The kitty person emailed me yesterday to say she'd forgotten all about our tentative plan for today. Hee! I so understand that. So tomorrow she is going to bring ALL the kitties to the hospital, so that I can
The last few days at work have been odd, which I was unable to describe in the midst of my bofa rage yesterday. On Wed I worked on the floor for the first time in 8 months, which was o.0. Actually, I didn't do the patient care; I was precepting one of the grad nurses, because there was no one else, a continuing bone of contention between me and my boss because PLEASE FOR THE LOVE OF GOD STOP HIRING GRAD NURSES WHO NEED 3 MONTHS TO TRAIN I HAVE NO ONE TO TRAIN THEM SOON I WILL BE USING THE HOUSEKEEPER WATCH ME OH YES but enough about my mental health or lack thereof, heh. The grad did the work while I kept her on track, which meant I had to be on track, and wow, I haven't had to work on a tight schedule for a while.
It reminded me of the essential split between management, education, and staff when it comes to inpatient nursing: Education thinks nothing of comandeering the staff for hour-long inservices, and management thinks nothing of comandeering them for hours to yell at them about their bad attitudes toward all the comandeering, but in truth those hours can be vital when it comes to accomplishing basic patient care. Those staff nurses run around like crazy to get everything done, but I think once we escape the madness, we forget how tight their time can be. My boss, in fact, had me sit down with her for an hour in the midst of that very shift to talk about whatever, and then got upset when the grad nurse interrupted a bunch of times. "She's not very independent, is she?" she said, and I said, "No, she's coming to me for entirely appropriate reasons, and I as her preceptor should be available to her." That got me the jaundiced eye, I'll tell you. My boss doesn't take criticism well, direct or implied, which is a source for many of the problems on our unit. I, in turn, am not famous for my skills in diplomacy. You're shocked! I know. :P
On Friday I had to accompany a patient to radiation oncology for a treatment. He was on cardiac tele, which requires monitoring by a nurse certified in ekg and cardiac lifesaving. Usually radiation treatments take about fifteen minutes, stick 'em under the Trilogy machine and ZAP. This was the patient's first treatment, however, so they had to measure and scan and simulate and plan and measure again and adjust, and I got to sit at the nurse's station for all that time and... wait. Oy. The treatment was complicated by the fact that this patient has lung ca, so he was unable to lay flat without feeling like his lungs were collapsing, and every couple of minutes or so he had to sit up and catch his breath. At one point he got very upset and agitated and started yelling I AM NOT DOING THIS ANYMORE I'D RATHER DIE, and the rads onc techs freaked out too and called me in, and I had to spend quite some time at that point talking everybody down.
I told the patient that he had the right to refuse, but I wanted him to understand the consequences of that decision: Soon, that feeling of not being able to breathe, that feeling that he had laying flat on the table that freaked him out so bad? Would be how he felt all the time, even sitting up. The radiation, however, would decrease that feeling, by decreasing the tumor size and the effects of the tumor. It was his choice, but I hoped he would wait until he felt better to actually make his decision. He told me he wasn't freaked out, pshaw, he just couldn't breathe, so I apologized and gave him some Ativan and let him sit and talk with his wife and recover for a while. The rads onc people were very frustrated at the long wait, but it's hard to understand the absolute panic of being unable to breathe if you haven't experienced it. Am I right, mom? *waves*
Finally we all sat down together, the rads onc people and me and the patient and his wife, and came up with a plan: when he raised his hand, he had to sit up NOW. The techs would then cut off the beam and open the shield door, and we would get to him within 10-15 seconds to sit him up. He agreed to the plan under the condition that I remain present in the treatment observation room to make sure the techs followed through. I said okay, under the return condition that he not try to be a tough guy and wait till the last minute to raise that hand. He gave me the eye, and his wife laughed, but he said okay, and the techs were agreeable too, and somehow having a better sense of control over the proceedings (plus the Ativan, I'm sure) enabled the patient to get through the rest of the treatment with no problems at all. He never had to raise his hand once.
Yeah, so that took 6 hours. Ai carumba! Poor guy, six hours of hurry up & wait and then No Breathing For You, over and over again. As if cancer isn't bad enough, the treatments often suck. But at least he will continue with the treatments, which will be fifteen minutes and out from now on, but it was touch and go there for a bit.
This whole thing reminded me of why I do this stuff. I will remember how good it felt that he agreed to continue based on his trust in my advocacy, quite an honor. Also, the rads onc techs gave me a piece of pecan pie to thank me for talking him down
Okay, back to it. I have to write a prescription for my pharm class. Man, reading this over... can it be that I miss direct patient contact?? Incontheivable.