Buffing auras

"Once a Marine", this one's for you!

Today, I had to sit through a seminar on healing touch. Ok, I'm not a healing touch kind of person, I don't really believe the whole energy field thing, auras, and chakras. So, it was sort of hard for me to take this whole thing seriously. Now, don't get me wrong, if having your energy field un-ruffled and smoothed makes you feel better, then go for it. If sticking Hershey's kisses to your forehead makes your headache go away, then by all means, go for it. But chances are good that if you ask me to "direct energy" or "un-ruffle" your energy field, I just might giggle.

So we are in this room and they are trying to get us to feel each other's energy field and then describe it. So some of the people are saying it is warm. Your hands are like 2 inches from the person's skin...of course it is warm...it's called body heat, morons. Well, I politely sat through the whole thing, dutifully participated, said the right stuff, and did not giggle too much!

So, Once a Marine....what was that hippie comment again???

Well, he is YOUR patient....

So, today I got to my floor after spending the weekend doing my USMC Reserve drills to find that they had only scheduled one NA. We had 26 patients, with a lot of pending admits. They are getting ready to renovate the other end of our hall, so they are having to move to another floor on Wednesday. Therefore, they are not taking new admits so we are getting them all. This wouldn't have been too much of a problem, but for some reason, today we had all the prima donna nurses on one shift. There are two specifically who refuse to do anything that might possibly be an NA skill. I decided that instead of shadowing one of the RN's, I would help the lone NA out and took half of the patients. That meant I had 13 patients to take vitals on, help with breakfast, get bathed, change linens, change wound dressings, help go to the bathroom, do blood sugar tests, and I also had 3 new admits to get settled and fill out part one of the admit form on. Not to mention the myriad of doctors, residents, attendings, and family members who all had requests. So, needless to say, I was a little busy. And yes, I understand that there are many people who do this all day every day with even more patients. Soooo, I was in the room with all of our guys who need one-on-one monitoring and one of the patients with a hip fracture asked to go to the bathroom. I had not ever had this patient, and I noticed that he had on a diaper so I went to find his nurse to see if he had been using a bed pan, the diaper, or a bedside commode. I finally found her (I had also never worked with her before), and asked what the deal was with him. She didn't know, so I asked if she would help me get him up on the bedside commode. SHE SAID NO. Yep, she said, "No, I'm busy, go find the other NA." I just kind of looked at her dumbfounded. I told her that the other NA was busy with her own 13 patients (like 6 were contact precaution and also needed to be fed....way more time consuming) and it would be great if she could just spend the one minute to HELP ME WITH HER PATIENT!!! Did I mention that it was her patient??? I got a little mad, so I left and went back to my other patients. I figured I would just end up cleaning him up later. But basically, I was appalled that she didn't even try to help me HELP HER PATIENT. She would die on one of the floors that don't have any NA's. And who is she to assume that her "busy" is more important than my "busy"??? Fortunately, I only had to deal with them for half of the day. The other half of the day, I had to sit through a class on "healing touch" (see previous post).

Lesson learned today: Never, ever treat the person who wipes your patient's butt badly. They will abandon you and you will have to do all of it yourself.....and they may never help you again!

Spying

I'm in special program this summer for student nurses. We work on a floor under the supervision of an RN preceptor doing Nurse Aide duties. We are also supposed to be learning how the nurse organizes his/her time, how they prioritize, and how they do their assessments. We also attend weekly meetings with the other students and the nurse educators who are sponsoring us. All in all, it is a great program, we work full time and are paid and get to have some good experiences. My problem with the program lies in the nurse educators. These are nurses who are all MSN's and who monitor and help keep the RN's on the floors within competencies and up to date on the lastest policies and procedures. Well, one in particular (the one for my floor) has taken to using us as spies to see what is really going on on the floor. This puts us in an awkward position because we have to watch everything we say around them to make sure we aren't diming out the nurses on the floor. I mean, I would say something if someone were doing something dangerous, but most of their short cuts are just that: short cuts to save time and are totally safe. Besides, I hardly think I have anywhere near the experience to be critiquing anyone on their technique!

I was telling my preceptor how I felt like the nurse educators were using us as spies and he said that they did the same to him when he was a new grad/new hire. This technique is not good for retention or morale. Does anyone really want to work in a place where they are always worried about who is spying on them? I don't. I understand the need in our society for healthcare workers to do everything according to policies and procedures so as to minimize the risk for/during lawsuits. But wouldn't it be nicer (I guess this is my naivete), to empower (good buzzword) and then trust your employees to do the right thing! All distrust and deception does is undermine authority and lead to angry workers who are more likely to do things wrong just to get back at you.

I have spent several years in the military as an officer. Everyone told me that when I became a nurse, I would hate it because I wouldn't be in charge and I would have to take orders from doctors. Let me set something straight: I don't care who you are, nurse, doctor, enlisted, officer, you are always taking orders from someone. From Privates to Generals, we all take orders from someone, I'm used to that and that isn't my problem right now. My problem is watching talented nurses be undermined in their duties by not being trusted.

I don't think I will be applying for a job at this institution when I graduate next year.

Work

Well, I have been working on the floor at my hospital for the past week and a half. I've been doing mainly nurse aide (NA) stuff which is a lot of hard work. Let me tell you, if you ever meet a NA compliment her/him on doing their job. It is hard, thankless, and smelly. I can't even count how many bed linen changes I've done, how many adult diapers I've changed, and how many urinals I've emptied. You know it is really going to be a great day when you have your patient up on his side and are cleaning up his backside and he starts having another bowel movement right then. Don't get me wrong, the RN's work very hard and do a lot of dirty work, but at least at my hospital, the majority of the disgusting jobs are done by NA's.

So, I've been working five 8 hour shifts a week. I'm beat! I have had a wide array of patients, from nice older men, young guys, and the occasional mean, crotchety old man. Some of the latter group have suffered strokes and this has changed their personality. We had one patient for about 6 days who would point his finger at us and call the women bitches and he threw his doctor's out of his room daily. It was quite the show. One morning he asked me to draw him a picture of a vagina. I wasn't quite for sure how to respond to that so since he didn't need any immediate care, I left.

Finally, several of the patient's have family members who visit. This is wonderful, for most of these guys (99% of my patients are men), it is the highlight of their day. There have been some cases where the family member was not welcomed by the patient and having them there created a non-therapeutic environment and we had to ask the family member to leave. The only problem I have is that some of the family members are very demanding. I understand very well that you want the best possible care for your family member, so do I! But I also need to provide that same level of care to all of my other patients. Sometimes I can't just drop what I'm doing (especially if I'm up to my elbows in feces), to get water for you father. I am more than happy to show you where the ice/water machine is and maybe you could help me out by getting it yourself.

Some things I've learned this past week:

1. C. diff. can make feces smell really bad. Not that it doesn't already.
2. It is hard to get a good stool sample from a patient on continuous tube feeding.
3. Duoderm will pull loose skin off, that probably hurts. I almost got kicked in the head because of this.
4. Make sure the blood glucose monitoring machine is working right BEFORE you do the finger prick. (Ok, this one wasn't my fault, it was working fine up until the part where you put the blood on the strip)
5. The soiled utility room really, really smells bad. Either breathe through your mouth or take a big breath and hold it before you go in.
6. They make saline soaked gauze pre-packaged. This stuff is great for wet to dry dressings and much less messy than a boat of 4X4's.
7. Condom catheters are a blessing and a curse. They make a nice non-invasive way for a patient who is not very mobile to void, but they are difficult to put on, can cause irritation, and come off at the most inconvenient times.
8. Don't let an ostomy bag get too full before you empty it, it just might explode. We had a patient who was transported via ambulance to the hospital and it wasn't checked before they left and it exploded during transport. He was a mess when we got him, but I'm glad I didn't have to ride in the ambulance!