from Target and sat myself on the floor, surrounded by nursing supplies, and inventoried. I still don't actually need most of it, but at least now I know what I have:

• Adult diapers, large and extra large
• Bath wipes, x 2
• Dressing supplies, including gauze, abd pads, tegaderms, and even my very own suture removal kit and two pairs of bandage scissors
• Isolation gown, goggles, and mask
• Lotsa rubber gloves. Can never have too many of those
• Foley catheters, urimeters, leg bags, a urinal
  
• Various creams, lotions, skin care ephemera
• Two sizes of emesis basins
• thermometers
• A sphygmomenometer! And a stethoscope! Apparently I didn't really need to be using the set I'd purchased seven years ago for nursing school.
  
• Lab collection supplies

I feel a bit better now actually knowing what I'm carrying around in my car, should any of my patients need something at the spur of the moment. Typically I can order supplies for them and bring them on the next visit, but there's always the family who waits till the last minute..."Hey, you don't have any extra diapers on ya, do you ?"
"As a matter of fact, I do! Let me just run to my car..." Thusly averting a messy situation.

And also, when your little puddle-drinking poo-sniffing dachshund starts suffering from diarrhea which turns bloody, it sure was convenient to have rubber gloves and a stool specimen cup laying around with which to take a sample to his vet. I don't think that was the intended purpose of the "car kit," but hey, now the little guy is started on his course of Flagyl and hopefully he'll be back to his energetic puddle-drinking poo-sniffing self soon.

So, to answer your question, yes, those are adult diapers in my car. What's in your trunk?

Nursing from the streets

So here I am, a full-fledged Hospice Case Manager Nurse. A month out of orientation, on my own, managing my own case load, and I can still safely say that I pretty much love this job. I realized that I loved it on Tuesday, after a grumpy, rainy, 45-minute drive to Newcastle. I may be a day-walker now, a recovering night-shifter, but I have not and will never quite get used to having to get up early in the morning. So I grumbled and scowled my way through rush hour traffic, gripping my coffee, trying to hear the bossy GPS directions over NPR, and squinting through the blustery, gray weather. After two wrong turns and a U-turn I finally arrived at my destination, and found my way to my new patient's front door. I met the patient and his wife, answered their questions and explained how our hospice services could help them. Yes, they could call and speak to a nurse 24 hours a day if they needed to. No, we would do everything we can to keep him from having to go to the hospital ever again. Yes, if he wants to eat apple pie, let him eat apple pie (in small bites and sitting straight up, of course). The patient's wife sighed deeply and relaxed back into her chair, years faded from her 84-year-old face, and she finally smiled at me. "Thank you," she whispered. "Thank you for what you do."

So I got back in my car, and steeled myself for a 30-minute drive on the highways through the sheets of rain to Issaquah. But my grumpy mood was gone, and I didn't mind the drive.

The view from the other side

I'm five weeks into this new hospice gig that I'm doing, and although I'm still on orientation, I am here to report that I'm pretty sure I really love it. I almost admit that hesitantly, because I'm doing things that I always swore I'd hate, things I scoffed at, things I mocked and derided others for doing. Okay, maybe that's a little harsh, but you get the picture. Those things include: sleeping during the night, waking up early each morning, working five days a week, having to do errands and shopping on the weekends...I could go on. Because to be honest, I LOVED night shift. I loved only working three days a week, and I was giddy over being to go shopping or do errands in the middle of the week. The middle of the night, even. I could avoid traffic and most of all, CROWDS. I did the nocturnal thing really well, and the few early mornings I've been forced to contend with have left me grumbly, crabby, and generally miserable. To be fair, I probably induced the same feelings in those unfortunate enough to be around me in the early mornings.

Well, nothing drastic changed...I'm still not a morning person, and given my druthers (what the heck are druthers, and why is someone giving them to me? Like a present?) I'd be staying up late and sleeping in till past noon. Oh well. But I've adjusted to this new schedule, in part because I'm a creature of habit...I ADORE habit. And routine. It's just so comforting. So the regularity of this new schedule fits me well. And I guess I'll give Matt a little credit...since I've moved in with him, my old night schedule got progressively more annoying and inconvenient. I was only home with him a few evenings a week for dinner, and those nights weren't the same week to week, and it was frustrating. Now I get to be home every night, and every weekend, and it turns out that five-day-a-week things isn't so bad when the shifts are only eight hours long, leaving me with plenty of time after work to walk the dogs, cook an Indian feast, plant some vegetables, whatever strikes my fancy. I'm not advocating either schedule/lifestyle over another, I'm just saying you gotta find what works for you at the right time for you.

At this point, you'd be forgiven for thinking that I changed jobs simply due to shift and schedule concerns, and while that is a huge piece of my overall contentedness, the nursing aspect of what I'm now doing versus what I was doing is the main thing. But that's a big topic for another post, and right now it's easier to write about and be silly about simple things like sleep schedules.

I'm sort of concerned that I need to rename the blog, or start a new one...since I'm no longer literally "knitting in the dark." Now it's more like "driving during the day" but that isn't too catchy...I'll have to ponder that.

And now for something completely different...

I quit my job. I got a new job. I start next week.

I will be an outpatient hospice case manager nurse. I will be working Monday through Friday, daytime hours, no nights, no weekends, no holidays. I have heard rumors that this is the schedule that most people keep, being up and about during daylight hours, sleeping at night, and keeping somewhat "regular" hours. I haven't lived this way in nearly eight years, since I started nursing school, so this may be an interesting, if possibly difficult, transition. I actually feel completely ready and excited for this schedule change however, which is something I honestly never thought I would ever say. I loved nigh shift, I was a great "day sleeper," I loved having three to four days off a week, doing my errands in the middle of the week, going to the grocery store at 2am. But I sort of over that now. I'm over working interminable, often-grueling 12 hours shifts, the sore back, the aching feet, losing half my week to the sleep/eat/work routine with no room for anything else. I'm over inpatient-unit manglement policies and procedures and decisions, isolation gowns, and short-staffing headaches.

I'm excited for the new job, both for the schedule but even more so for the hospice work...more on that transition later. Maybe I should start a new blog, chronicling my adventures as a visiting hospice nurse, interspersed with my attempts at photography, my foray into vegetable gardening, and my efforts at cooking 660 different curries? Or maybe this is all just a natural continuation of Knitting in the Dark...?