Sunday, June 1, 2008

Oooooops!


Boy is my face red.

Since graduating and starting my new job in acute dialysis, I haven't had much to say about being a middle-aged nursing student. Instead I've been blathering away about being a dialysis nurse....

....and I forgot to tell you. I'm so sorry!!

Anyway here is the link to my new home. If something comes up with regard to being a student, for example, if I run into a nursing student during my job, I'll come back and post about it here.

In the meantime come on over to the U No PP place and here more about patients who don't pee than you ever thought you need to know.

Monday, May 19, 2008

Toys In the Attic

For those of you too young to remember Aerosmith before they got sober, toys in the attic is a euphamism for crazy.

I don't know what it is about dialysis patients. They can be so crazy and controlling sometimes. Maybe it's all the grief and loss. Maybe it's the metabolites building up in their brain. Whatever it is, it's never a dull momement in Dialysisland.

The other day I had a patient whose husband created drama as I was leaving one night. The patient was a little hypotensive after treatment, which is not all that uncommon, but when she got to her room she told her husband she had chest pain. He came roaring out of the room demanding to know what had happened to her, and later insisting that she was allergic to one of the meds I had given her. Before I was able to get to the bottom of it, word had already spread throughout the unit that "that dialysis nurse gave her a medication she's allergic to."

By the time I arrived at her bedside the charge nurse was there trying to damage control and was fuming. I stayed with the charge nurse, trying to get to the bottom of what had really happened. I wanted to make the charge nurse understand that I was there to clean up whatever problem I might have created and that I wasn't going to dump the situation in her lap and then leave. Together we looked at the patients' record. The med I gave was prescribed by the nephrologist and had been given to her before. We checked her list of allergies and the med I gave her was not one of them.

About an hour later as we began to unravel what had happened, we realized that we were the victims of a drama king and an attempt at staff splitting. By teaming up with the charge nurse to solve the problem, we stopped the patient's husband from performing a "divide and conquer" episode with us. I'm glad I made the decision to work with the nurse and function as her ally. As things calmed down she relaxed and we were able to talk through what had happened. I could tell she was relieved that I stuck by her against the evil one and worked as a united front against him. Everything was documented thoroughly. We could feel a lawsuit in motion and thought we'd better have things written down. The next time I saw her she gave me a big smile and a wave. That made me feel pretty darn good about how we got through that difficult situation together.

Today I had a problem with my dialysis machine and was doing what I could to keep it running. Meanwhile the patient noticed I was spending a lot of time punching buttons and began a running commentary about it. "How come the other nurses don't have this problem? You don't know what you're doing. They need to get someone up here who knows what's going on." Stuff like that. I mostly ignored him and went about my business. I learned long ago that dialysis patients have lots of time on their hands and use it to invent new games to try and rattle the nurse. I've learned to deal with the crazy.

Today it took me 12 hours to run 2 patients. That's really way to long but actually it's an improvement over what I was doing before. It's going to get better. Even with all the playground games I already love this job.

Monday, May 12, 2008

Time For A Cool Change

Pinning was awewsome. Graduation was awesome. My family was awesome.

It is an interesting place to be; ending one kind of life and beginning another. In the past my life changes came on like a freight change. They were sudden and dramatic. This one is smooth and calm. It feels like moving in slow motion and it's very nice.

I have the uneasy feeling that I'm supposed to be doing something. People tell me this is normal after graduation. I still have this amazing feeling that whenever I do something fun I can keep doing it until I don't want to anymore. I can enjoy myself without guilt.

I still have to take the board exam. I had planned to spend an hour a day reviewing stuff to get ready for it. I can't quite get myself to do that yet. I just want to enjoy doing nothing for a little bit longer.

Then there's the unpleasantness of having to actually work.......full time. I haven't worked full time in 2 years. I'll be hating it for a while but eventually I'll adjust.

Meanwhile I am spending way too much time on YouTube and I Can Has Cheezburger, but what they heck. I worked hard for it.

Wednesday, May 7, 2008

I Feel Love

This weeek is filled with graduation frenzy.

My family arrived yesterday and we have not stopped partying since they landed. Last night we went out with my classmates. I've never been out with them in the evening; just lunch here and there. It was a big deal because I rarely stay awake past 10 p.m. The ideal bar for me would be one that has last call at 8:30 p.m.

Today was the pinning rehearsal. The pinning committee had put together a couple of slide show presentations. They were trying it out to see how it would work and we were all mesmerized. Our instructors saw that they could not get our attention once the slide show started so let us watch the whole thing. There were lots of photos and video of us from the past two years of nursing school. Lots of smiles, hugs, busy moments, etc. Each student also created a couple of slides thanking friends, family and whomever for helping us get through. So, yeah, all of us were riveted, waiting for our slides to appear.

Tomorow is the actual pinning. There will be plenty of Kleenex for all.

Friday is graduation. I'm pretty excited because miraculously I was able to keep my grades up and I'm graduating with honors. Yay me!

I'll write more once all the celebrating is over. For now I'm having a great time with my family, soaking up the love from my classmates and marveling at having made it through in one piece.

Peace out.

Thursday, May 1, 2008

Adapt......Or DIE

Boy, the stuff they don't teach you in nursing school.

I spent a day working with another dialysis nurse. As she hooked up the dialysis machine to the shower she said "Oh by the way. Call the manager and tell her you need a special plumbing adapter for this."

Special adapter?

Okay so I called the manager and she said she'd have someone drop off a kit at the hospital the next time I was there. A kit? I expected to find a charming little kit, maybe with fur lining and rhinestones and it would play music when you opened the lid, and a teeny little adapter inside. Instead I found this.



Inside are no less than 20 different plumbing adapters.



That's a penny on the bottom row second from the left.

I'm calm today, but when I saw this thing I just about shit a brick. What the hell am I supposed to do with all these?

Apparently what I am to do is attach an adapter to the dialysis machine and another adapter to the faucet or shower and couple things together until I get a tight seal. The one I saw the nurse use was a perfect fit for the dialysis machine and the shower head so only one piece was needed. No coupling required.

Wait it gets better.

So the other day I decided to put on my big girl panties and run a couple of patients all by myself. I get to the patient's room, introduce myself and get him all warmed up in preparation for dialysis. He's a new patient, just started dialysis a couple of days before, and so was a little edgy and nervous about the whole process. I fire up the dialysis machine and drag the hoses into the bathroom. I get out my sparkly new kit and begin trying out different adapters.

None of them fit. Oh sure, I could get one to fit the shower hose and another to fit the dialysis machine, but could not get them to fit each other.

Oh boy.

I called my manager and she said to call the machine tech. The machine tech said he could send someone over with the correct part and it would only take about an hour or so.

AN HOUR OR SO!?!

I cooled my heels in the cafeteria and played games on my Blackberry to relieve the tension. I had to get out of the room because the anxious patient set to whining and saying "well, how come the other nurse came in and hooked me up right away?"

Because I'm a lame-ass buffoon and they sent me here as a joke. April Fool!!!

The machine tech arrived with the correct adapter and threw in a pipe wrench for good measure. Thanks Dude. Much hillarity ensued and about three hours later I ran the patient and all was well with the world.

I took a lunch break and went to run my second patient and things went even further awry, but I'll save that story for another day. I'll just tell you that I spent 20 hours running two patients and I'm still trying to recover from that disaster.

The really awesome part is even with all the time I spent there that day, I still made more per hour than I did as a medical transcriptionist.

It's going to be fine. I just have to get over the hump.

Wednesday, April 23, 2008

Post HESI Survivor's Guilt

The past few days have been exhausting. After the elation of passing HESI wore off I have felt drained of energy. At first I thought maybe i was feeling a little guilty. I want to celebrate the fact that I passed, but 22 of 60 students didn't pass and I feel terrible about it. I feel traumatized by the whole experience, the preparation leading up to the test and the tension that had built up over time.

So much is at stake. If we don't pass, we can't graduate. We get several chances to try again, but only two chances before graduation and pinning. For a lot of people that means cancelling graduation plans, money wasted on plane tickets, the embarrassment of having to tell your family you didn't pass. To make matters worse some students have internships and jobs lined up that they won't be able to start if they don't graduate.

I didn't know what to do with these feelings. Fortunately another classmate who passed the test opened up to me and it turns out she feels the same way. We talked to other students and several others who passed are feeling the same strange funk.

At the beginning of the semester a classmate came up with a plan to help students succeed. She suggested that the students who pass HESI participate in tutoring sessions for the students who didn't pass.

It turned out to be a terrible idea for several reasons. The students who didn't pass are very embarrassed about it, and they feel humiliated to be in the same room with their classmates who passed. For those of us who passed, we're drained and exhausted. We feel that we just don't have anything left to give. I know that since the day of the test I have had this gnawing sense of responsibility for helping my classmates pass, and I resent it.

Then I have this classmate, the one who calls himself the class nerd, who has patronized me for every HESI I have passed. We have had three exams - one midcurricular exam, the LVN exam and now this one. I did well on all of them and he did not. He always says to me "well the reason you did so well is that you got a lot of questions on topics you're good at." Now I'd heard that the questions are random, but after talking to other classmates, I think we all had pretty much the same questions. I can safely say after taking the HESI three times and scoring more than 100 points beyond passing every time, it's not just the luck of the draw that got me through. It was hard work and staying on top of the material all the way through. There is no magic formula. It's not luck or fate. I hate it when he tries to minimize my accomplishment as a way of justifying his failure.

The other thing that bothers me is that that during our test review that was week before last, I listened to students asking questions and I realized that for many of them, this was not a review. For many of them, it was as if they were seeing the information for the first time.

As much as I would like to help my classmates succeed, I cannot teach them two years' worth of material in an afternoon study session. I'm sorry. Every once in a while during nursing school, a classmate would ask me to help him or her study, or I would be asked to join a study group. I would try and explain my study methods to them and they would always reject what I was trying to tell them or they would argue the information. I personally go straight to nursing interventions, then fill in the rest of the information later. That way if I run out of time to study before the test, I at least got the most critical information covered. I would try and convince them that, hey, you asked me how I do it, I'm telling you, you have to believe me. But okay. Have it your way. We'll go through the Powerpoints item by item if that is what you want to do.

So today in class the passers and failers eyed one another uneasily. The class nerd wouldn't even look at me, wouldn't talk to me. I take this as a sign that maybe somehow he finally gets it. I really did learn something in nursing school, and he's not really the class nerd after all. I know that the failing students have their own stories to tell. I know they have no sympathy for those of us who passed. They would trade places with us in a minute. Nevertheless, our feelings are real and we're doing our best to try and sort them out. We feel guilty as hell and we feel left alone to deal with the aftermath of this experience. We want to honor our committment to help our classmates succeed, but we're all too aware of what little we can actually do about it. I'm trying to choke down this ball of resentment mixed with guilt and it's not going down well at all.

I know the classmate who came up with the tutoring plan had her heart in the right place. I know she wanted us to bond as a class and help each other get through, but unfortunately it didn't turn out the way anybody had hoped. They say the road to hell is paved with good intentions. I never imagined the form of hell it would turn into.

But I'll be okay. It's just a weird place to be.

Monday, April 21, 2008

Acute Dialysis - Day One

It sounds great. Patient nurse ratio 1:1. Bring something to read because you'll be sitting down for four hours.

Four hours? What nursing job lets you sit for four hours straight? Wow. This my dream job. And it pays a whole lot more than any other graduate nurse job I've heard of. Some of the nurses told me that they made six figures last year. Six figures. My first year out of school. Oh man!

I figured sooner or later there would be something about this job that makes is suck bad enough that no one would want to do it. Turns out all the things that are good about it are also the things that make it suck.

Nurse-patient ratio 1:1 means the patient interprets this as meaning you are their personal servant for the day, at their beck and call. "I'm cold. Give me a blanket. Turn off the air conditioner. Give me a drink of water. My oatmeal is too cold. I need another Sweet N Low for my tea." You get the idea.

This also means we have way too much personal time with each other. The following is a sample of the verbal abuse I was treated to by my patient today.

"You aren't taking care of me right. I hope they don't ever let you take care of me again because you are a terrible nurse. You can't do anything right. You aren't very good looking are you? You're pretty fat for a nurse. If I get pneumonia I'm going to sue you. If you don't take me off this machine right now I'm going to call my lawyer. You never listen to anybody. You're just hard-headed and stubborn."

Yeah, yeah, yeah. Here's the phone, you grumpy bastard. Call your lawyer. Bring it!

Luckily I've had about three years' experience dealing with similar bullshit working in a chronic dialysis unit. I found that the best response is act like you're schizophrenic or retarded.

"I'm not good looking on purpose. I get so tired of men asking me out all the time that this works better. Really? I'm fat. Oh, if my weight is interfering with your treatment somehow, let me know what I can do differently so it won't be such a problem for you. If I'm not doing anything right how about if I heat up these pancakes for you? I'm hard-headed. You sound just like my mother. Oh, I can't tell you how many times she has told me that. You know the two of you would have so much fun talking about me. How's that oatmeal? So I was wondering, if you already have pneumonia, how are you going to sue me for giving it to you? I've never heard of this before and I'm wondering how that works."

I finally figured out how to eeeeeeeeeaase my chair back little by little until the dialysis machine was between me and his line of sight. I could still monitor him but he couldn't see me and, well, it's sort of like dealing with a baby. If he can't see you, you don't exist anymore.

Pretty soon his wife came in. A lovely woman, very attractive, every hair in place, dressed beautifully and very attentive to him. And he was a complete bastard to her. She didn't speak English and so he felt free to say ugly things about her to me.

I forgot. People suck.

Then there is the "nurses eat their own" thing. Yep. It's true. Since it was my first day on this unit I had to figure out where things were, how to make unruly equipment do what it is supposed to do, you know, just figuring stuff out. Every time I came out of the room to ask a question, I was met with much eye rolling. Once I stepped out of the room and two nurses were at the nurses' station and I asked a question. Both of them ignored me. I know they heard me. I'm loud. My mother would tell you. Finally a tech walked by and asked if I needed anything. I said "Oh thank God. For a minute there I thought I was invisible since nobody seems to notice me."

Probably not the smartest thing to say, but I'm only working near them, not with them. I could see the nurses huddling up, talking about that "stupid dialysis nurse". Wow. Eighth grade all over again, only without acne and I can smoke in front of anybody I want. And I have a driver's license. And a paycheck. Neat.

But I took the high road. When I left the unit I gave the nurse report on my patient and was all professional and business like. I thanked her for everything and said "I look forward to seeing you next week. I really enjoyed my day." If she thinks I'm crazy maybe she won't poke a stick into my cage.

The other thing that could be a negative is the ominous rumbling of many long hours. Yeah the nurses earn six figures but they earn every single penny. I'm hoping that somehow I can balance those long hours doing things I would usually do with my down time - reading, crossword puzzles, surfing the net on my Blackberry. But I get the feeling that somehow it's not quite going to work out like that.

At any rate, I can't think of any other nursing job that would work for me at this stage in my life. I won't be running up and down the hall, patient to patient, juggling hundreds of life and death details. The next patient who asks me why I'm so incompetent and stupid I'll just say "would you like some fries with that?"