Saturday, January 29, 2011

When Patients Refuse to be Discharged

My unit's mortality and morbidity stats suck.

But there's a reason for that, and it's no reflection on the quality of care or the competence of the staff. We take the sickest of the sick. We take the cases that nobody else will even consider. We're the dumping grounds for the private vascular hospitals in the area when things go wrong so their stats don't take the hit. There's a reason why the vascular specialty hospital across the street has some of the best M&M stats in the entire country.

When you look beyond the stats and put faces to the numbers, this translates into a good number of patients who die on our unit. And it would seem that some of those expired patients aren't ever truly discharged, if you catch what I mean...

Even if you don't believe in ghosts, it's hard to dismiss the fact that our hospital is well over a hundred years old and in that period of time, there has been one emotionally charged situation after another playing itself out within our walls on a regular basis. It would be difficult to pass off that amount of energy in such a small space without entertaining the idea that something, or someone, could end up staying behind. And there is no other unit in the hospital that sees more of this intense type of action than ours.

In short, our unit is haunted.

Every unit has that one or two beds that seem to have more than their share of deaths because highly critical or terminal patients are repeatedly assigned there. It may be because of specialized equipment available in that room, or proximity to the nurses station. It may be that it's a single bed room allowing for privacy for families to say goodbye, or a larger room that fits more pumps/machines for highly critical care.

For us, that bed is Bed 18.

Now keep in mind that the two incidents I'm about to tell you happened first hand to people that still work on the unit today. These aren't spooky campfire ghost stories handed down through the generations like some Greek mythological legend.

On our unit we don't have call lights (thank heavens!) due to the fact that there is never not at least one nurse present in any room at any given time. To communicate with each other, we use an overhead intercom system. Occasionally on night shift, if there is low enough census, several nurses have reported an unknown, but weak female's voice coming on the intercom asking for help in Bed 18, when there is no patient assigned to the room. It's happened on nights where every staff member was male...

And then...

One night shift, two nurses walked into Bed 18 to set it up for a highly critical patient coming out of surgery (heart & double lung transplant). The bed was currently unoccupied, but had a long term patient (months on the unit) expire earlier that day. When the nurses were prepping the EKG leads--attaching new pads--they noticed there was a rhythm reading on the monitor. Thinking it was another patient from another bed pulled up on that particular monitor, they tried to reset the monitor to the current bed, only to discover that it was indeed set for Bed 18. To verify, one of the nurses jiggled the EKG leads, and sure enough a corresponding artifact generated on the screen. As they watched, the rhythm deteriorated into an agonal rhythm, and then to asystole...

There are nurses on night shift that refuse to be in Bed 18 by themselves to this day...

Thursday, January 27, 2011

Audited

So apparently I raised some official eyebrows with my NCLEX sprint.

It turns out my test is being audited. After doing a little research, it appears that although PearsonVUE "regularly audits a random number of exams and exam results," they also hint around a closer inspection of "exams that may demonstrate signs of irregularity."

Oops.

On another note, I was finally able to take my state's online jurisprudence exam after the website was down all weekend.

Tuesday, January 25, 2011

Upswing

I told myself I wouldn't be *that* blogger that disappeared when my internship started. But it would appear that I kind of am, since I'm typing this on my phone from the comfort of my bed. Alarm is set for the ass crack of dawn, I've been home for less than an hour.

Tonight my unit hosted a meet and greet in honor of us interns. It was truly a good time. From the comfort of the laughter and the warm glow of newly kindled friendships, it was easy to realize I very definitely made the right choice in holding out for this position. Everyone was so eager to give encouragement and advice for getting through the internship.

The internship is straight up legit. They are not messing around. The pace is not dissimilar to trying to drink from a fire hose. I am confident that I'll be successful, but I have no doubt I will be stretched to my limits. My capacity for absorbing knowledge will be tested. I cannot even imagine attempting this without the experience I already have. I can't imagine it would be anything but painful.

Just wanted everyone to know I'm alive, and doing well.

Saturday, January 22, 2011

37 Minutes Flat

Took a little quiz this morning. You may have heard of it...called the NCLEX.

I tried my best to not have any trepidation since it's a standardized exam, and given my track record with the HESI. I have to say though, I did get a little anxious. Probably a good thing given the ramifications.

I got to the test center about 30 minutes early--thank goodness for zero traffic on a Saturday--and there was already a line of people at the door. I pulled number 5 though when we were let in because I was observant enough to read the sign that said "Take a Number Please".

When called to the desk I presented my passport, my drivers license, and my ATT. I got photographed, fingerprinted, and palm-vein-printed. I stowed my things in a locker, subjected to a hoodie-hood search, and then was escorted to a test cubicle. I sat down, stuffed the earplugs in, and took a deep breath. Short tutorial, and then there it was, Question #1.

I forced myself to read slowly and deliberately, focusing on not rushing. Question #2 was a drip calculation, and I nearly made a mistake by trying to move slowly. At that point I said, "Screw it", and just relaxed. I fell easily into a rhythm, and just took the questions as they came. The questions weren't easy, but I didn't think they were terribly hard either. I had to think, but none of them were too difficult to reason out. I was pleasantly surprised that at least two answers of every question were blatantly wrong. There were a lot more "select all that apply" questions than I expected--maybe as much as 20%.

I wasn't keeping close track of the question numbers, and looked up just as I submitted #75... and then the screen went blue.

When I was escorted back out front, the proctors we freaking out. "Done already?! That's a new record!"

Personally I feel like HESI was more challenging because it was much more in depth and detailed on each topic. Of course I don't know for sure that I passed NCLEX yet, but I don't think I'll be losing sleep until I do get results.

One less thing to worry about.

Now to get back into the gym.

Monday, January 17, 2011

Orientation

Today was my first day of hospital system orientation. Since I work for a hospital system with multiple campuses and 20,000 employees, they put on system wide orientation for all new hires at one central location.

It wasn't exactly your typical hospital orientation. Much less of the housekeeping type of stuff, and much more cheerleader type presentations. It was weird. I found myself quite bored at times while we were going over the copious power point slides all written in corporation-speak. In other words, a whole lot of words that don't really say anything. Thank goodness for the squishy man they included in our packets. Otherwise I might not have made it through without his antics...

However, the culture of the system as a whole is remarkable. 27% of employees have been there for 10 years or longer. That seems like a large percentage although I don't really have anything to compare it to. It also seems to be in line with my own personal observation during my management clinical and Capstone--every time I turned around it seemed like I was meeting someone who had been there 25-30 years.

The whole thing seemed a little unpolished and unorganized, but that's because it wasn't put on by an HR rep, but rather by two everyday employees. The idea was that anyone can come and do lip service to an organization, especially if that's what they're paid to do. However, just run of the mill employees that were just as pumped about the organization makes a statement.

On the flip side, there was a lot of support work involved too. For example, IT showed up with 25 laptops and set up a "Cyber Cafe" that was manned by an IT rep for every 2 computers to help people get logged in and work out any password issues. Very cool. Breakfast of fresh cut fruit, muffins, and bagels; lunch of baked salmon or baked chicken, rice pilaf, green beans and desert; then a cheese tray for afternoon snacks. There was an I-9 rep, there was a free gift from the hospital store. Tomorrow is the resource fair for benefits, including a wellness program that pays part of your insurance premium if you participate. Free classes by the public safety officers in defensive driving and personal protection. A system-wide credit union. Discounts through cell phone companies. The list goes on and on.

Really excited about working here!!

Saturday, January 15, 2011

I'm Back!

After nearly two weeks on the road, I am back. First the cruise to Mexico--amazing--and then a trip to hike the Grand Canyon--amazing!

I'll write up some details and post pictures later.

On the nursing side of things, I start orientation on Monday at my new job. Very excited for this fact. Had a minor freak out when the HR department called me on Wednesday, (when I was 1000 miles from home in spotty cell service), and told me the company they hired to do my background check couldn't verify I had a nursing degree. And I couldn't start unless I could provide them proof I'd graduated by Friday, end of business.

Uh...

So, a panicked call to my wife, and she ordered a stat official transcript Fed-Ex'd to the HR department ($24.00!!!!) so that I could start work Monday.

Other than that, things are pretty quiet.

Oh yeah. I take the NCLEX a week from today, next Saturday morning at 8 am. My ATT came by email while I was sitting in port waiting to depart on our cruise. So I hurriedly scheduled my exam as the ship was pulling out of port. Lucky for me I got it scheduled before we lost cell service.

Anyway, more posts soon!

Sunday, January 2, 2011

Blame it on Mexico

Wife and I are leaving bright and early tomorrow morning for our cruise.

I was going to get several posts written to post while I'm gone, but I chose to catch a stomach virus instead.

I know, selfish of me.

So, this space will be filled with dead air time until at least Saturday. Then I might get in a post or two before I leave for a week at the Grand Canyon the following Monday.

In the meantime...

Blame it on Mexico.

Saturday, January 1, 2011

The Rhythm of Life

Today my younger daughter asked me for a bowl of cereal, and since cinnamon Life cereal is one of her favorite things in life, I obliged. As I ambled into the kitchen she trailed along behind me, her feet padding double time on the tile as we went. First I pulled down a bowl from the cupboards, then the cereal from the pantry, and finally the rice milk from the refrigerator. As I moved around the kitchen, my daughter twirled and danced around me, her hair flipping out from her spinning, her arms and hands curving gracefully so that her fingertips just grazed the hem of her skirt. As I moved from one part of the kitchen to the next, her dancing motion was in perfect synchrony with my purposeful movements. Her tiny feet carried her around me, like a small moon around its parent planet.

I was struck by the beauty of the moment. The simplicity and the wholeness. The dance like quality.

It's a wonderful thing to be afforded these glimpses of knowing beyond the shadow of a doubt that there is no other time and space in which you belong more than this very moment.

Happy New Year.