So, a coworker whose worse than a GUNNER (in terms of behavior) tells me i'm going to page this doctor now. She was all hyped up and stuff after i told her the guy said to call if the patient wants benadryl because they weren't going to put in a prn order. anyway, she goes on making a big deal to the orientee about how stupid it is and all that. (Sometimes, i look at some nurses and just laugh in my head. I'm not sure how this girl thought her years as an LPN and whatever many months she spent at community college getting her associates equates to 4 years of med school and 4 years of resdiency)
Anyway, she calls the general team and they tell her to call the person covering. So i see the doc walking towards us and i said that's him coming. She turns and immediately turns towards the walk and go "oooo he's good looking." I thought, what happened to "i'm going to bug this person all day till he writes that benadryl order."
Anyway, i walk away,and when i walk back, i think the orientee realized i didn't tell them the patient was diabetic (ommission on my part but it's on the kardex and it's also in the emar so before she admister her meds, she'll realize that she needs a fingerstick). Anyway, in an effort to explain my oversight to her orientee, she tells her the fact that english isn't my first language impairs my ...... do i need to say more. I just like how some Americans judge intelligence by whether english is your first language or not. A friend in college once said to me "i can imagine how hard it must be for you learning this stuff because english isn't your first language so i can't imagine you translating this first into your language and trying to understand what it means." She always used to tell me let me help you study, let me help you study. Well, She was angry with me after graduation, didn't care till last year when she told me why she was angry. According to her, i made everyone think i was struggling when in fact i was making straight As. First of all, i have a policy of not telling people my grades because i think it's none of their business. Second, i worked all the time in college and i thought me complaining about not having time to study was the reason why she kept saying let me help you study. I mean that evening when she said she couldn't imaging how hard it is for me studying the stuff, i smiled at her and brushed it off as an ignorant remark. So i told her the fact that i didn't tell her my grades doesn't me she has to think of me as a stupid person.
I actually liked how i walked away with all those awards from school and wasn't on anyones radar. An American see you answering all the questions in class and still think you're stupid and struggling because english isn't your first language. An african sees me sitting quietly in class and even without saying a word, they call me a 'shark'. Of course, Jill is one american who looked at me sitting quietly in biochem when Dr R said the highest score was a 100 and she turned to me and said "i bet you had that 100". Again, i looked at her and smiled.
I don't mind when someone thinks i'm stupid. In fact it's easier for me because people who see the real me feel intimidated.
Showing posts with label work. Show all posts
Showing posts with label work. Show all posts
Saturday, March 12, 2011
Wednesday, February 16, 2011
The evil that men do
I just got news, it's unofficial, that my manager came back from vacation and they asked her to leave. I knew what goes around will come around for her but this soon? i was expecting it to happen later. We've had so many people quit on our unit it's pathetic. Staff are complaining and unhappy. Each day i pray i have a job. I was actually planning on quitting sometime this year before my evaluation.
I've been reading the book of Daniel and i was thinking about how God humbles these proud rulers. Last year, i thought Belshazzar's destruction came too soon. Looks like i'm seeing something similar manifest.
Nothing is permanent in this life. My manager was someone with great nursing skills. How to talk to people and deal with staff was a whole different issue. I feel like she worked hard and she did suck up to the administration. She was the on-call person at odd times when i'm sure no one else wanted to be on call, like during the snow emergency and on weekends. I know she put her heart into her work on the unit. I know she's saved the hospital money. She did do some unethical stuff, such as not paying people who stayed over after 7:30 to complete their work, she made us clock out after work for staff meetings and while she kept us there for 2hrs, she only paid us for 45minutes. She threatened people, she knew very well that the job market for nurses is bad and she brandished that fact around and said i'll fire you and hire someone else because i know many people who can't find a job. She was petty and flaky.
I guess there's soo much management can take. I wondered for a second if she took a minute to wonder why people were leaving our unit. But then i figured that if she's looking at it from the point of view that they're quitting because they can't do the job and i can always hire someone else, then she's likely to see herself as the major reason why people left. We've had 5 techs on nights quit, 3 on dayshift, so many nurses have quit it's not worth counting. I think the recent exodus of 5 nurses from dayshift this month, including one who's worked there for 9years did it.
Oh well, i feel relieved. Whew! exhaling....
I've been reading the book of Daniel and i was thinking about how God humbles these proud rulers. Last year, i thought Belshazzar's destruction came too soon. Looks like i'm seeing something similar manifest.
Nothing is permanent in this life. My manager was someone with great nursing skills. How to talk to people and deal with staff was a whole different issue. I feel like she worked hard and she did suck up to the administration. She was the on-call person at odd times when i'm sure no one else wanted to be on call, like during the snow emergency and on weekends. I know she put her heart into her work on the unit. I know she's saved the hospital money. She did do some unethical stuff, such as not paying people who stayed over after 7:30 to complete their work, she made us clock out after work for staff meetings and while she kept us there for 2hrs, she only paid us for 45minutes. She threatened people, she knew very well that the job market for nurses is bad and she brandished that fact around and said i'll fire you and hire someone else because i know many people who can't find a job. She was petty and flaky.
I guess there's soo much management can take. I wondered for a second if she took a minute to wonder why people were leaving our unit. But then i figured that if she's looking at it from the point of view that they're quitting because they can't do the job and i can always hire someone else, then she's likely to see herself as the major reason why people left. We've had 5 techs on nights quit, 3 on dayshift, so many nurses have quit it's not worth counting. I think the recent exodus of 5 nurses from dayshift this month, including one who's worked there for 9years did it.
Oh well, i feel relieved. Whew! exhaling....
Thursday, January 27, 2011
Internal medicine
I don't see surgeons taking a lot of crap and i don't see the attendings taking a lot of crap but residents and interns in IM do take a bunchload of crap. Surgery residents do take crap. Patients in the hospitals are so rude these days, well at least down here they are, it's sad they're crying about people going to specialty. I mean who wants to put up with an uneducated hiv, hepatitis drug seeker who insists on getting dilaudid?!
Doctors work hard to get where they are. Years of med school, crazy years of residency, putting up with insurance companies and meditech afterward makes me think they deserve every penny they get. The whole entitlement attitude from patients here is one that makes me want to go into a special where i don't have to deal with family members or patients themselves.
My heart goes out to nurses on these medical floors who have to put up with the bulk of the nasty attitude. I mean a resident only takes part of the crap if they decide to come up and see the patient. The nurse on the other hand is constantly on the floor and has to put up with peoples nasty attitude. For example, i've six patients, 3 primary cares, and i've joints i need to wash up and get in the chair in the morning. In order words, i'm overworked, stressed out and i have to put up with nasty attitudes. I wonder what would happen if med/surg nurses went on strike? Maybe the patients would learn to appreciate them? I doubt it!
I had a nasty patient last night, who just got on my very last nerve. He yelled at my charge nurse and i just had to walk over from the next room to tell him to not yell at us because we're trying to help and he doesn't own any of us. That shut him up for a couple of hours, then he started acting up again. 31 y.o male with HIV, Hep C, IVDA hx, all that crap along with the most nasty attitude. I pity the desperate female who has to put up with sight of him, let alone his attitude. The ER nurse couldn't stand him, the resident just said he's nasty and i think he's a pitiful thing. I guess the only way for him to gain some form of control is to yell at anyone when making any demands.
I respect everyone who works in the US health system, putting up with law school and other non-medschool graduates legislating healthcare in whatever way they seem fit. It's these same patients who eat the fruit of their actions. The sad thing is that there are those who are grateful and appreciate the help and sometimes, they make it worthwhile.
Doctors work hard to get where they are. Years of med school, crazy years of residency, putting up with insurance companies and meditech afterward makes me think they deserve every penny they get. The whole entitlement attitude from patients here is one that makes me want to go into a special where i don't have to deal with family members or patients themselves.
My heart goes out to nurses on these medical floors who have to put up with the bulk of the nasty attitude. I mean a resident only takes part of the crap if they decide to come up and see the patient. The nurse on the other hand is constantly on the floor and has to put up with peoples nasty attitude. For example, i've six patients, 3 primary cares, and i've joints i need to wash up and get in the chair in the morning. In order words, i'm overworked, stressed out and i have to put up with nasty attitudes. I wonder what would happen if med/surg nurses went on strike? Maybe the patients would learn to appreciate them? I doubt it!
I had a nasty patient last night, who just got on my very last nerve. He yelled at my charge nurse and i just had to walk over from the next room to tell him to not yell at us because we're trying to help and he doesn't own any of us. That shut him up for a couple of hours, then he started acting up again. 31 y.o male with HIV, Hep C, IVDA hx, all that crap along with the most nasty attitude. I pity the desperate female who has to put up with sight of him, let alone his attitude. The ER nurse couldn't stand him, the resident just said he's nasty and i think he's a pitiful thing. I guess the only way for him to gain some form of control is to yell at anyone when making any demands.
I respect everyone who works in the US health system, putting up with law school and other non-medschool graduates legislating healthcare in whatever way they seem fit. It's these same patients who eat the fruit of their actions. The sad thing is that there are those who are grateful and appreciate the help and sometimes, they make it worthwhile.
Friday, November 12, 2010
The strange case of the rising blood sugar
So, patient whose dinnertime blood sugar was 88 jumps to 528 at bedtime when the tech checks it. i check it about 20minutes later it was 574. Order said give 16units SSI and notify HO. Patient refused SSI and self-administered 9.7units of novolog via her insulin pump. recheck a little after an hour later, was more than an hour cuz i was busy and the fingerstick was now 584. Patient finally consented to getting SSI but the max she'll take is 10units. spoke to doctor who ordered it and administered. Rechecked a little over an hour and it was 594. at that point, gave 10 units and notified doc again.
Doc says give 20units. Then she says "i'm afraid she'll go into DKA, how much do you think i should give her?". I reply 10. She's NPO. She goes "If she keeps going up, she may not be able to go for surgery in the morning. give her 20units. if she drops too low we can always give d50." Surprisingly, i saw where she was coming from and didn't argue about the dose. Now was that a faulty logic? I don't know and i think it's hard to decide.
The thing with blood sugar levels is that too high is bad and too low is also bad. How will a person's body respond to insulin administration? It's hard to tell. For example, this lady's fingerstick kept climbing up despite multiple administration of insulin. Did the doctor think it was going to keep going up? Yes. She told me over the phone that "she needs a high dose of insulin".
Anyway, i recheck at 440am, it had dropped to 212. At 0639, it was 93. When i left patient, she said she was fine. After walking into the room to introduce new nurse, The patient stated i feel 'low'. Since i was done report, i told my coworker to have the tech check it while i complete the patients OR checklist. So at 0735, it was 31.
Coworker who left me in a crappy situation comes in this morning and tells me you shouldn't have administered 20units. Well, if the lady kept climbing high as she was and went into coma, first it would've been my fault and i'm sure this same person would've criticized the doctor for not being aggressive. Can we treat DKA? yes, insulin drip, IV NSS and a whole bunch of crap. I remember when i worked at Jeff, i had a lady who came in with bloodsugar reading "HI" on machine, she was on a insulin drip, q1hr fingersticks and it took more than 12hours for blood sugar levels to come to the 500 range. And we've had patients here at who've had to be transferred to the ICU so they can get an insulin drip. Can you push D50 and have the blood sugar come up in 30minutes, yes. Sometimes, you may have to administer D50 twice.
So was the doctor's reasoning faulty logic? i don't think so. I mean she could've looked the other way and said, let's not give her anything and the bloodsugar could've gone past 600 and she coulda been in a coma. Neither one of us can predict how the patient would react. It's bifurcated road that leads to the same place. You don't treat aggressively, you risk the patient going into DKA. You treat aggressively, you risk the patient bottoming out. At least in this case the patient was conscious and communicative and action was taken.
There's been times when i've looked at out comes and thought, this doctor could've done this or this should've been implemented in the patients care to avoid such and such. Today, i support the doctors judgement. I know on my drive home, i tried to think if there was anything i could've done differently and honestly? i couldn't think of any. Between 10p and 6am, the lady got 8 fingersticks. One almost every hour except during the hour between 5 and 6am. I did 6 of those fingersticks myself and my tech did 2. i documented 6 times each time i took it. Knowing i'd given the patient 20units insulin, i checked the blood sugar levels afterwards and 20minutes before shift change, i rechecked and documented. She was 93. How was i supposed to know she'll drop considering i held her AM dose of insulin? The doctor didn't play God. I feel like she did the best she could do. Her reasoning led her to the choice she made. It was based on sound logic considering the inability predict an individuals reaction.
I know some nurses look at medical judgement and think it shouldn't be done that way but i think we see things differently. Doctors stand far away and see a picture those of us standing close to the patient don't see. This time, i think the medical judgement, however aggressive it may look, was a fine decision.
Doc says give 20units. Then she says "i'm afraid she'll go into DKA, how much do you think i should give her?". I reply 10. She's NPO. She goes "If she keeps going up, she may not be able to go for surgery in the morning. give her 20units. if she drops too low we can always give d50." Surprisingly, i saw where she was coming from and didn't argue about the dose. Now was that a faulty logic? I don't know and i think it's hard to decide.
The thing with blood sugar levels is that too high is bad and too low is also bad. How will a person's body respond to insulin administration? It's hard to tell. For example, this lady's fingerstick kept climbing up despite multiple administration of insulin. Did the doctor think it was going to keep going up? Yes. She told me over the phone that "she needs a high dose of insulin".
Anyway, i recheck at 440am, it had dropped to 212. At 0639, it was 93. When i left patient, she said she was fine. After walking into the room to introduce new nurse, The patient stated i feel 'low'. Since i was done report, i told my coworker to have the tech check it while i complete the patients OR checklist. So at 0735, it was 31.
Coworker who left me in a crappy situation comes in this morning and tells me you shouldn't have administered 20units. Well, if the lady kept climbing high as she was and went into coma, first it would've been my fault and i'm sure this same person would've criticized the doctor for not being aggressive. Can we treat DKA? yes, insulin drip, IV NSS and a whole bunch of crap. I remember when i worked at Jeff, i had a lady who came in with bloodsugar reading "HI" on machine, she was on a insulin drip, q1hr fingersticks and it took more than 12hours for blood sugar levels to come to the 500 range. And we've had patients here at who've had to be transferred to the ICU so they can get an insulin drip. Can you push D50 and have the blood sugar come up in 30minutes, yes. Sometimes, you may have to administer D50 twice.
So was the doctor's reasoning faulty logic? i don't think so. I mean she could've looked the other way and said, let's not give her anything and the bloodsugar could've gone past 600 and she coulda been in a coma. Neither one of us can predict how the patient would react. It's bifurcated road that leads to the same place. You don't treat aggressively, you risk the patient going into DKA. You treat aggressively, you risk the patient bottoming out. At least in this case the patient was conscious and communicative and action was taken.
There's been times when i've looked at out comes and thought, this doctor could've done this or this should've been implemented in the patients care to avoid such and such. Today, i support the doctors judgement. I know on my drive home, i tried to think if there was anything i could've done differently and honestly? i couldn't think of any. Between 10p and 6am, the lady got 8 fingersticks. One almost every hour except during the hour between 5 and 6am. I did 6 of those fingersticks myself and my tech did 2. i documented 6 times each time i took it. Knowing i'd given the patient 20units insulin, i checked the blood sugar levels afterwards and 20minutes before shift change, i rechecked and documented. She was 93. How was i supposed to know she'll drop considering i held her AM dose of insulin? The doctor didn't play God. I feel like she did the best she could do. Her reasoning led her to the choice she made. It was based on sound logic considering the inability predict an individuals reaction.
I know some nurses look at medical judgement and think it shouldn't be done that way but i think we see things differently. Doctors stand far away and see a picture those of us standing close to the patient don't see. This time, i think the medical judgement, however aggressive it may look, was a fine decision.
Wednesday, June 23, 2010
The case of the maggot infested foot
God being so kind, yesterday was good. ER sent a patient up. As most times, report was shady but the nurse mentioned that the patient, who presented with blisters on bilateral feet that was infested with maggots, was all cleaned up and they'd gotten rid of the maggots. YAY or so i thought.
So up came the guy, btw, he is one of the sweet homeless folks ( i need to blog about the kinds of homeless folks who come to the hospital one of these days) but anyway, after getting him settled, i proceeded to do a skin assessment. when he walked in, i noticed an open wound, from a blister that had burst, on the plantar surface of his left foot. my goal was to figure out the length, breath and depth of it so i can apply an appropriate dressing. In so doing, i noticed something black between his great toe and 2nd toe so i went ahead to take a better look thinking it was gangrene. I mean with all the diabetics in bmore, i see gangrenous toes so often it almost looks like a normal variation of the foot and toes. Anyhoo, i open up the toes and out comes MAGGOTS!!! I freaked silently because i'd hate to have the patient think whatever. Anyway, i say maggots and the nurse doing the validation with me goes "let me see.
" Seriously?! if i was doing a skin validation with someone and they said maggots, i don't think i'd be so quick to see although on second thought, i'm soo nozy when it comes to medical stuff. Tell me a patient in room so and so has this and i'll make sure that even though i've no business in that room, i'll see it. So in hindsight, that would have been my reaction as well. Anyhoo, i call the resident asking if she'll like to order something for me to use to get rid of the maggots because i was told the ER had the guy soak his foot in something. The nurse wasn't sure what.
She turns around and asks me what would you like for me to order? I find it wierd that after 4 years of medical school, you expect a nurse to make a medical judgement for you. So i tell her i think the ED used betadine and she says i'll order it and she never does.
Anyway, the thing here is that there are tons of homeless people here who live in terrible conditions and go through awful things that Christe Eleison! makes my heart ache at times when i see them. To come to the point where maggots feed on you feet? boy, i thought the dead were the ones who had those little creatures feed on them. Are you better off than the dead or not? i mean the only difference is that you breathe but like the corpse underground, you're organic matter.
So up came the guy, btw, he is one of the sweet homeless folks ( i need to blog about the kinds of homeless folks who come to the hospital one of these days) but anyway, after getting him settled, i proceeded to do a skin assessment. when he walked in, i noticed an open wound, from a blister that had burst, on the plantar surface of his left foot. my goal was to figure out the length, breath and depth of it so i can apply an appropriate dressing. In so doing, i noticed something black between his great toe and 2nd toe so i went ahead to take a better look thinking it was gangrene. I mean with all the diabetics in bmore, i see gangrenous toes so often it almost looks like a normal variation of the foot and toes. Anyhoo, i open up the toes and out comes MAGGOTS!!! I freaked silently because i'd hate to have the patient think whatever. Anyway, i say maggots and the nurse doing the validation with me goes "let me see.
" Seriously?! if i was doing a skin validation with someone and they said maggots, i don't think i'd be so quick to see although on second thought, i'm soo nozy when it comes to medical stuff. Tell me a patient in room so and so has this and i'll make sure that even though i've no business in that room, i'll see it. So in hindsight, that would have been my reaction as well. Anyhoo, i call the resident asking if she'll like to order something for me to use to get rid of the maggots because i was told the ER had the guy soak his foot in something. The nurse wasn't sure what.
She turns around and asks me what would you like for me to order? I find it wierd that after 4 years of medical school, you expect a nurse to make a medical judgement for you. So i tell her i think the ED used betadine and she says i'll order it and she never does.
Anyway, the thing here is that there are tons of homeless people here who live in terrible conditions and go through awful things that Christe Eleison! makes my heart ache at times when i see them. To come to the point where maggots feed on you feet? boy, i thought the dead were the ones who had those little creatures feed on them. Are you better off than the dead or not? i mean the only difference is that you breathe but like the corpse underground, you're organic matter.
Monday, June 21, 2010
Whew!
Gen chem is done. OMG. i did start redox yesterday and my expectation was to finish before work. Well, i started reading KOV's which i believe is better than TBR. So that made reading TBR easier. it was just hard to read. Thanks God it's done. It's after midnight. I'm soo tempted to read bio and finish that off. I actually worked on gen chem at work last night but it took me forever to understand one of the exercises in TBR that my entire time was wasted. That and the fact that i was relaxing with my legs elevated at the front desk and laughing at catherine's jokes. Work isn't all bad. It really isn't bad. Actually, all that sux is the stupid politics and cliques but other than that, i love my patients, i love being there, i learn a lot each day and i like most of my night coworkers. i used Most because i don't care much for those who go to the "office" to rat people out.
On funny note, i got off work on time, got to church premises right at 8am because for some reason, i thought the morning service started at 8am. what was i thinking? So i sat in my car reading gen chem and then i fell asleep. i made it to the service. If i'd known it was father's day, i think i'd have skipped church. I thought it was next week. On the bright side, i figured out where the prayer center is at. I need to start praying some serious prayers if i need this to succeed.
On funny note, i got off work on time, got to church premises right at 8am because for some reason, i thought the morning service started at 8am. what was i thinking? So i sat in my car reading gen chem and then i fell asleep. i made it to the service. If i'd known it was father's day, i think i'd have skipped church. I thought it was next week. On the bright side, i figured out where the prayer center is at. I need to start praying some serious prayers if i need this to succeed.
Friday, June 18, 2010
Yet Another cancellation
So i've pushed back tonight. I saw it coming. I'm trying to finish the last but one chapter for ochem, amines. it's not going to great. So, i ate some haagen-dazs and i'm reading the 6/17 MCATers reaction thread. It's always the same reaction. People come back and write how hard it was, and a month later, they do better than they thought. Goal for tonite is to finish the ochem chapter i'm reading, finish bio lecture II in TPR and finish gen chem 10 in TBR. That'll leave me with the last ochem topic which i'm thinking i may do on sunday with the last section of EM cuz the EM chapter in TPR is long, almost a 100pages. I still need help with fluids. Plan is to go through Nova and see if that help with my physics intuition, review TPR gen chem quickly and TPR ochem next week. Then start all over with TBR only.
So far, bio has been intuitive. I think my approach of just knowing my Anatomy, physiology and pathophysiology for nursing school helped out. Honestly, those are all that matters, i actually think physiology is the main thing. Know how something normally works, the pathophys is the opposite. medical and nursing interventions are geared to reverse the pathophys.
Alright, back to studying. i'll finish going through the SDN threads at work tomorrow nite.
So far, bio has been intuitive. I think my approach of just knowing my Anatomy, physiology and pathophysiology for nursing school helped out. Honestly, those are all that matters, i actually think physiology is the main thing. Know how something normally works, the pathophys is the opposite. medical and nursing interventions are geared to reverse the pathophys.
Alright, back to studying. i'll finish going through the SDN threads at work tomorrow nite.
Cancellations
So here's the thing about working overtime. I don't do it anymore. Primarily because i have better things to do such as school but during the semester and now i've lots of studying to do. But the other reason why i don't do overtime anymore is the fact that on 2 occassions last year, i was called in for overtime and my name was put down to be cancelled on the saturday. On one of those 2 ocassions, i was working the thursday, i wasn't put down to be cancelled sunday. Instead i was put down for the weekend so i don't make the differential. Couple other people have stopped coming in for overtime primarily because of the latter reason.
Anyway, coworker of mine did overtime during the week. On saturday which she was scheduled to work, they cancelled her and pulled a nurse from a different floor to come work on our floor so they wouldn't pay my co-worker overtime. Now, this is just aboveboard but it leaves me with the question "how far are they willing to go to save a dime?"
Anyway, coworker of mine did overtime during the week. On saturday which she was scheduled to work, they cancelled her and pulled a nurse from a different floor to come work on our floor so they wouldn't pay my co-worker overtime. Now, this is just aboveboard but it leaves me with the question "how far are they willing to go to save a dime?"
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